Public Policy Priorities for the 111th Congress and the New Administration
July 1, 2009—amfAR has identified a number of critical policy and legislative priorities that must be addressed in the 111th Congress and by the new president’s administration. These priorities create a framework for a comprehensive domestic and global response to HIV/AIDS and must be adequately funded in all relevant federal agencies—including the U.S. Departments of Health and Human Services, State, Defense, Veterans Affairs, and the U.S. Agency for International Development (USAID).
TABLE OF CONTENTS
Advancing Domestic Priorities
National AIDS Strategy
While the U.S. has made significant gains in the fight against global AIDS with the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR), progress in eradicating the epidemic within the U.S. has slowed. A recent report from the Centers for Disease Control and Prevention (CDC) estimated that the number of new HIV infections in 2006 was 40 percent higher than previously estimated. Moreover, HIV incidence has remained at the same level for the past decade.
amfAR advocates the development of a comprehensive and coordinated national AIDS strategy—an evidence-based domestic emergency plan—and urges the new political leadership to:
- Establish and implement a national AIDS strategy and move AIDS to the forefront of the national health agenda;
- Create a federal coordinating committee with representatives from all executive branch agencies to identify clear priorities for action and implementation strategies;
- Involve key stakeholders including government, scientists, business, community and civil rights organizations, faith-based groups, and persons living with AIDS;
- Set prevention and treatment targets and require annual reporting on progress, paralleling the PEPFAR requirement for these outcome measures; and
- Increase access to quality, affordable healthcare for all Americans so that people living with HIV/AIDS may receive treatment and care services.
Harm Reduction Programs
An estimated one to two million Americans inject illegal drugs and those infected through injection drug use accounted for 19 percent of all people living with HIV and 12 percent of new HIV infections in 2006. Evidence shows that access to sterile syringes through syringe exchange programs reduces the risk of transmission of HIV and other blood-borne diseases among injection drug users (IDUs). amfAR supports syringe exchange programs and related harm reduction services and will continue to advocate the removal of the ban on federal funding for these programs as well as their expansion, both domestically and globally.
Ryan White HIV/AIDS Treatment Modernization Act (RWCA) of 2006
amfAR advocates extending authorization of the RWCA, which will continue to provide critical access to lifesaving treatment and care for more than half a million low-income Americans with HIV/AIDS. RWCA is one of the largest sources of federal funds for primary healthcare and support services for people living with AIDS.
Early Treatment for HIV Act (ETHA)
amfAR advocates the passage of ETHA, which would expand Medicaid coverage to larger numbers of low-income, HIV-positive Americans.
Ending the Travel and Immigration Ban for HIV-Positive People
amfAR worked successfully with Congress to eliminate HIV/AIDS from the list of communicable diseases that prevent people from entering the U.S. as visitors or immigrants. The Foundation will continue to provide leadership to ensure that the U.S. Department of Health and Human Services removes the ban completely.
Promoting Comprehensive Sex Education
amfAR supports comprehensive sex education that is science-based and age-appropriate. Research has demonstrated that in general comprehensive sex education is more effective at reducing high-risk behavior than abstinence-only programs.
[BACK TO TOP]
Investing in Research
amfAR advocates increased funding across the federal agencies for research on the causes, treatment, and prevention of HIV/AIDS. Investing in medical and health-related research offers both immediate and long-term benefits, serving as an immediate stimulus to the economy as well as an investment in America’s future leadership in healthcare, life sciences, and biotechnology. Funding for medical research also creates jobs across the nation while building the infrastructure for higher education.
The National Institutes of Health (NIH) is the principal federal agency charged with the conduct and support of biomedical and behavioral research. The NIH budget doubled from 1998 to 2003, rising from $13 to $27 billion. From 2003 until recently, however, the agency has been flat funded; when adjusted for inflation, the total budget in 2008, $29.47 billion, represents an 18 percent decrease in funding from the previous four years. As a result, fewer applicants to the NIH are receiving research grants, a situation that has negatively affected the recruitment and careers of the next generation of scientists. Currently, only 20 percent of grant applications to NIH are funded; the overall acceptance rate for a first grant submission is 10 percent. The NIH budget would need to increase 67 percent over the next three years to compensate for funding decreases over the past four years.
The NIH Office of AIDS Research is located within the Office of the NIH Director and coordinates AIDS research and budgetary and policy elements of the NIH research program. For FY2008, $2.9 billion was allocated for AIDS-related activities across all NIH institutes and centers. This figure was approximately 10 percent of the agency’s total budget for the fiscal year. Increasing the NIH’s research budget is one of amfAR’s top priorities.
In February 2009, the American Recovery and Reinvestment Act of 2009 (HR1) was passed by Congress and signed into law by President Obama. This bill includes a critical provision that allocates $10 billion to the NIH. amfAR played an important role in ensuring the inclusion of this provision in the act. The stimulus package funds represent an important 17.2 percent annual increase in the NIH budget through 2010 and will be used to support research, infrastructure development, and job creation over this two-year period. The NIH also received $400 million from the act for comparative effectiveness research to strengthen the knowledge base about which treatments work for various conditions. However, these new monies do not represent permanent increases to the agency’s budget. amfAR will advocate a continuation of significant funding increases for NIH and other federal agencies supporting AIDS research in the years ahead.
