Over a year in the making, the NHAS and its accompanying Implementation Plan were unveiled on July 13, 2010, by the Director of the White House Domestic Policy Council, Melody Barnes; Secretary of Health and Human Services (HHS), Kathleen Sebelius; Director of ONAP, Jeffrey Crowley; and HHS Assistant Secretary for Health, Dr. Howard Koh. President Obama hosted a reception that evening for advocates who are engaged in work to end the epidemic and support those infected and affected in the 30 years since HIV/AIDS was discovered. The NHAS has three goals: (1) reducing the number of people who become infected with HIV; (2) increasing access to care and optimizing health outcomes for people living with HIV; and (3) reducing HIV-related health disparities.[2] The strategy is based on a 15-month community engagement project undertaken by ONAP that involved community discussions, online engagement, and expert meetings, including ones focused on youth, women, and housing.

 

In order to achieve the first goal of reducing new HIV infections, the NHAS focuses primarily on targeting prevention resources to the populations at highest risk for contracting HIV and “[e]ducating all Americans about the threat of HIV and how to prevent it,”[3] With the goals of reducing new infections by 25% and the transmission rate of HIV by 30%, ONAP purposely outlined what they considered to be ambitious yet manageable goals. However, the strategy does not propose a significant increase in the funding that is currently being allocated for domestic HIV prevention programs, creating significant challenges to achievement of the strategy. Instead, the White House plans to more efficiently redirect funds to target high-risk populations.

 

The strategy focuses on the need to better direct where funding goes, as some communities and racial and ethnic groups are disproportionately affected by HIV. Men who have sex with men of all races and ethnicities are the only population group in which the annual infection rate is rising, and comprise 53% of the newly infected each year.[4] African Americans are similarly impacted, suffering 45% of new infections annually even though they make up only 12.8% of the U.S. population; and Latinos incur 17% of new infections each year while comprising only 15.4% of the U.S. population.[5] Compared to white women, African American women are 15 times more likely and Latinas are 4 times more likely to be infected with HIV.[6] In order to make the greatest impact, the NHAS concentrates on targeting limited HIV-prevention funding to the populations at highest risk. However, while the NHAS acknowledges that “[o]ne quarter of new HIV infections occur among adolescents and young adults (ages 13 to 29),” youth are not mentioned as a target group to which funding and prevention efforts should be directed.[7] The NHAS does recognize that education about how HIV is and is not transmitted is vital to prevention efforts, and President Obama has affirmed that people cannot possibly be expected to protect themselves against HIV if they are never taught how; however, the strategy does not include a specific call for comprehensive sex education in public schools—as the President called for in his World AIDS Day 2008 address—or make funding recommendations directed at the prevention needs of adolescents.

 

Another important component of prevention in the NHAS is to increase the number of people infected with HIV who know how much of the virus is in their bodies. Approximately one in five people infected with HIV are unaware of their status. If not on treatment, an HIV-positive individual has higher viral load levels, making it “easier . . . for that person to spread infection through such [activities] as unprotected sex.”[8] While there are over 56,000 new HIV infections annually, which is significantly lower than the high of 130,000 in the mid-1980s, the number of new infections reported every year has remained relatively steady since 2000.[9] That number is likely to increase in the future as the number of people living with HIV—and, thus, the number of people who can transmit the virus—grows.

 

The second goal of the NHAS is to increase access to care and improve health outcomes for people living with HIV. Central to achieving this objective is to quickly and seamlessly connect those diagnosed with HIV to medical care and support services. In addition, there must be an increase in the number and diversity of health care professionals with expertise in HIV care and prevention. The plan aims to increase the number of newly diagnosed HIV patients in care within three months of diagnosis, and for patients to access care at regular levels and have greater access to guaranteed housing.[10] The NHAS highlights that “the unique biological, psychological, and social effects of living with HIV,” as well as hunger, homelessness, and a lack of transportation or child care, are major factors that inhibit a patient’s ability to adhere to a treatment regimen.[11]