Fact Sheet

HHS' COMPREHENSIVE FIGHT AGAINST HIV/AIDS

BACKGROUND

The human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome, known as AIDS. This virus is passed from one person to another through sexual contact and blood-to-blood contact, including needle sharing. Pregnant women with HIV infection can pass the virus to their baby during pregnancy or delivery, as well as through breastfeeding.

HIV destroys certain kinds of blood cells -- CD4+ T cells (helper cells) -- that are crucial to the normal function of the human immune system. Most people infected with HIV carry the virus for years before enough damage is done to the immune system for AIDS to develop. During this period, infected people can spread the disease without knowing they are infected. Basic information on HIV/AIDS transmission and prevention is available at www.niaid.nih.gov/factsheets/hivinf.htm.

RESEARCH INTO HIV/AIDS

Coordinated efforts. The NIH's Office of AIDS Research (OAR) coordinates AIDS research efforts across NIH and each year develops a comprehensive AIDS research agenda and budget, including an International AIDS Research Strategic Plan. More information on the plan is available at www.nih.gov/od/oar.

Vaccine development. A key element of NIH's agenda is research to develop a safe, effective and affordable vaccine to prevent HIV infection, which currently does not exist. A preventive vaccine could save millions of lives worldwide. HHS' budget plan for fiscal year 2007 includes $607 million for vaccine research. In the past five years funding for AIDS vaccine research has doubled. More information is available at www.niaid.nih.gov/daids/vaccine.

Prevention Research. NIH and CDC support research to develop improved biomedical and behavioral strategies to prevent mother-to-child transmission of HIV and sexual transmission, including topical microbicides and management of other sexually transmitted infections; moderate behaviors such as drug and alcohol abuse and unsafe sex; and reduce the transmission of HIV through the use of antiretroviral therapies. More information may be found at www.nih.gov/od/oar, www.niaid.nih.gov/daids/prevention and www.cdc.gov/hiv/topics/research/index.htm#prevention.

Therapeutic Research. The development and evaluation of new drugs and therapeutic agent is also a critical aspect of the NIH research agenda. NIH-supported therapeutic research has helped define national and international guidelines for the treatment of primary HIV infection and associated opportunistic infections and co-infections, as well as prophylactic regimens for these secondary infections. Since the epidemic began, HHS' Food and Drug Administration (FDA) has approved 26 antiretroviral drugs to treat HIV infection. Antiretroviral drugs, used in combination drug therapy, have been a major factor in reducing the number of AIDS deaths from the mid-1990s to the present. More information is available at www.niaid.nih.gov/daids/therapeutics and www.fda.gov/oashi/aids/hiv.html.

Clinical trials. NIH conducts clinical trials of potential therapies, vaccines, microbicides and diagnostics on the NIH campus and through NIH-supported HIV/AIDS clinical trial networks. These trials have demonstrated the safety and efficacy of many AIDS-related treatment regimens, including both antiretroviral drugs and treatments for AIDS-related co-infections and malignancies. Currently, there are a variety of treatment and/or prevention (including vaccines) trials open to the public. For more about clinical trials, information can be found on the HHS-supported AIDSinfo website located at http://www.aidsinfo.nih.gov. The AIDS Clinical Trials Information Service Information Service, available to both clinicians and the public, and HIV treatment guidelines are also available on the AIDSinfo website.

PREVENTING THE SPREAD OF HIV/AIDS

Overcoming Domestic HIV/AIDS Challenges -- Testing those who do not know their status. The President's FY 2007 budget requests more than $90 million to facilitate the testing of more than 3 million additional Americans. Test kits would be distributed in areas of the country with the highest rates of newly discovered HIV cases and the highest suspected rates of undetected cases. Included in these amounts are approximately $20 million to facilitate the testing of more than 600,000 incarcerated persons and to offer assistance to states and localities in developing standards for routine testing of many more. And, since undiscovered cases are particularly high among injecting drug users, the initiative includes $20 million for testing of 500,000 drug users through drug treatment centers and healthcare professionals.

