The White House on Thursday released an updated version of its National HIV/AIDS Strategy that includes a comprehensive plan for reducing the number of new HIV infections between 2015 and 2020 by at least 25 percent.
The 74-page strategy document, which updates the Obama administration’s AIDS strategy plan first adopted in 2010, also calls for significantly reducing the rate of new HIV infections among gay and bisexual men, young black gay and bisexual men, black women and “persons living in the Southern United States.”
In addition, the document calls for focusing more resources on curtailing the HIV infection rate for transgender women, “particularly the high burden of HIV among black transgender women.”
The overall number of new HIV infections in the U.S. has remained at about 50,000 new cases each year for the past decade despite ongoing HIV education and prevention programs, according to the U.S. Centers for Disease Control and Prevention.
The White House announced on Thursday that President Obama officially launched the updated National HIV/AIDS Strategy through an executive order.
“This order is designed to ensure successful implementation of the Updated Strategy by requiring coordination and collaboration by, and accountability of, the Federal Government; fostering enhanced and innovative partnerships with state, tribal, and local governments; and encouraging the commitment of all parts of society,” Obama states in the order.
A statement and fact sheet released by the White House says the updated strategy retains the four main goals set in the 2010 strategy document: reducing new HIV infections; increasing access to care and improving health outcomes for people living with HIV; reducing HIV-related disparities and health inequities; and achieving a more coordinated national response to the AIDS epidemic.
The updated strategy calls for focusing on four “priority activities”:
• Widespread HIV testing and ensuring that those who test positive are given full access to care and treatment.
• Broad support for people living with HIV to ensure that they remain engaged in comprehensive care and they adhere to their treatment regimen.
• Universal viral suppression among people with HIV, which means lowering the level of the HIV virus through effective drug treatment so that the virus is undetectable and the chances that the person can infect someone else with HIV are greatly reduced.
• Full access to comprehensive pre-exposure prophylaxis, or PrEP, services “for those whom it is appropriate and desired.”
“As one of the tools in the HIV prevention toolkit, PrEP is a way for people who don’t have HIV to prevent HIV infection by taking a pill every day,” the White House fact sheet says.
The fact sheet and the updated strategy document don’t mention that the PrEP program has been criticized by some AIDS activists as a poor approach for HIV prevention because it could prompt people at risk for HIV to discontinue safe-sex practices, such as condom use, and lead to HIV infection if those on the prophylaxis drug fail to take it every day.
Supporters of the PrEP program, including officials with the National Institutes of Health and the U.S. Food and Drug Administration, point to studies showing that PrEP has been effective in preventing HIV infection among those who adhere to taking the required daily pill.
Several national AIDS advocacy groups released statements expressing support for the updated strategy document, saying it builds on the 2010 document’s goals for greatly curtailing the AIDS epidemic in the U.S.
“Since the first National HIV/AIDS Strategy was released in 2010, major advances have transformed how we respond to HIV, provided new tools to prevent new infections, and improved access to care,” a statement released by the New York based Gay Men’s Health Crisis says. “This updated strategy seeks to scale what is working, looking ahead to 2020 with a clear road map to help end the epidemic, once and for all,” the statement says.
Don Blanchon, executive director of D.C.’s Whitman-Walker Health, called the updated strategy “a more detailed roadmap to guide our ongoing journey to end HIV.”
Carl Schmid, deputy executive director of the AIDS Institute, a national AIDS advocacy group, called the updated document an “exceptional national strategy to address HIV in the U.S.,” but cautioned that the strategy could be undermined by proposed congressional budget cuts in various AIDS programs, including parts of the Ryan White AIDS CARE Act programs.
Michael Weinstein, president of AIDS Healthcare Foundation, the nation’s largest AIDS services and advocacy organization, praised the updated strategy for its focus on greater efforts to curtail HIV infections in the South, where he said the epidemic has been “exploding” during the past decade.
But Weinstein, a vocal critic of the PrEP program, said in a statement that the White House strategy should focus more on its call for universal treatment of people who are HIV positive than on “an overreliance on PrEP.”
He pointed to studies, which are also cited in the updated HIV/AIDS Strategy document, showing that people with HIV who are successfully treated with anti-retroviral drugs are 96 percent less likely to infect someone else with HIV than those who are not being treated with effective AIDS drugs.
The strategy document notes that as of 2012, the latest year in which figures were available, only 30 percent of all people living with HIV in the U.S. achieved full viral suppression.
“The HIV epidemic in the United States is concentrated in key populations and geographic areas and the Update guides our response to prioritize the following groups,” the White House statement accompanying the new strategy document says.
• Gay, bisexual, and other men who have sex with men of all races and ethnicities, “noting the particularly high burden of HIV among black gay and bisexual men.”
• Black women and men
• Latinos and Latinas
• People who inject drugs
• Youth aged 13 to 24 years, “noting the particularly high burden of HIV among young black gay and bisexual men”
• People living in the South
• Transgender women, “noting the particularly high burden of HIV among black transgender women.”
The updated National HIV/AIDS Strategy for the United States can be accessed here.