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February 2011

February 28, 2011

7

The 12 Cities Project

By Miguel Gomez, AIDS.gov Director

An important component of the HHS National HIV/AIDS Strategy Operational Plan is what is known as “the 12 Cities Project.” The HHS-wide project supports and accelerates comprehensive HIV/AIDS planning and cross-agency response in the 12 U.S. jurisdictions that bear the highest AIDS burden in the country.

We have touched on the project in some prior posts, but I recently spoke to Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases, to learn more about the project and its importance for helping the nation achieve the Strategy’s goals. View Dr. Valdiserri’s video below.

We have also prepared an overview (PDF) of the 12 Cities Project. 

While this initiative represents is a significant component of the HHS NHAS Operational Plan, it is by no means the only activity HHS is undertaking to pursue the Strategy’s goals. To be sure, HHS is actively pursuing more than 175 actions specified in the first NHAS Federal Implementation Plan plus many additional ones set forth in its Operational Plan.

In the coming weeks and months the AIDS.gov blog will be featuring updates about how all of these activities, including the 12 Cities Project, are unfolding.

HHS 12 Cities Project

February 27, 2011

5

Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

CAPTION

Dr. Ronald Valdiserri

On Saturday, February 26th, I attended a day-long meeting organized by the Centers for Disease Control and Prevention (CDC) and hosted by the Fenway Community Health Center in Boston. The theme of the meeting was “Moving forward with PrEP Implementation.” Meeting participants included researchers involved in the original iPrEX study and other ongoing HIV prevention studies, health care providers caring for men-who-have-sex-with-men (MSM), state and local health department program directors, MSM community advocates, policy experts, and federal officials.

The meeting began with a detailed review of the iPrEx study, which included nearly 2,500 participants from Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Participants were MSM engaging in high-risk sex with other men—including a small number of transgender women who reported high-risk sex with men. The study findings, released in November 2010, showed that sexually active MSM who took a once-daily pill containing 2 anti-HIV drugs were 44% less likely to become infected with HIV, compared with participants who took a placebo.

Because iPrEx was a “blinded” study, participants did not know if they were receiving active drugs or placebos (inactive drugs). As such, all study participants received intensive risk-reduction counseling. Along with this counseling, all study participants also received monthly HIV testing, condom provision, and treatment for other acquired sexually transmitted diseases.

When these results were summarized at the Saturday meeting in Boston, the audience was reminded that the level of protection experienced by study participants who received the active drug varied widely, depending upon how consistently they took their daily pills. For those who took the daily drug at least 90% of the time, HIV risk was reduced by 73%. Others, who took the drug less frequently, had only a 21% reduction in HIV risk. Given this finding, a significant theme of our discussion in Boston was the critical role that adherence counseling must play in any future efforts to develop and implement PrEP programs for MSM.

The U.S. Public Health Service is currently at work on guidelines for PrEP use among MSM. In the meantime, CDC has released interim guidance, as well as a fact sheet on Pre-Exposure Prophylaxis for HIV Prevention (PDF). But, as our meeting in Boston highlighted, there are many critical questions that must be answered before we can move this important prevention research finding from the pages of a scientific journal and into the day-to-day lives of MSM who are at high, ongoing risk for HIV infection. Several of the major questions raised by participants were:

  • Among the diverse communities of MSM in the U.S., what subset of men would be the most appropriate candidates for this new prevention tool?
  • Given the disproportionate burden of HIV infection among MSM of color—many of whom also live at or near the poverty level—how will daily drug treatments be financed?
  • In the real world of competing needs and resource constraints, how should PrEP programs for MSM be combined with other prevention approaches for MSM to result in the greatest pay-off in terms of decreasing new HIV infections?
  • How do we build the needed capacity among medical providers, health departments, and community-based organizations so that PrEP can be implemented as part of a comprehensive package of HIV prevention services for MSM at risk for HIV?
  • Could PrEP serve as a “gateway” into other equally effective—and perhaps less costly—prevention approaches for MSM?

While everyone at the Boston meeting recognized the promise of this new tool, there was a general consensus that PrEP is not a “magic bullet” and that it should not be viewed as the sole approach to reducing new HIV infections among MSM.

Moving forward with discussions about how to implement PrEP as a new prevention strategy for MSM, let’s keep in mind the necessity of supporting combined biomedical, behavioral, and structural approaches—all of which are called for in the National HIV/AIDS Strategy. Given the ongoing burden of new HIV infections among MSM communities in the United States, we are obliged to carefully examine our current approaches and, when called for, make changes in where and how we deliver our HIV prevention services.

February 25, 2011

0

2011 AIDS.gov Communication Strategy: Our Guiding Philosophy, Audiences, Activities, and More

by Jennie Anderson, AIDS.gov Communications Director, and Mindy Nichamin, AIDS.gov New Media Coordinator

2011 Communication Strategy

2011 AIDS.gov Communication Strategy

Behind the scenes at AIDS.gov, we use an internal working plan to guide our ongoing communication activities and special initiatives. Recently, our team sat down to update our 2010 plan. It was a useful exercise for us to stop and look back at where we've been over the past year and discuss where we want to go.