Prevention and education programs. Through CDC, HHS funds HIV prevention programs for high-risk populations in collaboration with 65 state and local health departments, 162 community based organizations, and 34 national and regional minority organizations. CDC also supports 73 state, territory and city education agencies to work with state health departments to implement HIV education in schools. See www.cdc.gov/healthyyouth/index.htm. In collaboration with CDC, a coalition of business, labor, faith, healthcare and civic/social organizations are working to reduce the spread of HIV/AIDS. See www.cdc.gov/hiv/dhap.htm. In addition, other HHS agencies run a wide array of education and awareness campaigns, including the Surgeon General's Leadership Campaign on AIDS (http://phs.os.dhhs.gov/aids/tlcapage1.html); the Maternal HIV Consumer Information Project (cms.hhs.gov/hiv) and the Minority HIV/AIDS Initiative (www.omhrc.gov/omh/aids/aidshome_new.htm). Through SAMHSA's role in regulating opioid treatment programs by program accreditation, providers are monitored on their effectiveness in counseling patients on HIV/AIDS, a mandated requirement. See www.dpt.samhsa.gov.

Promoting safety in the blood supply. FDA ensures the safety of the nation's blood supply by minimizing the risk of infectious disease transmission and other hazards. Preventing HIV from entering the blood supply is a key goal. For more information, see www.fda.gov/cber/blood.htm.

Monitoring the spread of HIV/AIDS. Since the epidemic was first identified in 1981, CDC has tracked the progression of HIV/AIDS, the behaviors that place people at risk, HIV-related knowledge and testing behaviors and now tracks HIV incidence. This information is gathered to provide communities with the information needed to plan prevention and care and treatment programs. More information on surveillance is available at www.cdc.gov/hiv/surveillance.htm.

National AIDS hotline. HHS operates a 24-hour toll-free national hotline, which provides anonymous, confidential HIV/AIDS information, including referrals to hospitals, clinics, testing and counseling sites, legal services, educational and support groups and service agencies. Information is provided in English and Spanish through 1-800-CDC-INFO (1-800-232-4636). More information is available at http://www.cdc.gov/hiv/hivinfo/nah.htm/.

HIV among healthcare workers. Though the risk is low, HHS works with state and local health departments, hospitals and professional organizations worldwide to prevent and manage accidental HIV infection in health care settings. CDC publishes guidelines for preventing HIV and other infectious diseases in health care settings and providing HIV post-exposure prophylaxis. HHS' Health Resources and Services Administration (HRSA) supports a Post-Exposure Prophylaxis hotline at 1-888-HIV-4911 for healthcare workers to call for advice after exposure to HIV by a "needle stick" or similar injury. For more information, visit www.ucsf.edu/hivcntr/.

PROVIDING HEALTH CARE AND SERVICES TO THOSE IN NEED

HHS agencies are dedicated to providing comprehensive HIV/AIDS treatment and services to all individuals in need. To ensure this process, the department has core programs in place to enhance access and improve the delivery of quality care. HIV treatment guidelines can be found at the HHS-supported site -- www.aidsinfo.nih.gov/.

Ryan White CARE Act. HRSA administers the Ryan White CARE Act, which provides HIV/AIDS primary health care, support services and medications for low-income people living with HIV/AIDS. The FY 2006 CARE Act appropriation of $2.1 billion helped 530,000 people with HIV/AIDS and family members. CARE Act funds are distributed to states and U.S. territories, community-based organizations, and large U.S. metropolitan areas hit hardest by the pandemic.

