At Last: A Landmark National Strategy to Fight HIV/AIDS in America

By Susan Blumenthal, MD and Bowen Jiang

The year was 2007. The setting was the Jefferson-Jackson dinner in Iowa, remembered today as one of the pivotal moments of then-Senator Barack Obama's campaign for the Presidency of the United States. Appearing before a standing ovation of thousands, Obama described his vision to the American people: "I am running in this race because of what Dr. [Martin Luther] King called 'the fierce urgency of now.' Because I believe that there is such a thing as being too late, and that hour is almost upon us."

"The fierce urgency of now." The same five words that ignited the crowd in Des Moines have been captured in the National HIV/AIDS Strategy (NHAS), a comprehensive plan of action released today by the Obama Administration to combat HIV/AIDS in America. The goal of the NHAS is to help the United States to become a nation where HIV infections are rare and where all Americans can receive high-quality care free from stigma or discrimination. Although the HIV virus was first identified 30 years ago, it has taken three decades to develop the first national strategy to fight this disease in the United States.

Three decades ago, people were dying from AIDS across America, emaciated and hopeless. Since then, many research advances have been made, including the discovery of lifesaving medications. But with this progress, the urgency about AIDS in America had faded into complacency. According to the Kaiser Family Foundation, Americans see and hear less about the domestic HIV/AIDS epidemic today than they did five years ago. Despite the fact that the Centers for Disease Control and Prevention (CDC) estimates the number of people newly infected with HIV each year in the U.S. is 56,000, higher than previously thought, the proportion of all adults who believe that HIV/AIDS is an urgent problem in their community declined between 2006 and 2009. Yet, more than one million Americans are living with HIV/AIDS today, and 14,000 die of the disease annually. Every 9.5 minutes another person is infected with the virus in the United States. In Washington D.C., one out of 30 people are HIV-positive, an infection rate that is higher than those in Ethiopia, Rwanda, and Nigeria.
The general public also continues to be misinformed about the current state of HIV/AIDS prevention and treatment. According to a recent survey, nearly one in five Americans is unaware that there is no cure for AIDS, and about a quarter mistakenly believe that there is a vaccine available to prevent people from becoming infected.

In recent years, the United States has played a powerful role in the fight against HIV/AIDS globally, which has infected 33 million people worldwide. The establishment and expansion of the President's Emergency Plan for AIDS Relief (PEPFAR) and other important international initiatives have brought vital resources to the developing world and required that recipient countries establish national plans to address their epidemics. But despite these lifesaving efforts abroad, there has been AIDS amnesia here at home. The number of Blacks living with HIV in America exceeds the number of HIV-infected people in seven of the 15 focus countries in Africa supported by the PEPFAR global initiative. And, when adjusted for inflation, the CDC HIV/AIDS prevention budget has declined by 19 percent since 2002.

The National HIV/AIDS Strategy, developed in consultation with a broad spectrum of stakeholders, serves as a wake-up call to the persistence and prevalence of the epidemic in America. It is an evidence-based and systematic plan with goals and measurable outcomes to fuel accelerated progress in the fight against this disease. Our nation will now have the committed leadership, action plan, and accountability that have been brought to the battle against this disease abroad.

Key objectives of the NHAS include: reducing the rate of new HIV infections by 25% over the next five years (if the current transmission rate remains unchanged, the number of infected people will increase to 75,000 annually within a decade); increasing access to care and prevention services including getting treatment to 85% of patients within three months of diagnosis; optimizing health outcomes; and reducing HIV-related health disparities among vulnerable populations, including gay and bisexual men (who account for 46% of people living with the disease) and African American and Hispanic men and women.

The strategy also aims to replicate some of the mechanisms that have proven successful in the PEPFAR strategy to fight AIDS in developing countries. These include setting specific targets and goals for action as well as fostering coordination among different government agencies to avoid duplication of efforts and to identify new opportunities for collaboration.

The NHAS is a testament to President Obama's belief in the "fierce urgency of now," a signal that the United States is bringing determination and innovation to eradicate HIV/AIDS in America. However, for the NHAS to be successful, effective implementation and resources will be required, including broad public support to sustain a long-term effort, as exists in our country for the battle against cancer. This means that all Americans must take action by learning more about HIV/AIDS, getting tested for HIV, using measures to protect against infection, working to shatter the stigma about the disease, contributing to the mission of AIDS organizations, and advocating for increased funding for research and services.

With leadership, this new roadmap, and the mobilization of the government, private sector organizations, and the public, let's hope that today's generation of children will someday have to turn to the history books to learn there ever was a disease called AIDS.

Rear Admiral Susan Blumenthal, M.D. (ret.) is the Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. She also serves as a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. For more than 20 years, Dr. Blumenthal served in senior health leadership positions in the Federal government, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association.

Bowen Jiang, a recipient of the Paul and Daisy Soros Fellowship, is a second-year medical student at Stanford University School of Medicine. He served as a Health Policy Fellow at amfAR, The Foundation for AIDS Research, in Washington, D.C.

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This article was adapted from an oped published in the San Francisco Chronicle on July 14, 2010.