The U.S. National HIV/AIDS Strategy, after more than a year of "consultations" with the community, was formally released at an invitation-only gathering in the White House complex on July 13.
It has three concrete goals according to Jeffrey Crowley, director of the Office of National AIDS Policy ( ONAP ) , who led the team that prepared it.
First, it aims to reduce new infections by 25% over five years by intensifying prevention efforts in communities where the epidemic is most heavily concentrated; expand targeted prevention efforts "using a combination of effective evidence-based approaches;" and educate all Americans about the threat of HIV and how to prevent it.
Second is to increase access to care and optimizing health outcomes. Much of that will rely upon elements within broad healthcare reform legislation passed earlier this year.
Third is to reduce HIV-related health disparities. Key elements will be increased reliance upon community and structural rather than individual interventions, and efforts to reduce stigma so that people are more likely to seek testing and treatment.
Crowley's office will make annual reports on progress toward meeting those goals.
"All of us are being asked to do more with less," said Kathleen Sebelius, Secretary of Health and Human Services. "We can't expect this [ HIV ] to be solved by a huge infusion of new resources."
A case in point happened last week when she released $25 million in unspent economic stimulus funds to help address waiting lists for the troubled AIDS Drug Assistance Program ( ADAP ) . It was far short of the $126 million advocates say is needed.
Those attending the event had seen earlier iterations of the strategy and greeted it with more hope than expectations. The document said the right things, but only so much can be done without significant new money.
"It's critical to acknowledge this is just the beginning. Advocates must stay engaged…to ensure this plan gets fully implemented," said David Munar with the AIDS Foundation of Chicago, reflecting the general tone of most AIDS advocates.
Charles King with the New York group Housing Works was one of the few willing to criticize the plan. He called the goal of reducing new HIV infections by 25 percent, "insufficiently ambitious. … We have the prevention tools to dramatically reduce the spread of HIV if only we would dedicate the resources to doing so. … Would President Obama suggest that we only clean up 25 percent of the Gulf oil spill?"
Last year Johns Hopkins University HIV prevention researcher David Holtgrave told Congress that prevention funding would have to nearly double, to about $1.3 billion a year, "to make a big difference in the epidemic in the U.S.," where an estimated 56,000 people become newly infected with HIV each year.
Sebelius offered $30 million spread over several years.
The administration's claim for wanting to further public education on HIV was belied by the strategy it took with this event. Sebelius was the lead speaker, not the President, and it was scheduled for a day when the FDA was considering the controversial diabetes drug Avandia.
It used the same tactic when Sebelius attended the CDC's HIV prevention conference in Atlanta last summer, releasing a major report on the H1N1 virus the same day. Both events knocked AIDS from the front page.
The National HIV/AIDS Strategy, and the accompanying implementation plan are available at www.whitehouse.gov/administration/eop/onap/ .