[BACK TO TOP]
Advocating the Power of Prevention
amfAR advocates a comprehensive and integrated approach to preventing the further spread of HIV infection. Discovering new preventive interventions and determining novel ways to implement existing strategies effectively are important amfAR priorities. Controlling HIV globally requires the discovery and development of a safe and effective HIV vaccine, and amfAR supports innovative efforts to achieve this goal.
No single strategy, however, will end the AIDS epidemic. Basic and applied biomedical and behavioral programs must include targeted research and interventions to help communities most at risk for HIV. The need exists for more intensive counseling and testing efforts; education on the use of cervical barriers and male circumcision, where appropriate; support for the development of safe and effective topical microbicides; expansion of harm reduction programs; and chemoprophylaxis interventions, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). In addition, amfAR supports international efforts to prevent mother-to-child transmission.
The CDC is the primary federal agency that supports domestic HIV prevention programs. The CDC also supports research, surveillance, and epidemiological studies. While the CDC will spend $872 million on HIV/AIDS activities in FY2008, HIV prevention still represents the smallest portion of the domestic HIV/AIDS budget—four percent—and the CDC’s Division of HIV/AIDS Prevention budget has been cut by $20 million over the past several years. When adjusted for inflation, overall domestic spending on HIV/AIDS prevention has decreased by 19 percent since 2002. In September 2008, in its Professional Judgment Budget to Congress, the CDC reported that an additional $877 million in FY2009 and an additional $4.8 billion over the next five years were needed to increase the impact of HIV prevention programs and to provide effective leadership in our country’s response to the HIV/AIDS epidemic.
The American Reinvestment and Recovery Act provides $1 billion for the Prevention and Wellness Fund, $600 million of which will be used to support and implement evidence-based clinical and community-based prevention and wellness strategies. It is expected that a portion of the Prevention and Wellness Fund will be allocated to HIV/AIDS screening and prevention, and amfAR will work towards this goal.
[BACK TO TOP]
Targeting Interventions to Vulnerable Population Groups
Men Who Have Sex with Men (MSM)
HIV prevalence among MSM varies widely by country and region of the world—from an estimated 1.2 percent in Eastern Europe to 16.1 percent in Latin America. In 2006, MSM accounted for the majority (53 percent) of the 56,300 new HIV infections in the U.S., with an increasing prevalence in African-American and Hispanic men. amfAR advocates both domestic and international prevention efforts to address the multiple factors that increase risk for HIV among MSM, and promotes targeted prevention and treatment programs to stem the increasing rates of HIV infection in this population.
Communities of Color
In 2006, 45 percent of new infections in the U.S were in African Americans. The incidence rate that year was seven times higher in African Americans than in Caucasians, and three times higher in Hispanics. In Washington D.C., at least three percent of residents are living with HIV/AIDS, a total that far surpasses the one percent threshold that constitutes a “generalized and severe” epidemic. Through its support for efforts such as the Minority AIDS Initiative, amfAR advocates increased attention and funding to address the social, structural, and economic factors that contribute to such health disparities. It also advocates the provision of culturally appropriate prevention messages and equal access to lifesaving treatment and care.
Women and HIV/AIDS
The increased vulnerability of women and girls to HIV/AIDS results from a combination of biological, sociological, economic, and political factors that make women more susceptible than men to viral transmission, more isolated from prevention and care services, and more vulnerable to injustice and human rights violations. In the U.S., the proportion of women living with HIV has more than tripled since the epidemic began. According to 2006 data, 27 percent of new diagnoses in the U.S. were in women, compared with 8 percent in 1985. Worldwide, in 2007, 46 percent of people living with HIV/AIDS—about 15.4 million—were women. amfAR is working to advance a research and policy agenda to address HIV/AIDS among women both domestically and globally.
[BACK TO TOP]
Supporting Global Initiatives
amfAR supports the expansion of the federal government’s global AIDS agenda, and advocates appropriate levels of funding for programs such as PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. U.S. assistance for global prevention, treatment, and care programs helps to decrease the number of new infections, improve access to necessary treatments for those living with HIV, and increase the economic stability of countries severely affected by HIV/AIDS.
Through PEPFAR, antiretroviral therapy has been provided to 2.1 million people in 15 focus countries, and many more millions have received prevention and care services. However, in the next five-year phase of the U.S. global AIDS program, taking effect in 2009, a number of concerns with the current program must be addressed and resolved, including:
- Developing targeted prevention, treatment, and care programs for MSM, IDUs, and other vulnerable populations;
- Integrating HIV/AIDS services more fully into sexual and reproductive health programs;
- Overturning the ban on federal funding for syringe exchange programs;
- Modifying program language about abstinence and fidelity, which, as currently worded, limits effective implementation of comprehensive sex education programs;
- Abolishing the requirement that the number of persons being treated for HIV/AIDS be linked to PEPFAR’s annual financial support, which encourages treatment at the expense of prevention and care; and
- Strengthening healthcare systems to build sustainable infrastructure in these nations.
AIDS is a pandemic that must be at the top of our nation’s health agenda. amfAR will work closely with the new administration and Congress to develop and implement sound, evidence-based public policies to fight HIV/AIDS domestically and internationally, and will continue to advocate funding increases for innovative federal research, prevention, treatment, and education initiatives.
To download a pdf of the compete document, click here.
[BACK TO TOP]