What We’ve Done to Address HIV/AIDS in America during the Obama Administration

Despite the progress made since its discovery in the 1980s, HIV is still a major public health issue in America.

Lifetime risk of HIV diagnosis, by state. Source: http://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html
  • Over 1.2 million Americans are living with HIV today.
  • 13% of those living with HIV are still unaware of their status.
  • Just over half of people diagnosed with HIV are virally suppressed.
  • Over half of all new diagnoses take place in the Southern U.S.

And certain groups are highly and disproportionately affected.

People living with HIV are our brothers and sisters, friends and colleagues, parents, children, teachers, veterans and more.

But unfortunately, even in 2016, many still face barriers, stigma, and discrimination that make HIV prevention or treatment services hard to access.

It’s our job to continue ensuring and providing effective services so they can lead long, healthy, productive lives.

So what has the United States been doing to address HIV?

On July 30, 2015, President Obama signed an Executive Order launching the National HIV/AIDS Strategy: Updated to 2020.

Launch of the National HIV/AIDS Strategy: Updated to 2020 in Atlanta, GA. Source: Office of National AIDS Policy.

It builds on the 5 years of progress since President Obama released our first, comprehensive National HIV/AIDS Strategy.

President Obama delivers remarks at a reception to release the National HIV/AIDS Strategy for the United States in the East Room on July 13, 2010. (Official White House Photo by Pete Souza).

The Updated Strategy integrates the incredible scientific advances and game-changing policies that have taken place during the Obama Administration:

The Strategy is our national roadmap to slowing the epidemic and improving the lives of people living with HIV through a comprehensive response in 2016 and through 2020.

ICYMI, here’s a recap of major accomplishments to improve HIV prevention, treatment, care, and research during the Obama Administration:

In 2009, President Obama reauthorized the Ryan White HIV/AIDS Program by signing the Ryan White Treatment Extension Act.

President Barack Obama, surrounded by Members of Congress and other officials, signs the Ryan White HIV/AIDS Treatment Extension Act of 2009 in the Diplomatic Reception Room of the White House October 30, 2009. (Official White House Photo by Chuck Kennedy).

And today, the Ryan White HIV/AIDS Program serves over 500,000 people, or half of all Americans living with HIV:

Source: Health Resources and Services Administration

On January 4, 2010, the United States ended its 22-year ban on entry of people living with HIV, thanks to persistent community advocacy and bipartisan effort begun under President Bush and completed by President Obama.

Source: http://www.nytimes.com/2009/10/31/us/politics/31travel.html

As a direct result, we not only hosted the 2012 International AIDS Conference in Washington, D.C. — the first such conference that the United States hosted since 1990 — but also helped reduce stigma and improved the lives of those living with HIV, their friends and family.

President Barack Obama views a section of the AIDS quilt on display in the Booksellers area of the White House, July 18, 2012. (Official White House Photo by Pete Souza)

In 2010, President Obama signed into law the Affordable Care Act (ACA), which has quite simply transformed health care access.

President Obama signs the Patient Protection and Affordable Care Act, a historic piece of legislation that will expand health insurance coverage to millions of Americans and put an end to the worst insurance industry practices, in the East Room of the White House on March 23, 2010.

Because of the ACA:

20 million more Americans have health insurance coverage
Protections against sex, gender identity, or disability discrimination in health care.
No denial of coverage because of pre-existing conditions, like HIV, cancer, or mental health diagnoses.
No more lifetime limits on coverage for people with chronic diseases like HIV.
Preventive services, like HIV testing, must be covered without cost sharing.

In 2011, President Obama announced $35 million in emergency funds for the AIDS Drug Assistance Program, whose waiting list peaked at over 9,000 people living with HIV.

A red ribbon hangs from the North Portico of the White House on Dec. 2, 2013 to mark World AIDS Day, Dec. 2, 2013 (Official White House Photo by Chuck Kennedy)

On World AIDS Day 2013, the President announced that all ADAP waiting lists were cleared.

In 2013, ONAP released two important policy documents following two Executive Actions signed by President Obama:

  • Presidential Memorandum establishing a Federal Interagency Working Group on the Intersection of HIV/AIDS, Violence against Women & Girls, and Gender-related Health Disparities
  • Executive Order establishing the HIV Care Continuum Initiative
FYI: With the Executive Order to implement the National HIV/AIDS Strategy: Updated to 2020, President Obama directed that the processes and activities associated with these two initiatives be fully integrated into the NHAS Federal Interagency Working Group and national activities to meet the goals of the Strategy.

These initiatives resulted in numerous new Federal programs to improve the way agencies work together, with their communities, and ultimately HIV health outcomes, including:

In November 2013, President Obama signed the HIV Organ Policy Equity (HOPE) Act. This bipartisan legislation ended the ban on research of organ transplanation from a donor with HIV to a recipient with HIV.

