National HIV/AIDS Strategy Key Issue at January PACHA Meeting

Much of the recent meeting of the Presidential Advisory Council on HIV/AIDS (PACHA) focused on implementing the National HIV/AIDS Strategy. The Strategy asks PACHA to provide, on an ongoing basis, recommendations on how to effectively implement the Strategy, as well as establish a mechanism to monitor the Strategy’s implementation. Last week, Council members heard updates from White House and agency officials, asked many questions and offered thoughtful suggestions. These are a few of the highlights. Mr. Jeffrey Crowley, Director of the White House’s Office of National AIDS Policy (ONAP), expressed appreciation to the Federal agencies for their efforts toward the Strategy’s goals to date. He also encouraged a balance of efforts between the important innovative planning and coordination taking place within and across agencies and actually executing the plans developed. Mr. Crowley also shared some of the activities his office has on the near horizon including further work on establishing indicators that measure progress towards the Strategy’s goals, preparing the 2012 NHAS Federal Implementation Plan, and drafting the first report to the President on the nation’s progress. That report, Mr. Crowley noted, will not merely be a report on Federal activities, but a review of the nation’s collective efforts including those by State, tribal and local governments, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and others.

Dr. Howard Koh, Assistant Secretary for Health, reported that HHS Secretary Kathleen Sebelius had recently issued a communiqué to senior leadership of all the Department’s Operating Divisions and Staff Offices reiterating the Department’s commitment to implementing the Strategy and detailing several steps to be taken to help achieve the goals of the Strategy. These included continued efforts toward greater intra-departmental coordination and collaboration on matters including grant administration, common metrics, and funding announcements as well as active support of the “12 Cities Project”.

The “12 Cities Project” was also discussed by several of the presenters and Council members. Though it is by no means everything that HHS is doing to work towards the Strategy’s goals, Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases, explained that HHS does consider the project to be an extremely important element of its NHAS operational plan. The project serves as a proving ground to demonstrate how the range of Federally-supported HIV prevention, care, and treatment activities can work together to improve local service delivery, identify and address gaps and unmet needs, and—where possible—realign resources from lower priority to higher priority activities. The project, now underway, supports comprehensive HIV/AIDS planning and cross-agency response in the 12 jurisdictions that bear the highest AIDS burden in the country. Built on an innovative CDC grant to those jurisdictions, the project engages HHS agencies including CDC, CMS, HRSA, IHS, NIH and SAMHSA. An initial accomplishment of the collaborative effort has been a comprehensive inventory of all HHS HIV-related funding at work in each jurisdiction so that the various local agencies involved have a complete picture. Efforts to incorporate information about the Department of Housing and Urban Development’s (HUD) Housing Opportunities for Persons with AIDS (HOPWA) program funding into that inventory are now underway. PACHA members expressed enthusiasm and optimism about the initiative and encouraged HHS to be thoughtful about how to share widely what is learned from these intensive efforts to better coordinate the full range of local HIV/AIDS activities from prevention planning to care delivery so that communities from across the country can benefit. Some encouraged the engagement of agencies beyond those from HHS that are already participating, including the Department of Veterans Affairs (VA), HUD and DOJ’s Bureau of Prisons (BOP).

Representatives from the Federal agencies designated by the President as lead agencies with responsibility for implementing the NHAS provided brief overviews of the operational plans they submitted to the White House. Those plans describe in detail each agency’s approaches to working toward the Strategy’s goals. The White House anticipates releasing a summary of the operational plans as well as the plans themselves in February. Presenting to PACHA were representatives of the HOPWA program, VA, the Department of Justice’s BOP and Civil Rights Division, the Social Security Administration, and HHS.

In response to these agency overviews, members of PACHA asked questions and shared a variety of feedback and recommendations with the Federal agency representatives. Among these were:

• HUD should consider requiring that HOPWA beneficiaries to be in HIV care
• Whether the repeal of the “Don’t Ask, Don’t Tell” policy will improve relatively low HIV testing rates at the VA since patients may become more comfortable discussing HIV risk (the VA has and will continue to offer HIV testing and HIV care to all veterans regardless of sexual orientation or prior or current substance abuse)
• The importance of developing strategies to address HIV healthcare workforce needs in the VA and elsewhere
• What opportunities exist for delivering prevention services to the partners of patients receiving HIV care within VA or BOP systems?
• How will each agency’s NHAS operational plan intersect with what states and localities are doing and how can those plans be used to motivate states and local jurisdictions to examine and improve their HIV/AIDS policies and programs?
• Remain mindful of the importance of addressing co-morbidities of aging among veterans in HIV care at the VA, 66% of whom are over 50 years old
• DOJ-BOP should explore the possibility of sending HIV-positive inmates released from Federal prisons back to their community with an appointment for HIV care as well as the 30-day ARV prescription (BOP would like to explore further with HRSA)
• Agencies should consider a coordinated intervention for “emerging communities” along the lines of the “12 Cities Project”

The members of the Presidential Advisory Council on HIV/AIDS passed two resolutions which are important for achieving that goals of the National HIV/AIDS Strategy. One resolution addresses the importance of routine HIV testing in all clinical settings and the second resolution encourages the government to support increased funding for HIV prevention services.

At the meeting, we asked three PACHA members from across the country—Douglas Brooks, Kathie Hiers, and Mario Perez—about what NHAS-related activities were unfolding in their cities. See their responses in the video below.