Commitment to Transparency, Accountability, and Partnerships On World AIDS Day and Beyond

This year’s World AIDS Day theme is “Increasing Impact through Transparency, Accountability, and Partnerships,” which is in line with President Trump’s commitment to “Making Government Work Again" [PDF, 1.01 MB] to ensure that Federal agencies are managing programs and delivering critical services more effectively; are focusing on maximizing the use of taxpayer dollars towards mission achievement; are more effective and efficient in supporting program outcomes; and are being held accountable for improving performance.

I am personally deeply committed to the theme of this year's World AIDS Day. During my time at the Centers for Disease Control and Prevention I established two offices focused on national and state level data to improve program results and impact. I carried this commitment on as I took on my current role as the Director of the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP).

OHAIDP is in the final stages of completing two reports that demonstrate transparency, accountability, and partnerships by providing updates on HIV programs, activities, and policies across the Federal government and progress toward national goals. The first describes the actions and progress made by Federal agencies toward achieving the goal of the National HIV/AIDS Strategy (NHAS), which remains our nation’s road map for fighting the HIV epidemic. The second will be the first annual progress report on the Secretary’s Minority AIDS Initiative Fund (SMAIF), which is administered by OHADIP.

2017 National HIV/AIDS Strategy (NHAS) Progress Report
As described in a letter from Acting HHS Secretary Eric Hargan to the Presidential Advisory Council on HIV/AIDS (PACHA), “It is the Department’s mission to enhance and protect the health and well-being of all Americans, and we are committed to improving the health of all people living with HIV. Our programs are guided by the NHAS as we continue to work to achieve the national goals. It is important to recognize, however, that the federal response to HIV must remain flexible in order to respond to scientific advances, new or increasingly important threats such as the opioid epidemic, epidemiological trends and indicator results, changes in funding, or other circumstances that require that we modify the approaches being taken in order to maximize our ability to prevent new HIV infections and improve the health of people living with HIV.”

The 2017 NHAS Progress Report describes progress in implementing the Strategy during the 2017 calendar year. The report highlights progress to date on the NHAS indicators and successful programs from Federal departments and agencies. The report also includes a comprehensive list of Federal actions and progress updates to date, along with commitments that have been made through 2020. Further, it lays out some of the future needs for the period from 2018-2020 based on progress to date and the Strategy’s roadmap for achieving its goals. 

Historically, implementation of the NHAS has been overseen by the White House Office of National AIDS Policy (ONAP) and the U.S. Department of Health and Human Services’ OHAIDP. During the transition of the Trump administration, OHAIDP has continued to work to support the implementation, monitoring, and reporting of the NHAS. The report has been submitted for final review to the participating agencies to ensure the information it provides is complete and accurate. It is expected that the report will be released at the very end of this year or very early in 2018. As you might imagine, taking on this task has been a substantial effort. I want to thank the members of the NHAS Federal Interagency Workgroup for their efforts in helping to complete the progress report.

2017 Secretary’s Minority AIDS Initiative Fund Progress Report 
We are especially pleased to be nearing completion of the first of many expected reports and materials resulting from a substantial effort to better monitor and evaluate projects funded by the Secretary’s Minority AIDS Initiative Fund (SMAIF). SMAIF works to transform prevention, care, and treatment for communities of color by bringing Federal, state, and community organizations together to design and test innovative solutions that address critical emerging needs and work to improve the efficiency, effectiveness, and impact of Federal investments in HIV programs and services for racial and ethnic minorities. Currently, these resources support 31 projects in 40 states, D.C., Puerto Rico, and Guam that are conducted by more than 200 organizations. A complete list of these projects can be obtained here.

When projects supported by the SMAIF were first set up in 1999 the pressing need was to allocate the resources as quickly and efficiently as possible. Over time the emphasis on documenting concrete outcomes of HIV programs has steadily increased. Monitoring and evaluation activities have been added to, or expanded in, programs across the entire federal government. In addition, the federal response to HIV evolved to have a clearer focus on national level goals and program objectives that aligned with the first NHAS that was released in July 2010. The response evolved further with the development of the HHS core HIV indicators for grantees to consistently measure prevention and care health outcomes and to make it easier to describe what SMAIF has accomplished, particularly for racial and ethnic minorities. 

For many years, the SMAIF program was overseen by a single individual who managed the administrative activities, provided scientific and policy-related guidance, and reviewed proposals, progress reports, and other documents produced by these projects. Additional support was clearly needed to align requests for data from the agencies and grantees with the NHAS and to support the centralization, analysis, and use of best practices that have come out of this work. This year, additional support involved two ORISE fellows, which has led to clearer information about SMAIF activities on HIV.gov and the first-ever SMAIF Annual Progress Report. 

The SMAIF Annual Progress report will describe the work that has been undertaken and highlight some of the lessons that have been learned and best practices that have been identified. It will also provide meaningful results including quantitative evidence of improvement that are key to assessing the appropriateness of scaling up specific interventions, activities, and policies across the nation. It is expected that this report will be released in the first half of 2018.

Transparency and Accountability
We have an obligation to be transparent about the ways that resources that Congress appropriates for these activities are used and to show what has been accomplished with them. If we are not improving, we accept the status quo. We need to show improvements over time, even among the most challenging areas that we deal with such as homelessness, the ongoing opioid epidemic, and HIV-related stigma. We have to be able to demonstrate results that have real value to the American public, Congress, and other stakeholders. If grantees are not doing the work that needs to be done, they should be supported in building the capacity and technical skills needed to get the job done, and they should be accountable, not only to the federal government, but to the communities they serve. In the same way, federal offices, agencies, contractors, and employees need to hold themselves accountable, and it is right for our nonfederal stakeholders to ask that improvements be made and barriers to success be removed.

Partnerships
As programs seek to meet unmet needs we must look even more closely for opportunities for partnerships that make it possible to maximize reach and promote efficiency and sustainability. Such partnerships should include integration of services into existing programs, systems, and infrastructure. These partnerships cannot be a one-way street that only benefits the goals of HIV programs but should also address how HIV programs can facilitate attainment of interrelated goals that contribute to the overall health and wellbeing of the populations we serve. 

Moving Forward
We have made great progress in the fight against HIV. This is due to the combined efforts of the Federal government; state, Tribal, and local governments; national and community-based organizations; academic and religious institutions; health care systems and providers; corrections and law enforcement; educational and religious leaders; and people who are living with or at risk for HIV.

To maximize the number of new HIV infections that are averted, improve the health of all people living with HIV, and reduce HIV-related disparities among racial and ethnic minorities, men who have sex with men, transgender women, people living in the Southern U.S., and others we will have to continue evaluating our programs and assessing which activities provide the best value to taxpayers, including those living with HIV. More efficiency in the delivery of program services, better management of health care, and control of medication costs will be needed so that everyone who is currently receiving lifelong treatment can continue to do so while we also work to double our care and treatment capacity so that all those living with HIV who are not in care can be engaged in life-extending care that also prevents transmission of the virus to others.

We cannot forget, however, that the progress we have made is fragile. It would be erased easily if we let up on HIV prevention, care, or treatment programs or the supportive services that help people access these services. Not only would our progress be dramatically slowed, it would also, in time, be stopped dead in its tracks. We would risk a resurgence of HIV infections and deaths, returning us to the dark days when the epidemic was at its worst and took an even greater toll on American lives. These reasons make the need for high quality monitoring and evaluation of HIV programs and the use of these data even more compelling.