Health Disparities, Hurdles and Hope: Ending the HIV Epidemic in the U.S.
Sheryl Zwerski, MSN, CRNPActing Director, Prevention Sciences Program, NIAID, NIH
July 22, 2012
AIDS in America: Forgotten, But Not Gone
Alabama
Arizona Arkansas
California
Colorado
Florida
Georgia
Idaho
Illinois Indiana
Iowa
KansasKentucky
Louisiana
Maine
MassachusettsMichigan
Minnesota
Mississippi
Missouri
Montana
NebraskaNevada
New Hampshire
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Connecticut
Delaware
Maryland
New Jersey
Rhode Island
Alaska
Hawaii
25,001-199,402
4001-8000
2001-4000
1001-2000
273-1000
8001-25,000
No. of AIDS Cases
El-Sadr, W. et al. N Engl J Med 2010
EfficacyEffectiveness: The Path to Combination Prevention
Basic science
Proof of concept
Efficacy Study
Proof of Activity
Scale-up to populations
Implementation
How do we move from single products to integrated combination prevention programs?
“Real-life” implementation
Testing combinations
Reducing HIV incidence
Increasing access to care and optimizing health outcomes
Reducing HIV-related health disparities
NIH Research Support
NIH is committed to fostering the research that address the goals of the President’s National HIV/AIDS Strategy
Clear disparity between populations in level of risk for HIV infection
NIH is committed to supporting studies that define details within the US epidemic and test interventions to decrease HIV incidence in the populations at highest risk
Vaccine
Harm Reduction
STI Treatment
PrEP
PMTCT
Condoms
Combination HIV
PreventionMicrobicides
Male Circumcision
Drug/Alcohol Treatment
Treatment as Prevention
Testing/ Counseling
The National HIV/AIDS Strategy
Grant Colfax, MDOffice of National AIDS Policy
The White House
HIV Prevention Trials NetworkSatellite Conference
Health Disparities, Hurdles and Hope: Ending the HIV Epidemic in the U.S.(7/22/12)
The National HIV/AIDS StrategyOverview
Goals
1. Reduce the number of people who become infected with HIV
2. Increase access to care and optimize health outcomes for people living with HIV
3. Reduce HIV-related health disparities
4. Achieve a more coordinated national response to the HIV epidemic
Facets of the Strategy• Small number of action steps• five-year targets• Emphasis on evidence-based approaches and populations at greatest risk• Multiple Federal agencies charged with Strategy implementation: HHS, HUD, VA, DOJ,
DOL, SSA– HHS lead coordinating agency.
• Roadmap for all public and private stakeholders responding to the domestic epidemic• Focus on improving coordination and efficiency across and within Federal, state, local and
tribal governments• Catalyst for all levels of government and stakeholders to develop their own implementation
plans for achieving their goals
As part of the NHAS, President Obama and his Administration have…
• Supported and increased investment in domestic HIV prevention and care.– Over $22 billion budgeted for HIV efforts– $2.5 billion increase during administration
• Directed resources to populations at greatest risk for HIV infection.– Focus on gay men, communities of color
• Implemented the Affordable Care Act.– Medical coverage extended to tens of thousand of persons living with HIV – Prevention services extended to millions of Americans
• Provided robust Federal funding to ADAP ($933 million, with $1 billion in 2013).– Waitlists have dropped by 80%– Federal share of funding sufficient to end waitlists with States doing their share
• Addressed HIV-related stigma and discrimination.– Lifted the HIV entry ban– Affordable Care Act prohibits denial of coverage based on pre-existing conditions, including
HIV• Supported groundbreaking NIH research in HIV prevention and care.
– Breakthroughs include: treatment as prevention, pre-exposure prophylaxis, vaccines, microbicides, cure research
Ongoing Challenges to Implementing the National HIV/AIDS Strategy
• Fiscal – Ensuring wise investments– Linking investments to health
outcomes
• Coordination among agencies– Metrics– FOAs– Traditional siloed approach
• Coordination across Federal, State, and local levels
– Higher you go, less understanding of issues on the ground
– Inadequate funding or staffing at some levels
• Ability of organizations to adapt to a changing environment
– Capacity– Technical assistance needs– Creating new models of prevention and
care delivery
• Will to allocate funds for interventions that are
– Achievable– Sustainable – Effective
• Educating providers about HIV prevention and care
– Number of HIV care providers decreasing– Reluctance to care for HIV+ patients– Reimbursement