A Summary of

the National
HIV/AIDS Strategy
July 2010

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A Summary of the
National HIV/AIDS Strategy
July 2010

Vision of the Strategy: The US will become a place where new HIV infections are rare and when
they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender
identity or socio-economic circumstance, will have unfettered access to high quality, life-extending
care, free from stigma and discrimination.

President Obama has given Federal agencies 150 days from July 13, 2010 to develop detailed
plans to implement the following elements of the National HIV/AIDS Strategy.

1. Reduce New Infections

Goal: Lower the annual number of new infections by 25
percent by 2015 as a result of: reducing annual transmissions
relative to the number of HIV-positive people by 30 percent;
increasing serostatus awareness among HIV-positives from 79
to 90 percent.
b. Expand targeted efforts to prevent HIV
Challenges to be addressed: 21 percent of HIV-positive people
do not know their HIV status; one third of HIV-positive peo-
ple are not engaged in care that would prolong their lives and
prevent new infections; prevention is not adequately targeted
where it is most needed; access to prevention is too limited;
there is diminished attention to HIV nationally and Ameri-
cans do not correctly understand how the virus is transmitted.
a. Intensify HIV prevention efforts in communities
where HIV is most concentrated
Support and strengthen surveillance systems to increase
understanding of who is at risk;
Spend federal, state and local prevention dollars where and
on whom the burden of infections occurs;
Address the epidemic through a better focus on gay and
bisexual men; and
The epidemic among African Americans is mostly among gay
and bisexual men and this must be a focus of national efforts.
Steps to be taken: Allocate funds to geographic areas
consistent with epidemiology; use funds to target high-
risk populations: gay and bisexual men and transgenders,
Blacks, Latinos, and substance users.
infection using a combination of effective, evi-
dence-based approaches
Increase awareness of serostatus and link HIV-positive
people as quickly as possible to care and support services;
increase partner notification; increase prevention-for-posi-
tives services;
Focus on proven prevention strategies: abstinence; testing;
condoms; sterile needles; HIV treatment; and
Develop new prevention approaches, including biomedi-
cal approaches such as a vaccine; microbicides; Pre-Expo-
sure Prophylaxis (PrEP); testing and linkage to care and
treatment.
Steps to be taken: Design and evaluate innovative preven-
tion strategies and combination prevention approaches for
high-risk communities; expand access to prevention ser-
vices with the greatest potential for population-level rather
than individual level impact in high-risk groups, including
by federal, state and local governments; expand preven-
tion-with positives-programs.

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A Summary of the
National HIV/AIDS Strategy
july 2010

c. Educate all Americans about HIV and how to
prevent it
HIV has not found its way into the general public in appre-
ciable ways. However, many Americans are at risk for HIV
and many have inadequate information or mistaken beliefs
about how HIV is transmitted .
Steps to be taken: Utilize evidence-based social market-
ing to increase awareness of the ways in which HIV is and
is not transmitted; promote age-appropriate HIV and STI
prevention education for all Americans.

2. Increase Access to Care and Improve Health Outcomes for People with HIV

Goals: Increase the proportion of newly diagnosed patients
linked to care within three months of diagnosis from 65 to
85 percent; increase the proportion of Ryan White clients in
continuous care from 73 to 80 percent; increase the propor-
tion of permanently housed Ryan White clients from 82 to 86
percent and expand housing access to all needy people living
with HIV.
ers; care providers should ensure that all eligible HIV-
positive people have access to treatment and that they have
adherence support, per HHS treatment guidelines.
b. Take deliberate steps to increase the number and
diversity of available providers of clinical care
and related services for people with HIV

Steps to be taken: Develop strategies to encourage primary

Challenges to be addressed: One-third of HIV-positive
care, reproductive health, STI, mental heath and substance
people are not in regular care and treatment; the nation has an
abuse services providers to offer HIV services; engage
inadequate number of medical providers delivering HIV care;
clinical providers and medical societies to encourage the
people with HIV have major needs for housing, mental health
offering of routine, voluntary HIV testing and clinical care.
and substance abuse and other services to prepare them for
and support retention in care and treatment.
c. Support people living with HIV with co-occur-
ring health conditions and those who have chal-
Resources: National health care reform will assure coverage lenges meeting their basic needs, such as housing
for care and treatment for most people with HIV and AIDS
by 2014; the Ryan White program will have to remain in place People with HIV face a wide range of clinical issues and
and be reconfigured at the next reauthorization in 2013 to co-infections that must be addressed in addition to HIV;
support entry to and maintenance in care and treatment. to assure access to care, it is essential to reduce barriers
through ‘medical homes’ and other approaches to provid-
a. Establish a seamless system to immediately link ing comprehensive, co-located services; case management
people to continuous and coordinated quality and access to a broad array of social services support access
care when they are diagnosed with HIV
to and retention in care and treatment.


