When President Obama took office in 2009, America had been neglecting its domestic HIV/AIDS epidemic for many years. The media and many policy makers' attention had largely shifted to global AIDS and away from an epidemic at home characterized by chronic, high rates of HIV infection, disturbing racial disparities, and an uncoordinated response.
Three years after the President released his National HIV/AIDS Strategy, the prospects for tackling AIDS in America have improved dramatically. The Strategy has brought needed focus on evidence based policy, targeting funding where it will have most impact and making progress on specific public health goals. The Affordable Care Act (ACA) will extend health coverage to tens of thousands of people living with HIV. And the scientific discoveries during this time have been startling, including the realization that HIV treatment truly is also HIV prevention because treating people for HIV makes it 96 percent less likely the virus will be passed on.
We now have the effective tools and improved policies necessary to begin to end the AIDS epidemic in America, but our biggest challenges lie ahead. Two major hurdles confront us: creating a care system that is more successful at reaching people living with HIV with lifesaving care, and battling the pernicious stigma that has surrounded HIV since the beginning of the epidemic.
First, we have to make the health care system work better for those groups most affected by HIV. It is estimated that 1.1 million Americans are living with HIV/AIDS and approximately 200,000 of them are not aware of their status. Less than half of people living with HIV in the US are in ongoing clinical care. But not only is it hard to get people into care, it's hard to keep them in care.
Doing better at delivering care to everyone living with HIV will require robust implementation of the ACA. While states like California, Massachusetts, and New York continue to lead the way in expanding access to care, it is troubling that some of the states that have the most intractable HIV epidemics have thus far decided not to take the Medicaid expansion option under ACA, effectively denying coverage to thousands of lower-income people in their state. As we usher in key ACA provisions in the coming months, it is time for all policy makers and health care providers at the state and local level to use health reform and other recent changes in federal law to expand access to HIV testing and treatment.
This includes fully implementing the recently announced recommendations in support of routine HIV testing for adults and adolescents ages 15 through 65. It also means supporting the implementation of the HIV Care Continuum Initiative, announced by the White House recently. Key elements of the Initiative include accelerating integration of national HIV prevention and care efforts, and encouraging innovative approaches to diagnose people living with HIV who are unaware of their status and keep them engaged in continuous care.
Second, we must do better at tackling stigma surrounding people living with HIV, as well as those groups that are most severely affected by the epidemic, including gay and bisexual men, transgender people, and African-American and Latino men and women. We have to combat stigma at every level, from the White House to the neighborhood health clinic. President Obama has set the tone. In his 2011 World AIDS Day declaration, the President said, "When new infections among young black gay men increase by nearly 50 percent in three years, we need to do more to show them that their lives matter." The National HIV/AIDS Strategy helps us refocus on stigma and disparities in the epidemic, setting as one of its chief targets improved viral control of HIV disease among communities of color and gay men.
Third, to achieve an AIDS-free generation in America, we must follow the science and base policy on the evidence. This requires repealing the ban on federal funding for syringe exchange, delivering accurate and comprehensive sex education in our schools and modernizing discriminatory state laws that criminalize HIV and foster fear, discrimination, distrust, and hatred. We also need to maintain our critical investment in research to identify better and easier-to-take treatment, more effective prevention options, and, ultimately, a cure and a vaccine.
Three years after it was released, the National HIV/AIDS Strategy remains a powerful set of principles that are essential for tackling the AIDS epidemic at home: relying on evidence-based policy, coordinating efforts, and holding ourselves accountable for improved outcomes. This year, in his State of the Union address, President Obama inspired all of us by recommitting the United States to achieving an AIDS-Free Generation at home and abroad. With the tools in hand, and renewed commitment by providers, advocates, and policy makers, we can realize that vision and make achieve the end of AIDS.
Barbara Lee is the representative for California's 13th District and a founding co-chair of the Congressional HIV/AIDS Caucus. Kenneth Cole is CEO of Kenneth Cole Productions and Chairman of the Board of amfAR, The Foundation for AIDS Research.