Kevin Fenton, Kevin Fenton, M.D., Ph.D., F.F.P.H.Director National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention December 14, 2010 HIV Prevention Leadership Summit CDC’s Role in Implementing the National HIV/AIDS Strategy

Vision of the National HIV/AIDS Strategy “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”

The National HIV/AIDS Strategy Goals: 1.Reduce HIV incidence 2.Increase access to care for people living with HIV and optimize health outcomes 3.Reduce HIV-related disparities 4.Improving coordination

National AIDS Strategy Supports CDC strategic vision of a tiered approach to prevention Prevention with HIV positive individuals Prevention with high risk HIV negatives Intensive, targeted community level interventions (geography, ethnicity etc) General population interventions HIV Screening, treatment, DEBIs, STD Rx, Combination prevention, SDH, DEBIs, Social marketing, HIV screening, stigma HIV Rx and Care, PN, Counseling, STD Rx, SSP

Key Principles for CDC Priority Activities in support of the NHAS Ensure strategic alignment of budget, programs and policy with the NHAS Focus on evidence-based, high impact activities with potential for scaling up interventions Support innovation with evaluation and research Leverage assets of the entire agency – not just DHAP Seek opportunities for collaboration and integration to address HIV and associated syndemics Maximize novel interagency collaborations to reduce duplication and missed opportunties

NATIONAL HIV/AIDS STRATEGY Goals of the

Interagency Coordination Strengthening Collaborations with other federal agencies Assisted Office of National AIDS Policy (ONAP) in development of NHAS Continues to coordinate and collaborate with ONAP – CDC participated in White House meeting on implementing the NHAS in the Latino community Working with Assistant Secretary of Health at HHS for HIV prevention, PrEP, Hepatitis Coordination Ensuring the DHAP, DVH and DSTDP strategic plans being finalized aligns with the NHAS Assigned specific tasks in the NHAS Implementation Plan

Interagency Coordination Novel partnerships with other Federal agencies CDC participating in federal workgroups established to implement and monitor the NHAS CDC working with other HHS agencies in implementing the “Enhanced Comprehensive HIV Prevention Planning and Implementation Program for state and local health departments” CDC and NIH collaborating to develop research opportunities HRSA and CDC to identify community health centers that provide “co-located” HIV testing and care and treatment services.

Interagency Coordination Promoting Program Collaboration and Service Integration PCSI aims to promote more coordinated, holistic and syndemic orientation of NCHHSTP prevention activities In September 2010, awards made to six health departments for new FOA, “Addressing Syndemics through PCSI” – Recipient jurisdictions are: New York City, North Carolina, Philadelphia, San Francisco, Texas, Washington, D.C. – $6.2 million over 3 years for the PCSI program Will be used to combine and streamline health services for HIV/AIDS, STDs, viral hepatitis, and tuberculosis; identify best practices; and build evidence base for integration

Reduce HIV Incidence Enhanced Comprehensive HIV Prevention Program Comprehensive Prevention Program for State and Local Health Departments Comprehensive Prevention Program for State and Local Health Departments funds demonstration projects for a combination approach to enhance effective HIV prevention – Intensifying prevention for people at greatest risk – Prioritizing prevention and linkage to care for people living with HIV – Directing funding to communities with highest burden of HIV Grants totaling $11.6 million awarded in FY 2010 to 12 hard-hit areas − Chicago, District of Columbia, Florida, Georgia, Houston, Los Angeles, Maryland, New York city, Philadelphia, Puerto Rico, San Francisco, and Texas

Reduce HIV Incidence Expanded HIV Testing Program Originally aimed primarily at African Americans, HIV Testing Initiative was expanded in FY 2010 to reach gay and bisexual men of all races, injection drug users of all races, and Hispanic populations, as well as African Americans Accomplishments to date More than 1.4 million people have been tested through CDC’s HIV Testing Initiative <10,000 have been newly diagnosed with HIV Majority have been linked to care Of new positives, 86 percent received their results, 75 percent were linked to medical care, and 78 percent were linked to partner services. Awarded about $55 million in FY 2010 for first year of 3-year expanded program

Reduce HIV Incidence Other CDC Commitments Strengthen community-based investments – Align Community Based Organization (CBO) activities to NHAS – Critically reexamine Community Planning Strengthen focus on highest incidence groups – HIV Prevention projects for CBOs and Young MSM of Color and Young Transgender Persons of Color – Strengthen STD screening efforts with a focus on STIs among MSM – Expand screening and mobilization with African Americans, Latinos Work with States to improve program, surveillance, M&E – Funding to 65 health departments for HIV prevention in FY12 – Ongoing reporting of data on HIV incidence in the US as well as new surveillance methods to track CD4 and Community Viral Load

Increase Access to Care CBO Program FY 2010 Awards Program provides funds for CBOs to implement effective HIV prevention efforts among populations at highest risk – Includes increase in linkage to care as a goal – $42 million awarded in FY 2010 to 133 community-based organizations Program funds were awarded to match the epidemic – 49 percent of organizations receiving funds focus efforts on MSM, while 38 percent focus on heterosexual men and women – 5 percent of CBOs focus on injection drug users – 58 percent of CBOs focus on African Americans, while 23 percent focus on Latinos, 11 percent on whites, 3 percent on Asian/Pacific Islanders and 1 percent on Native Americans.

Increase Access to Care Other CDC Commitments/Activities Enhanced Comprehensive HIV Prevention Planning and Implementation Program for state and local health departments – Includes prioritizing linkage to care for people living with HIV CDC working with Health Resources and Services Administration (HRSA) to support a six-clinic, multi- year evaluation of interventions to increase HIV- positive clients’ attendance of appointments.

Reduce HIV-related Disparities: Expanded Act Against AIDS Leadership Initiative A $16 Million, 6-year partnership between CDC and 19 of the nation’s leading AA and Latino organizations to integrate HIV prevention into their activities for African Americans, Latinos, and gay and bisexual men Examples of key activities include – Holding educational and training sessions – Integrating prevention messages into community forums – Placing PSAs in broadcast and print outlets – Working with celebrities to produce PSAs – Mobilizing local policymakers and community leaders – Extending campaigns through internet, social media,etc.

Reduce HIV-related Disparities: HIV Prevention Projects for CBOs and Young MSM of Color and Young Transgender Persons of Color Program provides effective HIV prevention services to young (up to age 22) MSM of color and young (up to age 24) transgender persons of color who are at high risk for HIV infection or transmission Major activities have included implementation of effective behavioral interventions and comprehensive risk counseling and services or counseling, testing and referral services

Reduce HIV-related Disparities: Enhanced Surveillance Enhanced HIV surveillance: Community viral load and CD4 monitoring – Funds awarded in FY 2010 to support additional data needs for community HIV viral load monitoring – CDC exploring how community viral load could be monitored nationally Publication in FY 2010 of estimate of impact of HIV and syphilis on gay and bisexual men Publication of white paper on social determinants of health: – Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States

Vision of the National HIV/AIDS Strategy “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”

Thank you! Kevin A. Fenton, M.D. Ph.D., F.F.P.H. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention