To End AIDS in the United States, Stay True to the National HIV/AIDS Strategy
May 8, 2017
Ten years ago, hundreds of organizations and individuals signed a petition calling on all presidential candidates to create a national AIDS strategy. We knew the approach to HIV in the U.S. had to change. If you read about AIDS in the paper, then it was likely about the horrifying scale of the global epidemic; the epidemic at home had largely become invisible. The national HIV response we saw was a patchwork: uncoordinated, without clear goals, underinvested where the challenge was most acute, with interventions delivered well below the scale necessary for impact. And the science of HIV prevention was changing dramatically without sufficient efforts to put it into practice.
By the end of 2007, most presidential candidates, including John McCain, Hillary Clinton and Barack Obama, had accepted the challenge to create a strategy. In June 2010, President Obama issued the first comprehensive National HIV/AIDS Strategy for the United States.
Five Things We Learned From Implementation of the National HIV/AIDS Strategy
1) A commitment to being strategic provides political cover to do tough things.
A new emphasis was placed on federal agency coordination that has shown some success and remains a work in progress, as well on the most affected communities, which are now at the leading edge of progress in the U.S. response.
2) Changing the conversation is important, and it's just the first step.
All of these were advances, but they only took us so far. The Affordable Care Act (ACA) -- which led to a marked increase in Medicaid coverage among people living with HIV -- as well as increased investments in appropriate services expanded access to lifesaving and infection-preventing measures.
3) It matters that the effort grew from the community.
4) It takes amazing science and the commitment to deliver its results to everyone.
When rigorous, multi-site clinical trials proved these approaches did work, it changed what was considered possible, and scientific and policy leaders in the U.S. and around the world now said we had the opportunity to "end AIDS." Soon, in places such as New York and San Francisco, activists, scientists and public health officials took up the challenge to end the epidemic and "get to zero" with localized, evidence-based, multi-sectoral strategies -- an effort that has now expanded across the country.
5) Effective interventions are necessary, but not sufficient.
Collective Progress and Now a Precipice
Ten years after the strategy effort started, we celebrate our collective progress, but know we are at a precipice. Recent advances will be squandered if Congress and the administration retreat on the ACA and other policy achievements, making it harder for people living with or at risk of HIV to get the services they need to stay alive and healthy. That is why we need federal policy that protects and fully implements the ACA, as well as investments in the CARE Act, HIV prevention at the Centers for Disease Control and Prevention, the Housing Opportunities for People Living With AIDS Act and the National Institutes for Health's comprehensive HIV/AIDS research program. We also need a strong ONAP to drive and coordinate these vital programs.
The National HIV/AIDS Strategy brought us a vision of a time when HIV infection is rare and everyone living with HIV has access to lifesaving care unfettered by stigma and discrimination. We must remain committed to that vision, for everyone. We need leadership at every level to do what the science tells us we can do: end AIDS in America.
The authors of this article are the original conveners of the Coalition for a National AIDS Strategy:
Judith Auerbach is a professor at University of California, San Francisco.
This article was provided by Project Inform. Visit Project Inform's website to find out more about their activities, publications and services.
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