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May 02, 2011

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Perspectives from Missouri

By Christopher Bates, M.P.A., Executive Director, Presidential Advisory Council on HIV/AIDS, and Senior Advisor to the Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

Christopher Bates

Earlier this month, I had the opportunity to spend time in Missouri speaking with audiences about the National HIV/AIDS Strategy (NHAS) and learning about what they are doing to support implementation of the Strategy locally. As in other communities across the country, the folks I spoke to in Kansas City and Jefferson City are eager to contribute locally to the nationwide efforts to achieve the Strategy’s goals.

In Kansas City, I spoke to the Campaign to End AIDS Exit Disclaimer (C2EA) Annual Summit. C2EA is a diverse coalition of people living with HIV and AIDS, their advocates, colleagues, friends, and loved ones. The panel discussion in which I participated was entitled “National HIV/AIDS Strategy Implementation: Federal to State to Community.”

NHAS In Action

The title captures the importance of engaging all sectors of society in implementing the Strategy if we are to achieve its important and life-saving goals. Joining me on that panel was Missouri’s State AIDS Director, Michael Herbert, who shared some of the approaches his agency is taking to align programs and activities with the Strategy’s goals to reduce new HIV infections, increase access to care, and reduce HIV-related health disparities. I provided an overview of what is underway at the Federal level and also encouraged the participants to ground their efforts in science, conduct assessments so they know what works best in their community in terms of prevention and treatment, and scale up those efforts sufficient to meet demand in the communities most impacted.

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April 26, 2011

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SAMHSA, Behavioral Health and the National HIV/AIDS Strategy (Part II)

By Gretchen Stiers, PhD, HIV/AIDS Policy Lead, Office of Policy, Planning and Innovation, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services

Gretchen Stiers

Gretchen Stiers, SAMHSA

As the HIV/AIDS policy lead at the Substance Abuse and Mental Health Services Administration (SAMHSA), I am pleased to return to the blog to discuss more of the activities that SAMHSA is engaged in to support the National HIV/AIDS Strategy (NHAS). In my last post, I discussed SAMHSA’s commitment to addressing the behavioral health problems that can put individuals at greater risk for HIV infection, co-occur with HIV infection, and hinder access to treatment and maintenance in care for mental and substance use disorders as well as for primary medical services. I also discussed SAMHSA’s efforts to examine the funding criteria that allow States to use five percent of the Substance Abuse Prevention and Treatment Block Grant funds for HIV/AIDS services, and our support of the 12 Cities Project. Today, I would like to provide an overview of how some of our current behavioral health activities are aligned with each of the three goals of the NHAS. Behavioral health refers to emotional health in general and the choices/actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders.

Goal 1: Reducing New HIV Infections

To reduce the number of new HIV infections, the NHAS calls for us to re-orient our prevention efforts by realigning resources to serve the populations at highest risk of acquiring or transmitting HIV including those with mental and substance use disorders1. The NHAS recommends that HIV testing and other comprehensive HIV prevention services be coupled with treatment and services for individuals with mental and substance use disorders. To help assess the need for additional services, SAMHSA is conducting a needs assessment to determine the distribution and frequency of HIV testing in SAMHSA-funded substance abuse and mental health treatment clinics. We will use the results from the assessment to determine areas for expanding HIV testing capacity in SAMHSA-funded clinics and centers. While many behavioral health service providers are not HIV specialists, their patient populations may be engaging in behaviors that put them at higher risk for HIV infection or hinder access to HIV treatment and maintenance in care. SAMHSA will develop resources, technical assistance and training to help substance abuse and mental health treatment providers offer HIV prevention services (such as access to rapid testing) and to increase their capacity to link people with HIV/AIDS to primary care in a timely manner.

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April 14, 2011

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Federal Leads Continue Collaborative Efforts

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

Federal Leads NHAS Meeting

On Monday, April 4, 2011, representatives from the six Federal agencies designated by the President as lead agencies with responsibility for implementing the National HIV/AIDS Strategy (NHAS) met to continue our collaborative efforts to implement the Strategy. The primary focus of the meeting was the continued exploration of the impact of homelessness and housing insecurity on HIV/AIDS outcomes with a focus on how to better coordinate program and policy efforts across Federal agencies.

Our discussions are informed by specifics about relevant programs and policies shared by our respective agencies; in this way we are able to identify potential opportunities for collaboration and coordination at both the Federal and local levels. Toward that end, representatives of the Department of Housing and Urban Development (HUD), Department of Veterans Affairs (VA), and Department of Justice’s Bureau of Prisons (BOP) shared program highlights with the group and fielded questions.