Immediate linkage to care and treatment of newly diag-
Steps to be taken: Federal and state agencies should sup-
nosed individuals, and efforts to re-engage people lost to
port case management and clinical services that improve
care, are essential.
health outcomes and increase access to supportive services
Steps to be taken: Target resources to establish linkage co-
such as housing, food, transportation, mental health and
ordinators in a range of settings where at-risk populations
substance abuse treatment; policies should be promoted to
receive health and social services; increase collaboration
increase access to housing and supportive services.
between HIV medical providers and social service provid-
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A Summary of the
National HIV/AIDS Strategy
3. Reduce HIV-Related Health Disparities
HIV exists in a health care system in which groups have vary-
ing access to services and achieve different health outcomes.
African Americans, Latinos, gay and bisexual men and sub-
stance users suffer disproportionately high burdens of HIV in-
fections and poorer health outcomes when infected with HIV.
Goals: Increase the proportion of HIV diagnosed gay and
bisexual men, Blacks and Latinos with undetectable viral load
by 20 percent.
c. Reduce stigma and discrimination against people
a. Reduce HIV-related mortality in communities at
high risk for HIV
Early initiation of HIV treatment and adherence support
improved health outcomes and enhance prevention.
Steps to be taken: Assure access to regular viral load and
CD4 testing for gay and bisexual men, African Americans
and Latinos.
b. Adopt community-level approaches to reduce
HIV infection in high-risk communities
Preventing HIV one case at a time will not meaningfully
impact the epidemic. Average viral load among all diag-
nosed people in a community is strongly correlated with
the number of new infections in that community; there-
fore, reducing community viral load is likely to be effective
in reducing the burden of new infections and disease in
heavily impacted communities. It is vital to address social
conditions such as poverty, homelessness, and substance
abuse in heavily impacted groups
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july 2010
Steps to be taken: Test community-level rather than
individual-level approaches to reduce risk of infection in
high prevalence communities; assure that high prevalence
localities are able to calculate and reduce community viral
load in high HIV incidence communities; promote a more
holistic approach to prevention among high-risk groups
that focuses on HIV and related co-morbidities, including
STDs and hepatitis B and C.
living with HIV
HIV related stigma and discrimination in American soci-
ety and among medical providers are significant barriers to
the willingness and ability of people at risk for and living
with HIV to access HIV testing, care and treatment.
Steps to be taken: Faith communities, businesses, schools,
community groups and media should affirm non-judg-
mental support for people living with and at risk for HIV;
people with HIV and AIDS should be supported to provide
visible and meaningful leadership in the fight against HIV/
AIDS; State legislatures should review and revise or elimi-
nate laws statutes that criminalize specific behaviors that
can transmit HIV and instead support public health ap-
proaches to preventing and treating HIV; Federal agencies
must enhance cooperation to facilitate enforcement of laws
that prohibit discrimination against people with HIV and
AIDS.
A Summary of the
National HIV/AIDS Strategy
4. Achieve a More Coordinated Response to the HIV Epidemic in the US
The Federal government spends $19.46 billion each year on
HIV/AIDS specific programs yet coordination and account-
ability of programs among Federal agencies, and between
Federal, State and local governments is insufficient. Federal
funds, particularly for prevention, do not necessarily go to
jurisdictions or communities where actual HIV cases and new
infections take place. HIV service providers receive funding
from multiple sources that are not well coordinated to have
maximum impact.
a. Increase the coordination of HIV programs
across the Federal government and between fed-
eral agencies and state, territorial, tribal and local
governments
Steps to be taken: Through the Office of the Deputy
Secretary of Health & Human Services, Federal agencies
should better coordinate planning of HIV programs and
services; the Federal government should review and revise
methods used to distribute Federal funds and ensure that
july 2010
resources go to States and localities with the greatest need;
the Federal government should simplify grant administra-
tion by standardizing data collection and grantee reporting
requirements and consolidating grant announcements.
b. Develop improved mechanisms to monitor and
report on progress toward achieving national
goals
Better efforts need to be made to measure whether pro-
grams and services are having impact. The efforts of the
Federal and State governments need to be better aligned.
Steps to be taken: Provide rigorous evaluation of current
programs and redirect resources to the most evidence-
based and cost effective efforts; report progress toward
achieving the goals of the Strategy on an annual basis;
encourage States to provide annual reports on progress
toward their HIV/AIDS plans.