AIDS in 2009

1. AIDS in 2009

2. Problem statement • We must decide what to do with American resources to fight AIDS • This is a global problem and we have already entered the global arena • Has the move to the globalization of AIDS taken it off the national agenda?

3. Evidence • People are living longer due to anti retroviral therapy • People on long term retrovirals are showing signs of premature aging as well as kidney disease, dementia, and cancer. • 52% of Americans infected with HIV suffer from some level of cognitive impairment • “Aging is the number one problem in HIV today,” Jules Levin, AIDS activist

4. Medications • AZT re-discovered in 1987, but not effective on its own • Protease inhibitors discovered in 1996 • Hit early, hit hard – start drug cocktail early and continue it indefinitely

5. National Institute of Allergy and Infectious Disease Study • Plan to test virtually every single adult in the Bronx and DC • Put everyone who tests positive on anti-HIV drugs • Untreated people are extremely infectious • Goal to stop transmission of the virus

6. New challenges • When AIDS and then its cause — HIV — were recognized in the early 1980s, no one imagined that individuals with HIV infection would eventually survive for decades. • Now, with a quarter of the HIV-infected U.S. population age 50 years and older, the biomedical and public health communities face new challenges at the intersection of HIV and aging.

7. Current research • September 18, 2009 was the first National HIV/AIDS and Aging Awareness Day: • recognize the importance of preventing HIV infection in this age group and understanding and addressing the unique health effects of the virus on older Americans. • individuals 50 years of age and older accounted for approximately 10 percent of all new HIV infections in the United States in 2006. • one quarter of HIV-infected adults in the United States in 2007 were at least 50 years old (NIAID, 2009).

8. Plan • Educate older people about the importance of routine HIV testing and early diagnosis; how the virus is transmitted; behaviors that place them at risk for acquiring or transmitting the virus; and strategies, such as condom use and needle exchange, that can reduce their risk. • Since early diagnosis of HIV is key to optimal treatment, the CDC recommends routine HIV testing for all adults up to age 64. • CDC also recommends HIV testing at least annually for adults aged 64 and over who have risk factors for HIV infection, such as injection drug use.

9. Medicare coverage • The U.S. Department of Health and Human Services this month proposed that Medicare cover HIV screening tests for beneficiaries at increased risk for acquiring the virus

10. Future study • Scientists now want to determine which HIV-infected individuals are at highest risk for developing HIV-associated frailty with the hope of identifying factors to mitigate or prevent its development. • NIAID and the National Institute on Aging (NIA), also part of NIH, are planning a workshop for late 2009 to identify current knowledge and research gaps in the areas of HIV and frailty, bone health, muscle health and vitamin D production.

11. Our recent history • In June 2001, at the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), 189 national governments, including the United States, adopted the Declaration of Commitment on HIV/AIDS. • The document commits governments to improve responses to their domestic AIDS epidemics and sets targets for AIDS-related financing, policy, and programming.

12. In 2006 • While an upcoming United Nations summit may cite U.S. leadership against the AIDS epidemic overseas, a new report released today shows that the U.S. is falling short on its commitments made at the UN five years ago to curb the disease at home. • The report, published by the Public Health Watch HIV/AIDS Monitoring Project of the Open Society Institute (OSI), provides the first comprehensive analysis of how the United States is responding to the domestic AIDS epidemic and calls on the U.S. government to step up prevention and treatment efforts.

13. What we’re doing wrong • U.S. efforts against the disease are uncoordinated, with no national plan for comprehensive HIV prevention, treatment, and support. • Half the people in the U.S. who need HIV treatment are not receiving it. • The number of new HIV infections in the U.S.—40,000 a year—has not decreased in over a decade. • HIV/AIDS continues to have a devastating impact on communities of color, gay men and men who have sex with men, injecting drug users, and the poor.

14. Our lack of a national response • “Five years after the United States committed to reach those most vulnerable to HIV, we still see huge racial and economic disparities in infection rates • “Communities of color, especially African Americans, women, gay men, injecting drug users, and the poor continue to bear the greatest burden of this disease. African Americans account for half of new HIV infections in the U.S., despite being less than 13% of the national population, and AIDS is the leading cause of death for African-American women ages 24-34. • These are not the signs of a strong national response to AIDS.” • (From :Public Health Watch Project Director Rachel Guglielmo).

15. Recommendations • Establish a national HIV/AIDS strategy that focuses on outcomes • Comprehensively address racial disparities in HIV/AIDS impact • Dedicate increased resources to proven-effective interventions

16. April 7, 2009 • “Today the White House teams up with Department of Health and Human Services and the Centers for Disease Control and Prevention to launch a $45 million campaign to raise awareness on AIDS, an issue the President has spoken passionately about for years”. • This marks the first federally funded national domestic HIV/AIDS campaign in almost twenty years.

17. Call to action • Brainstorm ideas and identify specific action steps • Develop recommendations • Write a summary of your group’s recommended action steps • Type your recommendations directly into the web site comment field or upload a Word or PDF file with your recommendations directly on to the ONAP web site: http://www.whitehouse.gov/administration/eop/onap/action (ends 11/23)

18. Major AIDS legislation • Lantos/Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act – 2008 • The large majority vote (80-16) in favor of the bill appears to acknowledge the program as the most successful foreign policy initiative under the Bush administration • Tripled funding to fight AIDS and other diseases around the globe ($40 billion over 5 years) in “an open-ended "entitlement program" for citizens of other countries”. • According to the Office of the U.S. Global AIDS Coordinator, the money ($19 billion 2003-2008) has provided services in poor nations that have prevented 194,000 HIV infections among infants. • US provides about 40 percent of global AIDS assistance.

19. Other aspects of this legislation • (1) an amendment that urges the United States to work with other creditors to provide increased debt relief to poor countries, especially those suffering the most from HIV/AIDS; • (2) a conscience clause that will ensure that Catholic Relief Services, and other religious organizations – who are the principal providers of care for those affected by HIV/AIDS – will not be discriminated against on the basis of their religious or moral convictions; and • (3) a recognition that abstinence and fidelity must be principal components of prevention education in order to help curb the spread of HIV.

20. Domestic response • “People living with HIV here haven't seen help from Washington since the Ryan White CARE Act passed in 1990” (AIDS activist). In 1985, Ryan, a 13 year old hemophiliac is diagnosed with AIDS. He is barred from his school in Indiana. He died in 1990.

21. Ryan White (CARE) Act • The Ryan White Comprehensive AIDS Resource Emergency Act offers medical care to people living with HIV/AIDS who do not have sufficient health care coverage or financial resources to cope with the disease. • Groups that receive grants through the Ryan White CARE Act serve a large number of Medicaid patients, as well as indigent patients who have no health care coverage. • These organizations often struggle with insufficient funding through Medicaid.

22. October 2009 • Wisconsin Congresswoman Tammy Baldwin introduced new legislation that would strengthen the federal response to HIV/AIDS • "The Ryan White Grantee Payment Equity Act" (H.R. 3665), would authorize increased Medicaid funding to health care providers. • The HIV/AIDS population would benefit from a higher Medicaid reimbursement rate. • A higher rate would enable clinics to expand operations and care for the growing number of people living with the disease. • More than 56,000 Americans become infected with HIV every year. • Bill is currently in committee

23. Next steps?