Mr. David Vos, director of HUD’s Housing Opportunities for Persons with AIDS (HOPWA) program, recognized the importance of our group meeting on a regular basis, noting that sharing information across agencies and joint problem solving would result in better outcomes for persons living with HIV/AIDS. He shared that the HOPWA team is currently engaged in an effort to identify model programs among its grantees. Those best practices will be documented and disseminated among all the grantees. Mr. Vos also noted that HUD is pursing a revision to its HOPWA funding formula as recommended in the NHAS. In a guest blog post, he recently shared more details on that activity. Finally, Mr. Vos noted that all of these activities are unfolding amidst broader department-wide efforts to utilize HUD assistance to improve health outcomes and quality of life for beneficiaries and communities.

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April 13, 2011

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Updating the HOPWA Funding Formula

By David Vos, Director, Office of HIV/AIDS Housing, U.S. Department of Housing and Urban Development

David Vos

David Vos, HUD

The Department of Housing and Urban Development (HUD) is committed to working with our Federal and community partners to ensure the success of the national response to HIV/AIDS articulated in the National HIV/AIDS Strategy (NHAS). In my prior post, I described some of the activities we are undertaking and how community members can engage with us on them. Today, I want to share information about our efforts to carry out one of the important tasks assigned to HUD in the Strategy’s Federal Implementation Plan.

The Strategy asks all Federal departments and agencies to review the methods used to distribute Federal HIV/AIDS-related formula grants or project implementation funds and take steps to ensure that resources go to the States and localities with the greatest need. At HUD, this means an examination of formulas related to the Housing Opportunities for Persons with AIDS (HOPWA) program.

First, a quick overview of that program for those of you who may not be familiar with it. To address housing needs for low-income persons who are living with HIV/AIDS and their families, HUD manages the HOPWA program. The program is the only Federal program dedicated to address the housing needs of persons living with HIV/AIDS and their families. In program year 2010, grantees utilized HOPWA funds to provide housing support to 60,699 households, and leveraged other funds to provide housing support to an additional 31,000 households.

In fiscal year 2010, the appropriation for HOPWA was $335 million. Ninety percent ($298.5 million) was allocated by a formula based on cumulative AIDS cases to 133 qualifying areas. That formula, however, was crafted in and has been in use since 1990. It reflects the nature of AIDS surveillance information available at that time. As changes have occurred in HIV/AIDS surveillance tools over time, the method used for allocating HOPWA formula funds has become increasingly dated. Recognizing this, the Strategy’s Federal Implementation Plan specifically tasks HUD with responsibility for working with Congress to develop a plan (including seeking statutory changes if necessary) to shift to HIV/AIDS case reporting as a basis for formula grants for HOPWA funding.

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April 11, 2011

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The Role of Communities in Implementing the Strategy: Perspectives from Florida

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

Dr. Valdiserri

Dr. Ronald Valdiserri

In early April, I was privileged to be able to talk to a group of nearly 300 health care providers, lawyers, public health and community leaders about the implementation of the National HIV/AIDS Strategy (NHAS). The event was the 19th annual "Florida Bioethics: Debates, Decisions, Solutions" Exit Disclaimer conference, a day-long meeting hosted by the University of Miami. I was honored to share the stage with Dr. Dwayne Turner who is the current Communicable Disease Director of the Broward County Health Department Exit Disclaimer and the former Associate Director for Planning for AIDS Project Los Angeles. I was especially impressed by Dr. Turner’s comments on the role of communities in the implementation of the NHAS and wanted to share them with readers of AIDS.gov.

Dr. Turner talked about the importance of getting communities ready to “receive” and implement the strategy. An important responsibility of public health leadership, according to Dwayne, is to listen to communities and to go as deep as necessary in order to understand community needs and preferences when it comes to HIV/AIDS and other public health services. He noted that engaging communities in public health decision making is an ethical imperative, especially when those decisions are difficult and may involve discussions of how best to allocate scarce resources to address competing needs. Finally, Dwayne recognized the significant responsibility of public health organizations at all levels of government to “look at the evidence” and, if it becomes apparent that strategic goals and health objectives are not being met, to reorganize, reprioritize, and redirect.

Dr. Turner’s perspectives are very much in-sync with the NHAS which calls upon us, collectively, to take a hard, careful look at our HIV/AIDS policies, programs, and research priorities. The NHAS asks us to redirect existing resources, as necessary, to high-burden populations and to scale up interventions and services that will have the greatest payoff in terms of reducing new HIV infections, improving health outcomes of people living with HIV, and reducing HIV-related health disparities. This will not be easy. Nor will it be painless. But it is, nevertheless, critically important to achieving the goals of the NHAS.

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