Dr. Ronald Valdiserri.
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The Department of Health and Human Services (HHS) recently released a report [PDF] describing findings of an interagency collaboration to identify, review, and assess the effectiveness of HHS-funded, discretionary initiatives and programs to reduce HIV infections among African Americans. The report describes relevant prevention programs and initiatives, identifies future opportunities, and provides insights that will help inform strategies to reduce HIV infections among vulnerable African-American populations
The inventory was one of the tasks assigned to HHS in the National HIV/AIDS Strategy (NHAS), which notes that prevention efforts must acknowledge the heavy burden of HIV among Black Americans and target resources accordingly. Based on the most recent data from CDC, African American men and women represent 14 percent of the total U.S. population, but account for a disproportionate 44 percent of all persons living with HIV in the United States.
The cross-departmental working group responsible for the effort agreed that programs/projects for inclusion in the review would be those that had been funded within the past five years with the intention of reducing HIV infections among African Americans or to support related program efforts, like capacity building. Surveillance activities, international prevention programs, and NIH research activities were not included in this analysis. Information was self-reported by individual agencies and offices using standard spreadsheet software.
The report summarizes data for 56 HHS-funded HIV prevention programs and initiatives serving African Americans that were active between Fiscal Years (FY) 2009-2011. The programs reflect an average annual investment of nearly $293 million in prevention programs and initiatives to reduce HIV infection among African Americans. It is noteworthy that racial and ethnic minorities also benefit from other HHS programs that provide HIV prevention, treatment, or care but do not target any single subgroup of the population.
"Curbing the HIV epidemic in the U.S. requires a robust national response to the prevention needs of African Americans, who are disproportionately affected by HIV/AIDS," said Dr. Andrew Forsyth, Senior Science Advisor in the HHS Office of HIV/AIDS and Infectious Disease Policy, who oversaw data collection and analysis.
According to the report, programs provided HIV prevention and related services (71.7 percent); mental health/substance use services (11.8 percent); outreach and education (5.2 percent); family planning services (3.8 percent), and capacity building/technical assistance (2.2%) among other activities.
Although the report found that program investments generally follow the epidemiology of the HIV epidemic among African Americans it also suggests areas where targeting of services might be enhanced -- particularly in disproportionately affected subgroups (e.g., young men who have sex with men and women) and in hard-hit U.S. regions (i.e., South, Northeast). As stated in the report: "A systematic review of the effectiveness and regional distribution of effective HHS-funded services may help to ensure that resource allocations are optimized. This may be especially important for preventing new HIV infections in subgroups of African Americans with the highest incidence rates, including adult and adolescent MSM, injection drug users, and women, including transgender women."
The inventory was conducted by the African American Program Inventory Working Group, an interagency effort led by the HHS Office of the Assistant Secretary for Health (OASH), with representatives from the Departments of Housing and Urban Development (HUD), Justice/Bureau of Prisons (DOJ/BOP), and Veterans Affairs (VA); Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC NCHHSTP); Health Resources and Services Administration's HIV/AIDS Bureau (HRSA HAB); National Institutes of Health Office of AIDS Research (NIH OAR); Substance Abuse and Mental Health Services Administration's (SAMHSA) Centers for Substance Abuse Prevention (CSAP), Treatment (CSAT), and Mental Health Services (CMHS); and OASH Offices of Minority Health (OMH), Population Affairs (OPA), Women's Health (OWH), and HIV/AIDS and Infectious Disease Policy (OHAIDP).
Though the report is a "snapshot" of a short period of recent time (FY09-FY11), efforts to develop, deploy, and support HIV prevention interventions that serve African Americans are ongoing. Examples of ongoing efforts include the cross-agency Care and Prevention of HIV in the United States (CAPUS) project and SAMHSA's Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS. Read more about current CDC activities addressing HIV among African Americans.
Given the disproportionate impact of HIV among African Americans, ongoing evaluation of federal investments and support for high-impact prevention are needed to fully achieve the National HIV/AIDS Strategy goals of reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.
Ronald Valdiserri, M.D., M.P.H., is the Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services.