Health Disparities, Hurdles and Hope: Ending the HIV Epidemic in the U.S. Sheryl Zwerski, MSN, CRNP Acting Director, Prevention Sciences Program, NIAID, NIH July 22, 2012

AIDS in America: Forgotten, But Not Gone Alabama Arizona Arkansas California Colorado Florida Georgia Idaho IllinoisIndiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada 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, , ,000 No. of AIDS Cases El-Sadr, W. et al. N Engl J Med 2010

Efficacy  Effectiveness: 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 Prevention Microbicides Male Circumcision Drug/Alcohol Treatment Treatment as Prevention Testing/ Counseling

The National HIV/AIDS Strategy Grant Colfax, MD Office of National AIDS Policy The White House HIV Prevention Trials Network Satellite Conference Health Disparities, Hurdles and Hope: Ending the HIV Epidemic in the U.S. (7/22/12)

The National HIV/AIDS Strategy Overview 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