National HIV/AIDS Strategy Briefing

By:  Kathleen Sebelius
Date: July 13, 2010
Location: Washington, D.C.

Thank you, Melody. The strategy we're announcing today reflects the hard work of many people from across the Administration. But no one has played a bigger role than the three people who are here with me today. This is the first time we've ever had a national HIV/AIDS strategy, and over the last year, Melody, Jeffery, and Howard kept us moving forward while making sure we didn't take any shortcuts. They each deserve a lot of credit for the announcement we're making today.

So do the many advocates, policy experts, and community groups who were consulted along the way. This is not an approach that was conceived inside a Washington bubble. It reflects our belief that if you want to learn about how to expand access to HIV/AIDS treatments, for example, you need to talk with people who are living with HIV/AIDS. And if you want to identify the most effective approaches for reducing HIV transmission, you need to talk to the communities that are using those approaches. So I want to thank everyone whose ideas and suggestions made this strategy stronger.

When President Obama announced our plans to develop a comprehensive National HIV/AIDS strategy, he recognized that we were at a turning point. After AIDS was first identified in the early 1980s, we were slow to respond. But eventually, a coalition that included government, employers, community-based groups, and the health professionals came together and developed a series of effective approaches for treating and reducing the spread of HIV/AIDS.

In partnership with the HIV/AIDS community, we began to speak frankly about the sexual and drug use behaviors that put people at risk for HIV/AIDS. We developed procedures for screening blood transfusions. We encouraged screening of pregnant women, and supported HIV testing programs for persons whose behaviors placed them at risk for AIDS. We promoted community-based and clinical strategies for reducing infections among injection drug use. We discovered new therapies that were much more effective at keeping the disease in check.

Together, these approaches helped turn the tide against the disease. The number of new HIV infections among people who inject drugs dropped by 80 percent. Transmissions during pregnancies went from more than 1,600 to fewer than 200 a year. Total annual infections went from more than 130,000 a year in the mid-80s to just over 50,000 a year in the 90s. At the same time, the length and quality of life for people living with HIV rose dramatically thanks to better treatments and better access to care.

This reversal was a great accomplishment. But since the late 1990s, our progress in preventing new infections has slowed. Annual infections have held steady at about 56,000 a year. Because the number of Americans living with HIV has gone up over those years, that means we are still driving down infection rates. But not fast enough. We're keeping pace, when we should be gaining ground.

That's why President Obama called for the first-ever comprehensive, national HIV-AIDS strategy. And after a year of information gathering and analysis -- of conversations with doctors and persons living with HIV/AIDS, researchers and health workers, activists, community leaders and academics -- we are announcing a plan today that has an ambitious vision.

That vision, and I quote, is that "The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination."

In order to achieve that vision, this strategy outlines three concrete goals: reducing new HIV infections, increasing access to care and optimizing health outcomes for Americans with HIV/AIDS, and reducing HIV-related health disparities.

These goals aren't necessarily new. But the strategy for achieving them is. We knew we couldn't keep using the same approach and expect different results. We also knew that at a time when all of us -- the federal government, states, communities, non-profit groups, businesses -- are being forced to do more with less, we couldn't expect a big infusion of new resources.

So while this strategy does highlight areas for additional investment, it also identifies how we can use the resources we have more effectively to prevent, diagnose and treat HIV/AIDS.

To do that, we're looking at areas where we can do better. For example, we've been very successful at keeping HIV/AIDS incidence low for some populations. If you're a white, heterosexual woman like me, your chances of being infected by HIV/AIDS are very low -- just 1 in 50,000. But if you're a black female who's an injection drug user, your chances of being infected are more than 1,000 times higher -- closer to 1 in 35. If you're a gay Hispanic man, your chances are 350 times higher. In some U.S. cities, it's estimated that almost half of all gay black men are HIV-positive.

So part of what this strategy says is that we're going to intensify our prevention resources in the communities where infections are concentrated.

And when it comes to intensifying our resources, it can't just be one approach. Condoms are important. So is testing -- especially since one in five Americans with HIV don't know it, meaning they're more likely to spread the virus than others. But what we've learned is that prevention is most successful when we use all the tools available to us, whether it's educating people about health behaviors or better substance abuse treatment and prevention programs or breakthrough medical research on vaccines or microbicides. We're taking an all-of-the-above approach because it's these overlapping layers of prevention that get the best results.

The final piece of our prevention strategy is education. The progress we've made over the last 30 years has come with an unintended side effect: Americans have become less fearful of HIV/AIDS. In 1995, nearly half of all Americans said HIV/AIDS was our most pressing health issue. Today, it's just one in twenty.

We can't afford complacency -- not when in the ten minutes I've been talking to you, another American has just contracted HIV. That's why our strategy calls for aggressive efforts to educate Americans about how dangerous this disease still is and the steps they can take to protect themselves and their loved ones.

Earlier this year, we got a head start on those goals when we enacted the Affordable Care Act, which included an unprecedented Prevention and Public Health Fund. Over the next ten years, that fund will invest $15 billion to prevent disease or detect it early before it becomes severe.

