Treatment Action Group (TAG) has been working on high-level advocacy efforts in order to push the government to revitalize action on NHAS goals. TAG has coordinated dialogue amongst HIV/AIDS policy makers, experts, researchers, service providers and community activists, synthesizing lessons into their ‘Revitalizing the U.S. National HIV/AIDS Strategy’ 2013 Report and Action Plan. Key recommendations were outlined, which include the need to scale up evidence-based strategies and practices, maximize engagement in care and treatment outcomes, and facilitate tighter collaboration between various federal agencies.
Thirty years into the HIV/AIDS epidemic, an artillery of scientific knowledge and medical strategies have been developed in which to mount a fight against the HIV epidemic. But an array of social, political, behavioral and cultural factors still pose significant barriers to making this potential a reality.
Approximately 1.2 million people are living with HIV in the U.S. Prevalence and new infection rates are disproportionately higher in communities facing extreme marginalization and discrimination, men who have sex with men (MSM), commercial sex workers (CSWs), and people who use drugs (PUDs). Entrenched inequities also remain and are divided along race and gender lines. In the US, whereas black men and women represent approximately 14 percent of the population, they accounted for almost half of all new HIV infections in 2010.
Racism, homophobia, poverty, violence, trauma and criminalization are some of the structural factors that continue to drive the HIV epidemic and affect access to prevention, care and treatment services. In the US, one in five people are unaware of having been infected, and only 40 percent are engaged in continuous care. Moreover, only one in four people living with HIV is being successfully treated with antiretroviral medications and maintaining undetectable viral loads, meaning one’s health is potentially endangered and one can transmit the virus to others.
In order to mount a worthy fight, political commitment, a supportive policy environment, adequate funding, multi-sectoral dialogues, effective service delivery mechanisms and empowered communities are vital.
The US National HIV/AIDS Strategy 2010 -2015, that has been fully supported by the White House, is a stated commitment towards reducing the number of HIV infections in key affected populations (KAPs), increasing access to care and improving health outcomes for PLHIV, and reducing HIV related health disparities through the use of community level approaches.
Vision for the National HIV/AIDS Strategy:
The United States 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 circumstances, will have unfettered access to high quality, life extending care, free from stigma and discrimination’
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Many of the targets however are not likely to be met under the current pace.
Gaps not addressed in the roadmap include a funding shortfall, estimated at 15.2 billion as well as a need for state level action. TAG also recommends the need for priority allocation of resources, so that they can be directed to where they are most needed, demographically as well as geographically. HIV infection rates in the South continue to rise, particularly in states such as Mississippi and Florida where existing resources are stretched to breaking points.
There is also strong need to apply ‘implementation science’, which is a ‘bottom-up’ approach to research. It is primarily concerned with evaluating and translating interventions that have proven effective in clinical trials and other studies, taking into consideration the complex and shifting dynamics of real world settings.
Underlying these recommendations is the critical need for involvement of people and communities directly affected by HIV. Community mobilization and activism remains essential in the fight against HIV, both in terms of achieving and surpassing the goals of NHAS, and for ensuring that accurate data and information from the community are fed into decision-making bodies. The opinions, experiences and voices of PLHIV and KAPs need to be strengthened, validated and prioritized within HIV agenda setting, and in devising sustainable and local solutions that are impactful, realistic, and relevant.
Due to advocacy efforts, President Obama issued an Executive Order in July 2013, establishing the HIV Care Continuum Initiative which integrates many of the key recommendations outlined by TAG. A collaborative and cross-sectoral working group was established, with a mandate to focus on improving health care delivery, identify research gaps, and obtain input from affected communities.
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