AW16_Overview_and_Briefs-Absolute Final2

EndingAIDSinAmerica:
MeetingtheChallenge
1987
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41,000Dead;71,000LivingwithHIV
AIDSQuiltfirsttimeonNationalMall
FirstAntiretroviralDrugApproved– AZT
FirstpublicSpeechbyPresidentReaganonAIDS
ACT-UPFounded:AIDSCoalitionToUnleashPower
1988
HIV&AIDSOverTime:OurLegacy
IntroductionofHighlyActive
AntiretroviralTherapy
(HAART)
198919831986198919921995199820012004200720102013
=
LifetimeTreatment
Cost$379,668
50,000NewInfections
TreatmentCostsofHIV
=
LifetimeTreatment
Cost$18.9Billion
= $94.9Billion
Insurance Coverageof
Nonelderly Adults withHIV
2009Pre-ACA
HIV=
A Disease of
Disparities
HIVDiagnosesTrends2005-2014
ByRace
HIVDiagnosesTrends2005-2014
ByModeofTransmission
HIVDiagnosesTrends2005-2014
ByRaceamongMSM
LifetimeRiskofHIVDiagnosis
intheUnitedStates(CDC,2016)
LifetimeRiskofHIVDiagnosis
intheUnitedStates(CDC,2016)
CDCEstimated2014NewHIVInfections
BlackMSM
11,207
9,012
WhiteMSM
7,057
LatinoMSM
4,657
BlackHeteroWomen
2,113
BlackHeteroMen
OtherMSM
All subpopulations
accounting for 1,000 or
more of 2014 infections
2,105
LatinaHeteroWomen
1,282
WhiteHeteroWomen
1,115
0
2,000
4,000
6,000
8,000
10,000
12,000
HIVwithinTransCommunities
“Transgender
communities
areamongthe
groupsat
highestrisk
forHIV
infectionin
theUnited
States.”
A2008meta-analysisof29studiesfocusing
ontranswomenintheUnitedStatesfound:
27%
MTFtestedHIVPositive
11%
Self-reportedknowingtheywereHIV+
AmongAfricanAmericans
56% MTFtestedHIVPositive,
31%
Self-reportedknowingtheywereHIV+
RatesofAdultsandAdolescentsLivingwithDiagnosedHIV
Infection,Year-end2013—UnitedStatesand
6DependentAreas
N=950,811
Total Rate=355.9
Note.DataincludepersonswithadiagnosisofHIVinfectionregardlessofstageofdiseaseatdiagnosis.Alldisplayeddatahavebeen
statisticallyadjustedtoaccountforreportingdelays,butnotforincompletereporting.
Incomeaswellasracepredictwhoismorelikely
todiefromHIV
(Levine,2007)
(Singh,2013)
NHASVision:
TheUnitedStateswill
becomeaplacewherenew
HIVinfectionsarerareand
whentheydooccur,every
person,regardlessofage,
gender,race/ethnicity,
sexualorientation,gender
identityorsocio-economic
circumstance,willhave
unfetteredaccesstohigh
quality,life-extendingcare,
freefromstigmaand
discrimination.
Source:UNAIDS/Lohseetal/Hoogetal/Mayetal/Hoggetal
HPTN052– TreatmentasPrevention
Graphic
developedby:
RodgerAet
al.HIV
transmission
riskthrough
condomless
sexifHIV+
partneron
suppressive
ART.
PARTNER
Study.21 st
Conference
on
Retroviruses
and
Opportunisti
cinfections,
Boston,
abstract
153LB,2014.
ChangeinARVTreatmentGuidelines
Basedonnew
researchfrom
NA-ACCORD
cohortofHIV+
people,life
expectancy of
HIV+adults
initiating
therapytoday
isapproaching
thelife
expectancy of
thegeneral
population.
DHHS2012Guidelines: ARTis
recommended forallpeople livingwith
HIVtoreduce theriskofdisease
progression.
WHO2013Guidelines: ARTis
recommended aspriorityforindividuals
at<350CD4,forindividuals at>500
CDC,andforallpeople livingwithHIV
andwithactiveTB,co-infected with
Hepatitis andevidence ofliverdisease,
andsero-discordant couples.
StagesofCare– TheUnitedStatesTreatmentCascade
100%
1,201,100
86%
1,032,800
61%
725,302*
40%
478,433
37%
441,661
30%
361,764
HIV-Infected
DiagnosedLinkedtoHIVRetainedin
Care
HIVCare
Source:CDCVitalSigns,US2011;EarlyRelease11/25/14
OnARTSuppressed
viralload
PrEP is a new prevention method in which
people who do not have HIV take a pill a day to
reduce their risk of acquiring the virus.
When taken consistently, PrEP has been shown to
reduce the risk of HIV acquisition by up to 92%
Impact on HIV &
Current Challenges
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Norescissions, noabilitytoexcludebased onpre-existing conditions;
Expansion ofnumbersofindividuals withinsurance, particularlythe
poorvis-à-vis statesoptingintoMedicaidexpansion,
Establishing abaseofessential health benefits;
Expansion ofpreventative healthservices, includingtesting;
Insurers currently facingchallenges linkedtoplacingallHIVdrugsin
specialtyand/ortoptiers,increased co-paysandsmaller networks–
challenges beingworked out.
Transparency offormularies &networks ofcare.
