In a welcome advance toward ending the HIV epidemic, the Biden administration’s newly inclusive National HIV/AIDS Strategy (NHAS), announced December 1 on World AIDS Day, prioritizes many of the at-risk populations GMHC serves.
After major setbacks under the former administration, the White House Office of National AIDS Policy (ONAP) has also engaged GMHC and other HIV community stakeholders in shaping policies, said Jason Cianciotto, GMHC’s Vice President for Communications and Policy.
Critically, he said, the populations that the plan prioritizes “track with the some of the highest risk populations we serve: men who have sex with men of color, women of color, trans women, youth, and people who inject drugs.”
The NHAS also prioritizes people aging with HIV, he added—an essential update because people over age 50 already make up over half of those living with HIV.
“It’s an affirmation of the populations that GMHC has been working with for decades—and the services and programs we prioritize as critical to ending the epidemic,” Cianciotto said. “It’s taken the federal government a while to catch up.”
Cianciotto was able to provide feedback to ONAP to ensure priority populations and their needs for HIV prevention and treatment are integrated in funding and implementation, because GMHC is part of AIDS United’s Public Policy Committee, a national coalition of HIV and AIDS services organizations.
That is a welcome change. The former administration quickly disbanded ONAP in early 2017. While it later embraced a federal End the Epidemic initiative with a 2030 target, many of its policies undermined that plan.
By contrast, President Joe Biden’s administration revived ONAP and appointed Harold Phillips, a gay, Black, openly HIV-positive man, as its director last June. Phillips is a public health veteran from the Department of Health and Human Services.
Integrated approach
Significantly, ONAP is providing strategic guidance for support and funding across multiple federal agencies. As an example, Cianciotto said, the NHAS now directs the federal Administration on Aging to provide training on issues affecting people aging with HIV to both its program staff and the community agencies it funds. That will expand competency in meeting this growing population’s needs beyond GMHC and the other HIV/AIDS service agencies who have led the way.
The updated NHAS is also taking a comprehensive approach to HIV treatment and prevention, Cianciotto added. The Department of Housing and Urban Development (HUD), for instance, currently provides supportive housing for low-income people living with HIV through its Housing Opportunities for Persons With AIDS program (HOPWA). Could HUD expand into stable housing initiatives for populations at high risk for HIV?
“How can the housing that HUD manages address homeless youth of color living with or at high risk for HIV?” he asked, adding that this population makes up over 40% of homeless youth in New York City. GMHC has served LGBTQ youth of color in New York’s House and Ball community, including those who are homeless, since the early 1990s.
As part of its prioritization of youth ages 13 to 24, Cianciotto added, the NHAS for the first time is focusing on youth who age out of foster care—also a population under age 25 at high risk for HIV. Could HUD expand supportive housing to them?
And what could HUD do with the housing funding it manages for the elderly “that aligns with new NHAS goals to support people aging with HIV?” Cianciotto asked. “These are broader ways of thinking about how to weave HIV treatment and prevention across government agencies and their programs, instead of taking a siloed approach.”
The strategy also focuses on sex workers as a priority at-risk population. “Given how hostile the federal government has been to sex workers, this is a sea change,” Cianciotto said. “Our sociopolitical culture is such that people who engage in sex work are forced underground, which leads to a higher risk for HIV and criminalization.”
While ONAP’s 98-page strategy provides a detailed policy blueprint, Cianciotto emphasized that “the work ahead is to ensure there is comprehensive implementation and oversight.”
PrEP access
An important part of that work is expanding access to PrEP (pre-exposure prophylaxis) for HIV prevention. “We have a hodgepodge of state policies for PrEP access, so leadership and direction is needed from the federal government,” Cianciotto said.
“Those who need PrEP the most, including Black and Latinx men who have sex with men, as well as Black women, are the least able to afford it,” he said, adding that GMHC and other HIV community organizations are “strongly advocating for new dedicated funding streams to get PrEP to the communities hardest-hit by HIV risk.”
States like New York accept Medicaid expansion funds, which is important since Medicaid covers 40% of people on PrEP prescriptions. New York also covers HIV lab and medical visit costs. But other states, particularly those in the South, do not.
In a positive sign, the federal government implemented a new Affordable Care Act rule last September that requires most insurers to pay for PrEP—a law already in place in New York.
“But if you live in a state that doesn’t support, or is even hostile to, people living with HIV, then you do not have what you need to stay healthy and help end the HIV epidemic,” Cianciotto said
Top Image: A large red ribbon hangs in the North Portico of the White House to commemorate World AIDS Day, December 1, 2021. Reuters/Kevin Lamarque
