White House Announces HIV/AIDS Strategy: 'Aggressive but Realistic'

The country's first National HIV and AIDS Strategy, announced Tuesday, focuses on reducing the number of new infections, increasing access to care for people living with HIV, and reducing HIV-related health disparities.

Melody Barnes, director of the Domestic Policy Council, and Secretary of Health and Human Services Kathleen Sibelius unveiled the plan. Developed over 15 months, it fulfills one of President Barack Obama's campaign promises and shows a renewed White House commitment to gay rights issues. However, the plan received mixed reviews from advocacy groups.

An estimated 1.1 million Americans are infected with HIV, and approximately 56,000 contract the virus that causes AIDS annually. The strategy aims to decrease the rate of HIV infection by 25 percent in the next five years and lower its transmission rate by 30 percent in the same period. It further sets out to ensure that at least 85 percent of people with the disease receive clinical care within the first three months of diagnosis (this figure currently stands at 65 percent). By 2015, the strategy says the proportion of people with HIV who know of their condition should be increased to 90 percent from the current 79 percent.

The administration is essentially depending on broad coordination among federal agencies to refocus and more efficiently use existing funds (current spending on domestic HIV and AIDS programs is $19 billion per year), though Sibelius did announce that $30 million of the Affordable Care Act's Prevention Fund would be dedicated to the plan. It calls for the Office of National AIDS Policy to work with the Office of Management and Budget to set domestic priorities, and it designates lead agencies (including the Departments of Health and Human Services, Justice, Labor, Housing and Urban Development, Veterans Affairs and the Social Security Administration) to implement the strategy.

To reduce new infections, the strategy calls for agencies to focus on communities where transmission and infection rates are greatest, including among gay and bisexual men of all races, black men and women, Latinos and Latinas, drug addicts and those in "geographic hot spots," including the Southern and Northeastern United States, as well as Puerto Rico and the Virgin Islands. The plan pairs these efforts with better education about HIV and related issues and a system to link patients to "continuous and coordinated" clinical care.

Sibelius stressed that the president recognized this moment as a "critical turning point" in the battle against HIV, recalling a slow response in the 1980s, when the disease was first discovered. Though a coalition was eventually formed to treat and reduce the spread of the disease -- lowering annual infections from 130,000 per year in the mid-1980s to just over 50,000 in the mid-1990s -- the rate of infection has held steady since then.

"Because the number of people living with HIV has gone up over the years, that means we're driving down infection rates slightly, but not fast enough," she said. "We're keeping pace when we should be gaining ground."

In developing the strategy, the White House met with local community groups and AIDS advocacy organizations around the country and in Washington, holding 14 community discussions and a dozen White House meetings. While some gay rights groups, including AIDS Action, hailed the plan as a "significant step forward," it likewise called it "a beginning, not an end." The organization called for coordination among federal agencies and local groups, cautioning against federal programs that demanded a "one-size fits all solution."

Other advocacy groups were sharper in their criticism.

Charles King, the chief executive of Housing Works -- a community-based AIDS organization -- said in a statement, "The president's plan is so flawed that it might actually represent a step backwards in combating HIV and AIDS in the United States." He called the goals "insufficiently ambitious" and "without adequate funding to reach even the modest HIV prevention and treatment goals that it sets out."

At the White House, King added, "I wonder how we think going from one new infection every 9 minutes to one infection every 12 minutes is making new infections in the United States exceedingly rare."

In response, the director of the Office of National AIDS Policy, Jeffrey Crowley, said: "I think we went through a very serious process and are trying to be honest about what we think is achievable. Setting a goal of a 25 percent [reduction in new infections of HIV] is aggressive but realistic. I wish I could tell you that we could set a goal of 50 percent or 75 percent. I just don't know how we would do that in the short term."