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Reaction to Obama National AIDS Strategy (HCV)
  from Jules: below are excerpts from many internet articles on the Obama plan. Here is a response by me. It's only been 30 years since HIV & AIDS was discovered & 15 years since the Ryan White Care Act was implemented HA, and we are still trying to learn how to deal with this problem. It's been NO mystery for many years that African-Americans need extra services because they do not do as well as caucasians on HAART. We've known for years patients are diagnosed late. We spend hundreds of millions on vaccine research & global HIV, yet patients in the USA are on waiting lists to get HAART and ADAP remains underfunded. For USA patients aging & HCV coinfection are key causes in morbidity & mortality and the future predicts this are key concerns that will increase death rates without adequate attention. Sure it's great Obama declared this new strategy, will it be adequately implemented, will it take years to move, what about HEPATITIS C and coinfection, where there is NO FEDERAL FUNDING: 5 million in USA have HCV, the patient population is aging and getting sicker, yet there is NO federal funding for screening, we need a HCV Testing Day!!! Is this new plan just another federal stall effort, thevfederal response to HCV has been just that for 12 years, with lots of talk saying they support efforts but absolutely no money yet.
The question, the president said, is whether the nation will fulfill its obligations, and devote the resources and political will to confront what he called a preventable tragedy.
Michael Weinstein is president of the AIDS Healthcare Foundation.
"Access to care for HIV is declining in this country," said Michael Weinstein. "You can't say this is a new strategy, if you don't intend to spend any money on it."
Show us the money
Resources to support such expanded efforts are in short supply, however. The administration has dedicated $30 million from the Patient Protection and Affordable Care Act (the recently passed health care reform legislation) for NHAS implementation, but new money is not on the agenda.
"This strategy is a day late and a dollar short," said Michael Weinstein of the AIDS Healthcare Foundation. "Fifteen months in the making, and the White House learned what people in the field have known for years. There is no funding, no 'how to,' no real leadership."
Others also were critical.
"The Obama administration is spending only 4 percent of the National Institutes of Health AIDS research budget to find a cure, they're leaving 2,000 people without AIDS drugs because of a $100 million ADAP shortfall, and they're cutting AIDS treatment in Africa," said AIDS Policy Project Executive Director Kate Krauss. "That isn't a plan, it's a disaster."
In the days leading up to NHAS unveiling, the administration announced that an additional $25 million would be allocated to cash-strapped AIDS Drug Assistance Programs. But advocates argue that the need is closer to $125 million. Nearly 2,300 people are now on ADAP wait lists, according to the National Alliance of State and Territorial AIDS Directions' latest July 9 ADAP Watch.
"It is imperative that this nation has a comprehensive approach to HIV care and prevention," said Randy Allgaier, a member of the Coalition for a National AIDS Strategy. "The current ADAP crisis is a prime example of what is wrong with our current response to HIV/AIDS; it is fragmented and seems to move from crisis to crisis rather than to think strategically."
Obama stressed that while the government must do its part, "our ability to combat HIV/AIDS doesn't rest on government alone. It requires companies to contribute funding and expertise to the fight. It requires us to use every source of information from TV to film to the Internet to promote AIDS awareness. It requires community leaders to embrace all and not just some who are affected by the disease."
As a first step, the White House issued a memorandum asking federal agencies including the Department of Health and Human Services, Centers for Disease Control and Prevention, the Departments of Labor, Housing and Urban Development, and Veterans Affairs, and the Social Security Administration to develop plans to implement the strategy and reallocate funding within the next five months.
"This creates a roadmap for other administrations so that politics doesn't dictate strategy," said Sorensen. "It demands all sectors of society contribute. Certainly we could make that happen if we choose to. If the business sector, the public sector contribute, we can make that strategy happen."
Focus on high-risk groups
The NHAS aims to reduce the number of new HIV infections by 25 percent, lower the rate of HIV transmission by 30 percent, increase the number of infected people who know their status by nearly 10 percent, raise the number of people accessing care within three months of diagnosis by 30 percent, and increase the proportion of gay and bisexual men, blacks, and Latinos with undetectable viral load by 20 percent.
A key theme of the strategy is allocating resources where the need is greatest. Gay and bisexual men make up a small percentage of the U.S. population estimated between 2 percent and 10 percent but account for more than half of all new HIV infections. Blacks make up about 13 percent of the population but nearly half of people living with HIV.
The administration's goal is to reduce the number of new cases, improve access to care, and give greater help to poor people who are less able to afford antiretroviral drugs.
Gay or bisexual men and African American men are two of the highest-risk groups for HIV, which causes AIDS. More than half of all transmissions stem from male-to-male sexual contact, and African Americans are seven times as likely to contract the disease as other races. Latinos are also named as a priority by the plan.
Experts said gay and African American men tend to live in communities with higher rates of the disease and engage more frequently in such risk behaviors as male-to-male intercourse and intravenous drug use.
"For the Bay Area and San Francisco, the plan allows a more coordinated effort between communities and federal agencies," said Jason Riggs, deputy director of the Stop AIDS Project, a prevention group in San Francisco.
Some gay rights groups and AIDS activists said the strategy took too long to develop and should have more funding, given the 2,200 Americans who are on wait lists for antiretroviral drugs as states struggle to cover the costs of treatment.
The strategy calls for the lead federal agencies to re-evaluate prevention programs in high-risk areas and use social media campaigns to educate the public about risk behaviors and the importance of getting screened.
"Sixty to 70 percent of new infections come from people who don't know their HIV status, so by finding people, getting them into care and helping them live a normal life span, we also help reduce transmission person to person," Saag said. Michael Saag heads the Center for AIDS Research at the University of Alabama at Birmingham and is also president of the national HIV Medicine Association. He said the plan will help lower the rate of infection and improve care for HIV and AIDS patients nationwide and here in Alabama.
Key goals in the national strategy on HIV and AIDS:
25 percent Reduction in infection rates nationwide by 2015.
$30 million Funding from health care overhaul law to reduce infection rates.
85 percent Portion of infected people to be treated three months after
diagnosis. $25 million Funds to help states pay for drugs to treat HIV.
In December of 2009, the American Academy of HIV Medicine submitted a set of policy recommendations for the National Strategy to the White House. Included in that document, were recommendations to bolster the U.S. workforce through tuition incentives and training opportunities in HIV care, increased reimbursement rates for HIV providers services, better coordination among government bodies that oversee and fund HIV providers, encouragement of health technologies, innovative research, and routine HIV testing.
The Strategy echoes the need for initiatives such as health professional training grants and financial incentives to compensate for HIV care management, but stops shy of outlining actual plans for implementing these types of provider programs. Also, unlike many of the other sections of the Strategy, the workforce section does not list anticipated results for 2015.
"So much of this strategy depends on an adequate supply of well trained practitioners," Friedman said. "Yet the implementation plan contains no quantified targets for replacing the nearly 1/3 of HIV practitioners who plan to retire over the coming decade. It's our hope that all the excellent workforce ideas included in the Strategy will be well underway by 2015, bringing qualified care providers to HIV patients nationwide."
National HIV/AIDS Strategy | The White House
One of the President's top HIV/AIDS policy priorities is the development and implementation of a National HIV/AIDS Strategy (NHAS). ...
µ Download the National HIV/AIDS Strategy (PDF) µ Download the National HIV/AIDS Strategy Implementation Plan (PDF)
National HIV/AIDS Strategy for the United States. July 2010.
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