January 10, 2013
The first of a two-part series about the stories to keep your eyes on during 2013. Look for part 2 next week.
President Barack Obama's re-election in 2012 ended concerns that there would be an end to the Patient Protection and Affordable Care Act (ACA), which has already led to increased access to HIV testing and other HIV/AIDS-prevention services for millions of Americans. It also dispelled fears that gains made by the Obama administration and the National HIV/AIDS Strategy(NHAS) would be abandoned or reversed. Now that the president doesn't have to worry about getting re-elected, the administration can build on the foundation laid out in the previous four years.
What to watch for: The continued implementation of the ACA and the ability of the president toreduce the federal deficit are two factors that will affect Obama's legacy when it comes to HIV/AIDS.
We've been bombarded with news of the dreaded "fiscal cliff," but in reality, if a compromise isn't reached, the HIV/AIDS community will be devastated by sequestration -- a word that refersto the massive cuts in federal spending that will automatically kick in on Jan. 2, 2013. If we fall off the fiscal cliff, it is estimated that $538 million would be cut (pdf) from four HIV/AIDS programs in the first year alone. The Centers for Disease Control and Prevention'sHIV-prevention programs would lose $64 million, the Ryan White HIV/AIDS Program would lose $196 million, AIDS research by the National Institutes of Health would lose $251 million and Housing Opportunities for People With AIDS, or HOPWA, would lose $27 million. The AIDS Drug Assistance Program (ADAP) would also lose $77 million in 2013, estimates show.
What to watch for: While there's a consensus that some type of deal will eventually be reached,that doesn't mean the HIV/AIDS community is in the clear. A deal will most definitely include cuts to domestic programs. What remains to be seen is if HIV/AIDS programs will be among them.
While we have the tools to end the HIV/AIDS epidemic, those tools can be effective only if HIV/AIDS professionals understand how to use them. Unfortunately, that's not always the case,since many lack basic knowledge about the latest treatments and recent biomedical advances,such as pre-exposure prophylaxis. To bring more awareness to the information gap and take the first step to solve it, the Black AIDS Institute has unveiled the first Workforce Survey for HIV/AIDS Professionals, which, over a six-month period, will gauge knowledge and attitudes about HIV/AIDS among professionals who serve the HIV/AIDS community.
What to watch for: The dissemination of the survey findings will play a critical role in ensuring that HIV/AIDS professionals are getting relevant information to the community. The findings can also serve as a starting point for training and education programs for HIV/AIDS professionals. "Quite possibly for the first time in the history of the epidemic, we will be able to provide information to health departments, policymakers and community organizations on the baseline knowledge, attitudes and beliefs of people who are working and volunteering in AIDS," said Institute President and Chief Executive Officer Phill Wilson.
It's been two years since the U.S.'s first-ever NHAS was released in 2010, but the true measure of its success is its implementation. In July the Office of National AIDS Policy released anupdate (pdf) of 2011-2012 implementation efforts, looking at how much progress has been made in reducing new HIV infections, improving health outcomes for PLWHA, reducing HIV-related health disparities and achieving a more coordinated national response.
What to watch for: The deadline for achieving most of the goals in the implementation plan is 2015, giving the U.S. two years to make good on plans to lower the annual number of new infections by 25 percent, reduce the HIV transmission rate by 30 percent and increase the proportion of newly diagnosed patients getting linked to care within three months by 20 percent.With more than $22 billion allotted to domestic HIV-specific programs -- including $1 billion for ADAPs -- in President Obama's proposed 2013 budget, the White House has shown that the NHAS remains a priority. However, with the threat of sequestration (see above) and "fiscal cliff" talks still under way, the actual amount that will be allotted to HIV programs remains unclear, and economic constraints are likely to be the biggest challenge to the NHAS' implementation in 2013.
This year saw two major threats to the ACA overcome: the legal challenge heard by the Supreme Court and the candidacy of Republican Mitt Romney, who vowed to repeal the law if he was elected president. Now the ACA's implementation can go forward, but new challenges remain. The ACA will expand coverage to 30 million uninsured Americans, with as many as 17 millionthrough Medicaid. However, states can refuse federal support to expand Medicaid, and as of early December, nine states had opted out of Medicaid expansion. The other pressing detail that will affect the ACA's implementation is the establishment of essential health benefits, the minimum health-care benefits an insurer can offer. The states get to decide on their own essentialhealth benefits, meaning that there's no federal mandate to prevent states from setting insufficient standards to address the needs of PLWHA.
What to watch for: Though the election is over, political grandstanding continues to surround the ACA. States have begun submitting their essential health benefits to the federal government, though 19 states missed the initial deadline. It remains to be seen whether states that are unhappy with the ACA provide less-than-robust essential health benefits, just as it remains to be seen whether Medicaid expansion continues to be ignored in certain parts of the country.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about health and wellness.