Today, we're announcing that $30 million from the first wave of that funding will go to support new and existing efforts to help more Americans learn know HIV status, particularly in vulnerable populations. These funds will be available for community organizations to apply for soon. And they'll provide a critical boost to our prevention efforts across the country as our implementation of this strategy gets underway.

But even as we strive to reduce new infections, the strategy we're announcing today also calls for us to refocus and reenergize our efforts on behalf of the 1.1 million Americans who are living with HIV/AIDS. And they'll benefit from the Affordable Care Act too.

Under the new law, we'll expand Medicaid, a reliable source of support for many Americans with HIV/AIDS. We'll also create a new consumer-friendly health insurance marketplace where plans will be forbidden from denying people coverage because of a medical condition, a fate that has befallen too many Americans with HIV/AIDS in the past.

These changes won't happen until 2014. But as we work quickly and responsibly to implement this new law, we're also taking steps to help Americans with HIV/AIDS right now. In the last three months, we've begun mailing $250 rebate checks to seniors who've fallen into the Medicare prescription drug donut hole, a group that includes many seniors with HIV/AIDS. We're working with states to create a new temporary Pre-Existing Condition Insurance Plan that will offer coverage to Americans with who have been denied insurance because of their medical conditions.

And we've announced a new Patient's Bill of Rights that will restore some basic fairness to our health insurance markets. Under this Bill of Rights, insurance companies will be forbidden from canceling your coverage when you get sick or putting a lifetime limit on your benefits so that they disappear when you need them most.

Each of these steps will help Americans with HIV/AIDS get the care they need to live healthy, comfortable lives. But they are not enough. Under this strategy, we will also work to link testing to care, since the latest evidence shows that the earlier care is started, the better the results. We'll build on the provisions of the Affordable Care Act that strengthen our healthcare workforce. And we'll work to supplement medical care with other supportive services like housing, nutrition, and child care assistance that we know can make the difference between someone staying on their treatment regimen or dropping it.

This goal is especially important at a time when budget shortfalls have made it hard for many Americans to get the care they need. That's why when we recently learned that some states had been creating waiting lists for the AIDS Drug Assistance Program, we quickly pulled together $25 million from other programs in our department to help meet demand for the rest of the year.

To make sure our prevention and treatment resources reach Americans -- especially the communities with greatest need -- we must also continue to change Americans' attitudes. In too many communities today, HIV/AIDS still carries a stigma. These are too many people who don't get tested because they're afraid what their family or friends might say if the test comes back positive. Too many people who don't pick up a flyer about treatment because they're afraid if they're seen with it, someone will make a judgment about their sexual orientation. As part of this strategy, we will continue look for concrete ways to reduce the stigma associated with HIV/AIDS such as ending the HIV entry ban, a long overdue step we set in motion last year.

For each of these goals, we have set ambitious but reachable targets for the year 2015. And the national strategy is not the only document we're releasing today. Along with it, we're also announcing a National HIV/AIDS Strategy Implementation Plan that lays out next steps for every department that contributed to these documents. This strategy is not a white paper. It's a detailed action plan that is going to lead to real changes in our approach and, we hope, real improvements in our results.

It's also a partnership. There are a wide range of cabinet agencies and sub-agencies that do work on HIV/AIDS from the Department of Justice to the Department of Labor to the Department of Housing and Urban Development. One thing we hope to do better as we implement this law is work together. To that end, the Implementation Plan calls for our department's Assistant Secretary for Health, Howard Koh, who you'll hear from in just a few moments, to take on a key coordinating role -- not just for agencies within our department, but for agencies across government. And he's got a great advisor in Dr. Ron Valdiserri, one of our country's leading experts on HIV/AIDS, who just joined our department as Dr. Koh's top deputy on infectious diseases.

This partnership also extends outside government to the community- and faith-based organizations, businesses, health care professionals, and activists who played such an important role in this strategy. We developed this strategy together. And our only chance of success is to carry it out together too.

As we implement this strategy, we're also recommitting ourselves to laboratory research that promises better prevention tools, treatments, and ultimately, a cure for HIV/AIDS. Under President Obama, we have delivered the biggest boost to biomedical research in American history adding more than $10 billion to the NIH budget over two years as part of the Recovery Act. Last week, we saw just how big the payoff from this investment can be when NIH scientists discovered three antibodies that could potentially be used as part of an HIV vaccine. And going forward, we will continue our work to promote new discoveries and eliminate obstacles on the path from microscope to market.

When President Obama took office, we had reached a turning point. Either we could choose to get used to HIV/AIDS, to accept that it's a permanent feature of our society, to be satisfied with lengthening lives instead of saving them. Or we could choose to redouble and refocus our efforts, to put a new emphasis on prevention, to expand access to care, to target HIV/AIDS in the communities that bear the brunt of this disease.

With this new strategy, we are choosing the second path. We refuse to accept a stalemate, to dig in and just hold the disease at bay. We want to be moving forward. We want to see infections going down, access to care going up, and awareness expanding. The strategy we're releasing today is not the end of our work; it's the beginning. We've set a target. Now it's up to all of us, working together, to go achieve it.

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