In FY 2006, 51 metropolitan areas in 22 states received $580 million in CARE Act funds to support care, treatment and support services for people living with HIV/AIDS. Also in FY 2006, all 50 states, the District of Columbia, and U.S. territories and associated jurisdictions shared almost $1.1 billion in CARE Act funds, including $790 million for life-saving medications through the AIDS Drug Assistance Program (ADAP). Additionally, more than 450 CARE Act grants support HIV early intervention services and services targeted to women, infants, youth and children. A small percentage of CARE Act funds is used to evaluate models of care, promote the replication of effective ones, and support innovative program design. The CARE Act also provides professional clinical training to improve the quality of health care and treatment services (see www.aids-ed.org).

In FY 2006, the CARE Act completed 15 years of providing HIV/AIDS care and services to the medically underserved. More information on the CARE Act is available at www.hab.hrsa.gov.

Medicaid and Medicare programs. HHS' Centers for Medicare & Medicaid Services (CMS) is the largest payer of care provided to persons living with HIV/AIDS in the U.S. Medicaid alone pays for more than half of the care given to HIV adults and for 90 percent of the care for children with HIV. The estimated total federal share of Medicaid spending on HIV/AIDS for fiscal year 2003 is $4.7 billion, with Medicare spending totaling $2.2 billion. The $6.9 billion estimated total for HIV/AIDS services in 2003 represents an increase of $650 million above the fiscal year 2002 budget. More information is available at www.cms.hhs.gov/hiv/.

Services for American Indians and Alaska Natives. HHS' Indian Health Service (IHS) helps to meet the health care needs of American Indians and Alaska Natives with HIV and AIDS through direct health services, services contracted by tribes and urban Indian health programs. See www.ihs.gov/MedicalPrograms/AIDS/.

Substance abuse and mental health services. HHS' Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources for HIV testing and counseling to states with high rates of AIDS cases and supports other programs focusing on the interface of substance abuse, mental health and HIV/AIDS. More and specific information is available at http://alt.samhsa.gov/grants/content/2002/spo2004_HIVplan.htm. In addition, SAMHSA's Center for Substance Abuse Treatment (CSAT) has three specific program initiatives that further support the fight against HIV and AIDS:

• SAMHSA's Targeted Capacity Expansion (TCE) - HIV/AIDS grants support projects to strengthen substance abuse treatment capacity and expand HIV-related services including treatment for sexually transmitted infections, tuberculosis and Hepatitis B and C in minority communities. In 2005, there were 143 TCE-HIV grants awarded by SAMHSA for a total of $66 million. Across these projects, targeted populations included African-American, Hispanic/Latino, Asian Pacific Islander, and other minority groups or communities, such as women, men who inject drugs, including men who have sex with men (MSM), as well as at-risk MSMs who do not inject drugs, and individuals who recently have been released from prison. Using a variety of therapeutic intervention services, grantees address past trauma and immediate crises associated with substance abuse, HIV/AIDS health disorders, and mental illness, as well as provide support for transition towards recovery.

• Through its Rapid HIV Testing Initiative (RHTI), which began in FY 2005, SAMHSA provides OraQuick ADVANCE Rapid HIV- 1/2 Antibody Tests and control kits at no cost to eligible service providers serving to targeted populations. To receive these free kits, eligible service providers must meet SAMHSA's readiness requirements, including compliance with all State specific policies and procedures on rapid HIV testing, certified proficiency in rapid HIV testing methodology, HIV counseling, adherence to State HIV testing regulatory requirements, and assurance of compliance with data collection. SAMHSA provides training and support to potentially eligible service providers, and since the start of the RHTI, approximately 300,000 Rapid HIV Test Kits have been distributed.

• SAMHSA's initiative on Substance Abuse and Infectious Disease: Cross-Training for Collaborative Systems of Prevention, Treatment, and Care provides training and technical assistance to State and local public health, mental health, criminal justice, and substance abuse health care delivery systems so that they can collaborate more effectively to serve individuals with concurrent substance abuse problems and/or infectious diseases such as HIV/AIDS, other sexually transmitted diseases (STDs) (e.g., gonorrhea or Chlamydia), viral hepatitis, and tuberculosis (TB). This workshop brings together training participants representing the following: substance abuse prevention and treatment programs; public health and sexually transmitted disease clinics; tuberculosis prevention and treatment programs; HIV/AIDS service organizations; mental health agencies; criminal justice systems; trainers from prevention, treatment, and other health systems; and consumers in recovery, affected and infected by these diseases.