AmericanKnowledge&Attitudes
(Washington Post/KaiserFamilyFoundation2012Survey)
•
61%ofAmericans believeAmericans don’thaveaccesstoHIVtreatment;
•
50%ofAmericans nevertestedforHIVdespite CDCrecommendations
•
34%ofAmericans identifysharingadrinkingglass,touchingatoiletseator
swimminginpoolasriskofHIVtransmission
•
20%wouldbesomewhatorveryuncomfortable workingwithsomeone who
hasHIV;and44%similarly wouldnotwantanHIVpositivepersonpreparing
theirfood.
NotJustPopulation-at-large,butalsoProviderAttitudes
LimitingSuccess:ParticularlyforTransPopulations
OurAsks
OurAsks
1.InsuranceandCoverage
2.Housing
3.Education
4.Decriminalization
5.Research
The Facts
Massachusetts:
From2000to2011,the
numberofHIVinfection
diagnosesdecreasedby44%
andthenumberofdeaths
amongpeoplereportedwith
HIV/AIDSdecreasedby41%.
ACA+RWP=
FasterprogresstowardsanAIDS-freeGeneration.
The Asks
• EnforceACA nondiscriminationmandates;
• Enactlawstoreducediscriminatorycost-sharing for
HIVmedications;
• MaintainfederalcommitmenttoMedicareand
Medicaid,withemphasisonsupportforlate-comer
statestoexpandMedicaidandstillgarnerthreeyearfullcoverage.
TheRyanWhite
HIV/AIDSProgram
• Servesanestimated536,000Low-IncomePeopleAnnually
(nearlyhalfofallindividualslivingwithHIVintheU.S.
• Isasafetynet/payeroflastreset- criticalincoveringthe
uninsuredandelementsnotcoveredunderinsurancethat
areneededforengagement&retentionincare.
• Lastauthorizedin2009&Expired(notsunset)in2013
• Reauthorizationwillbeneeded,butmoretimeneededfirst
toseeimpact/needsrelatedtoACA.
TheRyanWhite
HIV/AIDSProgram
• TheRyanWhiteProgram(RWP)isacritical
componentofthenationalpublichealthresponse
toHIVinfectionanddisease.
• Whilereauthorizationmaynotbeready,fulland
continuedappropriations areneeded.
STABLEHOUSING
TheFacts
• Alifelinefor
peoplelivingwith
HIV
• Oneofthe
greatestunmet
needsof
Americansliving
withHIV/AIDS
• HOPWA
Enacted1990
FY16$335Million
STABLEHOUSING
Theasks
ModernizeFormula–
Ratherthancurrentapproachofallocatingbased on
cumulative AIDScases,newformulashould betieddirectlyto
number ofindividuals currentlyliving withHIV,povertylevel,
andhousing costs.
IncreaseFunding –
Provide a$40million increasetoHOPWA attime of
modernization toclosegaponneed,andtoensure
modernization getsmore equitable resources toareas
withgrowingepidemics, while otherareasarenot
destabilized.
TheFacts
• Lessthanhalfofallhighschoolsandonly20%of
middleschoolsintheU.S.provideallofthe16
topicsidentifiedbytheCDCascriticalsexual
healtheducation.
• Youngpeopleunderageof25accountedfor20%
ofallnewHIVinfectionsin2014and68%ofall
chlamydiacasesin2013.
TheAsk
• SupportcontinuedauthorizationofthePersonal
ResponsibilityEducationProgram(PREP)forFY20162020,andincreasedfundingforTeenPregnancy
PreventionInitiative(TPPI)andDivisionofAdolescent&
SchoolHealth(DASH)inFY2017
• Eliminatefederalfundingforabstinence-onlyprograms,
asproposedinthePresident’sbudget
• Co-sponsorRealEducationforHealthyYouthAct
TheFacts
• 33statesandtwoterritorieshaveHIV-specificstatutes
thatapplyonlytopeoplelivingwithHIV;
• InU.S.,morethan1,000peoplelivingwithHIVhave
facedchargesunderHIV-specificstatutes;
• Longsentences,evenwherenorealriskof
transmissionhasoccurred,havebeendocumented.
• Criminalizationislimitedtothosewhoknowtheir
status,andassuch,couldinhibitsomefromseekingto
learntheirstatus(anti-publichealth).
TheAsk
Supportand/orCo-SponsorHR1586
sponsoredbyRep.BarbaraLeeandS2336
sponsoredbySenatorCoons
TheRepealofExistingPoliciesthatEncourageandAllow
LegalHIVDiscrimination)REPEALAct.
– Requiresafederalreviewofstatelaws,policies,andregulationsrelatedto
HIVCriminalization.Won’tchangestatelaw,butwillhopefullyinfluence.
AIDSBudget&Appropriations
Ø InvestmentinResearch,Care,Preventionand
Housingcriticaltobendingthecost-curveof
newinfections(eachpreventedHIVinfection
saves$377kinfuturetreatmentcosts)
Ø EnsureBudgetRequestsfromAIDSBudget
andAppropriationsCoalitionaresupported
Ø NIHBudgetfallshortof$100millionincrease
promisedforHIVresearch
the End of AIDS
“Weareonscientifically solidgroundwhenwesaywecanendtheHIV/AIDS
pandemic,”Dr.Fauci said.“TheendofAIDSwillnotbeaccomplished, however,
withoutamajorglobalcommitment tomakeithappen.Wehaveahistoric
opportunity— withscience onourside— tomaketheachievement ofanAIDSfreegenerationareality.”
- 2012Int’lAIDSConference