President Barack Obama signs S. 330: HIV Organ Policy Equity Act during a signing ceremony in the Oval Office, Nov. 21, 2013. (Official White House Photo by Lawrence Jackson)

As a result, earlier this year, the first-ever organ transplants between people with HIV became a reality:

President Obama also, twice, authorized the use of Federal funds for syringe services programs.

In December 2009, President Obama signed into law a modification to the longstanding ban on most Federal funding for needle exchange programs, giving us more opportunities to stop the spread of HIV and other infections among people who inject drugs. Unfortunately, in 2012, Congress reinstituted that ban.

As a result, HHS released guidance for organizations who want to utilize funds for aspects of SSPs. All agencies involved with SSP provisions will release agency-specific guidance.

But, in December 2015, following a year that included an HIV and hepatitis C outbreak in Scott County, Indiana, a bipartisan effort resulted in the Fiscal Year 2016 Omnibus spending bill which now allows local jurisdictions to petition CDC to use Federal funds for syringe services programs.

President Obama said that an AIDS-free generation is within reach.

President Barack Obama delivers remarks on World AIDS Day event at George Washington University in Washington, Dec. 1, 2011. (Official White House Photo by Lawrence Jackson)

And has repeated that vision every year since:

President Obama, Secretary of State John Kerry, and Secretary of Health and Human Services Kathleen Sebelius deliver remarks in observance of World AIDS Day at the White House on December 2, 2013.
President Obama announcing the updated National HIV/AIDS Strategy via video on July 30, 2015.

This vision is possible because of the many advances we’ve made.

Three major studies unequivocally demonstrated the benefits of HIV treatment:

Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health

SMART trial: people diagnosed with HIV should stay on uninterrupted treatment.

HPTN 052 trial: starting treatment immediately after diagnosis dramatically reduced the risk of transmitting HIV.

START trial: starting treatment early prevents AIDS-related and other diseases.

In 2012, the FDA approved PrEP. In 2014, the U.S. Public Health Service released clinical practice guidelines for prescribing PrEP.

And since then, the community at large has been working to spread the word to key populations and health providers that PrEP is available and a key prevention option for people at risk for HIV infection.

Source: Centers for Disease Control and Prevention
Source: Centers for Disease Control and Prevention

That’s why these are the 4 overarching goals of the National HIV/AIDS Strategy:

And these are the 4 key areas of focus needed to achieve these goals:

These are possible because our investments in research, development, science and innovation have paid off.

Dr. Tony Fauci has said:

Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health

That’s why the National HIV/AIDS Strategy’s indicators of progress by 2020 are:

So, since we released the Updated Strategy, a lot has happened.

Community organizations expressed their support and dedication to the Strategy’s successful implementation.

ONAP released a Spanish translation, the Federal Action Plan, and Community Action Plan Framework.

The Federal Action Plan outlines over 100 specific action items that Federal agencies committed to completing in 2016 and through 2020. The Community Action Plan Framework serves as a guide for community-based organizations, service providers, health departments,

Agencies have been working hard to implement their action items, many of which have already been completed:

This year marked the 35th anniversary of the first cases of AIDS.

We’ve come a long way.

And, part of that, we’re proud to say, can be demonstrated through President Obama’s commitment to opening the White House to more people than ever before.

The White House is lit with the colors of the rainbow in celebration of the Supreme Court ruling on same-sex marriage, June 26, 2015. (Official White House Photo by Chuck Kennedy)

Bending away from silence, shame, and stigma, has allowed the White House to be a place to foment inclusion, conversation, and resilience over the last 8 years.

During the Obama Administration, ONAP is proud to have convened and hosted the first-ever White House meetings on HIV and black men, aging, women and girls, the southern U.S., gay and bisexual men, transgender community, and stigma.

But, our work is not over:

On World AIDS Day 2016, we released the National HIV/AIDS Strategy 2016 Progress Report, which includes updates on progress on Federal implementation, examples of community implementation around the country, and latest available data on the Strategy’s indicators.

The progress report also includes 3 new developmental indicators:

Increasing viral suppression among transgender women in HIV medical care
Increasing use of PrEP
Decreasing HIV Stigma

Overall, progress is being made in the fight against HIV, nationally, in key groups, and in each of the Strategy’s goals. The data also shows that we aren’t seeing progress on some indicators, and that some disparities are widening.

For indicators that did not meet their annual target, we must look carefully at the data and our actions to consider what needs to be scaled up, intensified, targeted, or changed.

Our vision is 2020. We can do this.

This is our Strategy. Let’s keep it moving, together.

Source: AIDS.gov