INTERNATIONAL EFFORTS TO FIGHT HIV/AIDS

The Bush administration is committed to providing leadership in global efforts to reduce the spread of HIV and AIDS. It is estimated that more than 40 million people worldwide are living with HIV/AIDS. More than 70 percent of these people live in Sub-Saharan Africa; another 16 percent live in South and Southeast Asia.

Global AIDS initiatives. In fiscal year 2006, the United States committed approximately $3.3 billion to the President�s Emergency Plan for AIDS Relief (The Emergency Plan) President Bush has requested approximately $4 billion for fiscal year 2007, keeping the Emergency Plan on track to meet the President�s five-year, $15 billion commitment.

Building on a long history of HIV/AIDS work within the United States, HHS plays a key role in the Emergency Plan, through the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), and Substance Abuse and Mental Health Services Administration (SAMHSA), implementing prevention, care, and treatment programs in developing countries and conducting HIV/AIDS research. In addition, HHS field staff work with the country coordinating mechanisms of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to help foster strong Global Fund grants and programs, The CDC Global AIDS Program�s (GAP) staff, work in 24 countries (including the 15 focus countries), assist with surveillance, laboratory capacity building, training, monitoring, evaluation, and implementation of HIV/AIDS prevention, treatment, and care programs. With technical assistance from regional and headquarters offices, GAP partners with host governments, ministries of health, non-governmental organizations, international organizations, U.S.-based universities, and the private sector to help implement the Emergency Plan. GAP works with and is strengthened by its link to CDC�s other global health programs, such as global disease detection, public health training, and prevention and control of other infectious diseases such as malaria and tuberculosis, as well as with CDC�s domestic HIV/AIDS prevention programs in the United States.

NIH supports a comprehensive program of basic, clinical, and behavioral research on HIV infection and its associated opportunistic infections, coinfections, and malignancies. This research will lead to a better understanding of the basic biology of HIV, the development of effective therapies to treat it, and the design of better interventions to prevent new infections, including vaccines and microbicides. NIH supports an international research and training portfolio that encompasses more than 90 countries and is the lead federal agency for biomedical research on AIDS.

HRSA builds human capacity for scaling up care and treatment based on its more than 20 years of experience in providing quality comprehensive HIV/AIDS care to underserved communities. Strategies are implemented through activities such as twinning, training and technical assistance, rapid roll-out of antiretroviral drugs, mentoring for nursing leadership, and enhancement of the continuum of palliative care.

FDA manages an expedited review process to ensure that OGAC can buy safe and effective antiretroviral drugs for the Emergency Plan at the lowest possible prices. FDA�s medical reviewers, scientists, and inspectors are uniquely qualified to do this work.

SAMHSA works domestically through domestic State and community programs to treat addiction and dependence, to prevent substance abuse, and to provide mental health services, including support of an educational and training center network that disseminates state-of-the-art information and best practices. This technical expertise and program experience is being applied to the program areas of drug and alcohol abuse in the Emergency Plan.

The Office of Global Health Affairs in the Office of the Secretary coordinates all of the HHS agencies to be sure all of the Department�s resources are working effectively and efficiently under the leadership of the Coordinator.

HHS Global AIDS Budget. HHS' fiscal year 2007 budget proposes $222 million for NIH and approximately $122 million for the Global AIDS Program at CDC to promote prevention strategies and programs in 25 countries, see www.cdc.gov/gap. In addition, HHS intends to contribute $100 million to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, which, coupled with $100 million from the U.S. Agency for International Development, Department of State, will complete the $500 million pledged by the U.S.