Our updated 2011 AIDS.gov Communication Strategy Internal Working Plan (PDF 341 KB) incorporates strategies for best reaching our audiences through new and traditional media, and includes a breakdown of our communication channels, strategies, activities, staffing, future directions, and more. We hope that our communication plan can help you understand more about the span and reach of our work at AIDS.gov, as well as serve as a resource for you as you develop or augment your communication strategy to reach your audiences in the HIV community and beyond.

Do you have any examples or advice on developing a communication plan for your project/organization that you'd like to share? Leave us a comment.

February 24, 2011

0

A Call to Action: Leveraging Private Sector Support for the National HIV/AIDS Strategy

By Melody C. Barnes, President’s Domestic Policy Adviser; Director, Domestic Policy Council (Cross-posted from the Office of National AIDS Policy Blog)

When President Obama released the National HIV/AIDS Strategy (PDF 1.2MB) in July 2010, he said, “The Federal government can’t do this alone, nor should it.  Success will require the commitment of governments at all levels, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and others.” 

Clearly, success at achieving our aggressive goals in the Strategy depends not only on Federal leadership, but new investments and new partnerships from all parts society.  We know that some of our biggest successes in fighting HIV/AIDS have come about because of private sector initiatives, and we’ve called on businesses and foundations to provide that next level of leadership by stepping up their efforts in a few targeted areas.  We want to hear about your successful partnerships and new ideas for working together.

Priority areas where private sector partners can help us to achieve the National HIV/AIDS Strategy goals are:

  • Bridging the gap in access to HIV medications:  Over the past year, a growing challenge has arisen as an increasing number of people living with HIV are placed on waiting lists for state operated AIDS Drug Assistance Programs (ADAP).  Most states have managed to avoid imposing these waiting lists, but nearly 6,500 people in 11 states are currently on waiting lists.  Even states without these lists have had to make difficult decisions such as to restrict the scope of drug coverage available or to limit the income standards of people who qualify for assistance. The Federal government has a role to play in responding to this situation and states must remain committed to investing in these programs, but we need the continued commitment from our private sector partners to weather the economic downturn that is afflicting many parts of the country.  Pharmaceutical companies and related charitable organizations have maintained patient assistance programs that provide critical aid to those in need.  We are appreciative that these companies have maintained and increased their commitments in this area.  Foundations have also helped to support community efforts to bolster state investments in programs providing HIV medications.

Continue reading "A Call to Action: Leveraging Private Sector Support for the National HIV/AIDS Strategy" »

2

The National HIV/AIDS Strategy: Grounded in the Best Science

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

CAPTION

Dr. Ronald Valdiserri

The President has committed the Federal government to implementing a National HIV/AIDS Strategy (NHAS) that is “grounded in the best science.” Scientific research efforts have greatly expanded our understanding of HIV/AIDS and produced a large number of critical tools and interventions to help us diagnose, prevent, and treat HIV. The past year has been particularly productive with impressive scientific advances in microbicides and pre-exposure prophylaxis (PrEP), among others.

But our knowledge of this deadly disease remains incomplete and both a cure and a vaccine are, for the time being, elusive. Simply stated, we cannot achieve the vision of the NHAS without continued and sustained progress in biomedical, behavioral, and social science. Reducing new infections will require additional research to identify and evaluate new prevention strategies as well as population-specific information on the most effective combination of approaches to prevent new HIV infections. Improving health outcomes for people living with HIV/AIDS requires continued investments in research to develop safer, cheaper, and more effective treatments as well as ongoing research to find a cure. Additional research is also needed to better understand, prevent, and treat co-infections, co-occurring conditions, and complications of HIV disease. Nor can we afford to neglect the policy, operational and social questions that often arise as a result of new research findings—these, too, require thoughtful inquiry and study.

To learn more about rapidly evolving HIV/AIDS research, I will be attending —along with a number of other Federal colleagues—the 18th Conference on Retroviruses and Opportunistic Infections (CROI Exit Disclaimer) in Boston, Massachusetts beginning Sunday, February 27. The conference provides a critically important global forum for basic scientists, clinicians, and global health researchers to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and the diseases they produce with the ultimate goal of translating laboratory and clinical research into progress against the AIDS epidemic—at home and abroad. At the CROI a diverse community of some 4,000 scientific experts, providers, and community leaders will interact with one another and share information and perspectives about recent scientific and technical advances in HIV/AIDS.

I hope you will have an opportunity to read this blog next week, as I look forward to sharing important information with you from the conference. In addition, CROI will be making all conference sessions available as webcasts and podcast on the CROI website Exit Disclaimer approximately 8 hours after the conclusion of each session. See the CROI pocket program Exit Disclaimer for a complete listing of the plenaries, symposia, scientific overviews, oral abstract sessions and themed discussions.

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