ADDRESSING HIV/AIDS AMONG MINORITIES

HIV and AIDS have a disproportionately large impact on racial and ethnic minorities, with African-Americans and Hispanics accounting for more than half of the nation's AIDS cases although they represent only about 27 percent of the population.

Ryan White Comprehensive AIDS Resources Emergency (CARE) Act: The HHS fiscal year 2006 budget for the Ryan White programs is $2.1 billion and includes special programs to reduce the disproportionate impact of HIV/AIDS in minority communities. These programs build on the department's core mission to protect and improve the health of vulnerable populations. Administered by the Health Resources and Services Administration, the Ryan White programs address the unmet health needs of persons living with HIV disease by funding primary health care and support services that enhance access to and retention in care. The 2006 Ryan White appropriation of $2.1 billion helped provide services primarily to racial and ethnic minorities through local community health centers. For more information, visit www.samhsa.gov.

Substance Abuse (SA), HIV, & Hepatitis Prevention: SAMHSA's Substance Abuse (SA), HIV, & Hepatitis Prevention for Minority Populations and Minority Reentry Populations in Communities of Color Initiative supports grantees in building a solid foundation for delivering and sustaining effective substance abuse prevention and related services. The program aims to engage community-level domestic public and private non-profit entities to prevent and reduce the onset of SA, and transmission of HIV and hepatitis among minority populations and minority reentry populations in communities of color disproportionately affected these diseases. This initiative funded 81 grants for $20.6 million in fiscal year 2005. For more information, visit www.samhsa.gov.

The Leadership Campaign on AIDS: The Office of HIV/AIDS Policy created The Leadership Campaign on AIDS (OHAP/TLCA) in 1999 as part of the Minority HIV/AIDS Initiative. OHAP/TLCA supports external and internal partners by offering technical assistance for organizational development, resource development, communications and media outreach, website development, graphic design, logistical support, program development, and evaluation support. Pursuing an innovative outreach strategy, OHAP/TLCA works with civic, public health, and faith leaders who have not previously been involved in the fight against HIV/AIDS to educate, motivate, and mobilize leaders in minority communities across America to get involved in the fight against HIV/AIDS. For more information, visit http://www.osophs.dhhs.gov/aids/tlcapage1.html.

HHS Intra-agency Initiatives: The HHS Minority HIV/AIDS initiative, funded at a level of $398.7 million in fiscal year 2005, has doubled since it was first developed in 1999. The initiative includes $52.4 million in fiscal 2005 to fund new projects at the National Institutes of Health, the HHS Office of Minority Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Office of HIV/AIDS Policy and other agencies through the Minority HIV/AIDS Initiative Fund. One multi-agency collaboration supported by the fund and led by the Office of Minority Health seeks to assist the U.S. associated Pacific Island jurisdictions in building a Pacific Health Resource Center, foster the growth of community based organizations, assist local government in organizing prevention campaigns and supporting the development of educational materials on AIDS as well as associated diseases such as tuberculosis. www.omhrc.gov.

HHS commitment. HHS' fiscal year 2003 budget includes $410 million for efforts targeted specifically at reducing the disproportionate impact of HIV/AIDS on racial and ethnic minorities. This includes $105 million for SAMHSA for expanded treatment and services in affected communities, as well as $124 million under the Ryan White program, and $116 million for community-based prevention activities at the CDC. NIH's fiscal year 2003 budget includes $536 million for research on AIDS in minority populations.

Health Disparities Initiative. In addition, addressing the impact of HIV and AIDS are a key element of HHS' broader efforts to eliminate health disparities -- including Healthy People 2010 (www.health.gov/healthypeople/), an HHS-led effort to set the nation's health goals for each decade and then measure progress toward achieving them. More information about these efforts is available at HHS' Office of Minority Health Web site at www.omhrc.gov.

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Last Revised: December 14, 2006

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