HHS's Comprehensive Fight Against HIV/AIDS
Overview: In the United States, more than 440,000 people have died as a result of AIDS since the epidemic began in 1981. HHS' Centers for Disease Control and Prevention (CDC) estimates that nationwide there are 850,000 to 950,000 people currently living with HIV -- one-fourth of whom do not know that they are infected. An estimated 40,000 more people become infected each year. African-Americans and Latinos are disproportionately affected by HIV/AIDS, representing an estimated 70 percent of new HIV infections. Gay and bisexual men also continue to have high rates of infection nationally.
Significant progress has been made in the first two decades of the HIV/AIDS epidemic. By the early 1990s, infections in the U.S. had been reduced from a high of roughly 150,000 per year to an estimated 40,000 per year. In the mid 1990s, AIDS-related deaths began to decline significantly as effective combination drug therapies became available. Also, mother-to-child HIV transmission has fallen sharply from 2,500 infections in 1992, to an estimated 300 to 400 infections annually in recent years.
HHS continues to support a vigorous, broad-based public health response to HIV/AIDS that includes extensive research, prevention initiatives, and efforts to expand access to quality health care and services for those who need them. HHS also is working to address the disproportionate impact of HIV/AIDS among racial and ethnic minority populations in the United States and to fight the epidemic on a global scale. President Bush's fiscal year 2003 budget plan includes a total of $12.9 billion to address HIV and AIDS at home and abroad -- an increase of $906 million, or 8 percent, above the current year's appropriation.
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 a certain kind 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 http://www.niaid.nih.gov/factsheets/hivinf.htm.
Research Into HIV/AIDS
HHS' National Institutes of Health (NIH) provide the largest and most significant public investment in AIDS research in the world and support cutting-edge research into HIV and AIDS, including vaccine development, drug therapies, and prevention measures. HHS' fiscal year 2002 budget includes $2.5 billion for NIH research on HIV and 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. More information on the plan is available at http://www.nih.gov/od/oar.
Vaccine development. A key element of NIH's agenda is research to develop an effective vaccine. HHS' budget plan for fiscal year 2002 includes $340 million for AIDS vaccine research. More information is available at http://www.niaid.nih.gov/daids/vaccine.
Clinical trials. NIH provides information about ongoing AIDS clinical trials and treatment to healthcare providers and the public through the AIDS Clinical Trials Information Service at http://www.actis.org/.
Effective drugs. Since the epidemic began, HHS' Food and Drug Administration (FDA) has approved 19 antiretroviral drugs for use in combination therapy for the treatment of HIV/AIDS. The growing number of HIV drugs, used in combination, is considered a major factor in reducing the number of AIDS deaths during the mid- to late-1990s. NIH funded substantial research that helped develop many of these drugs. More information is available at http://www.fda.gov/oashi/aids/hiv.html.
Preventing the Spread of HIV/AIDS
HIV infection is preventable, yet an estimated 40,000 people living in the U.S. are infected each year. CDC will devote $939 million this fiscal year to support HIV prevention programs, including efforts to reduce the number of people at high risk for acquiring or transmitting the virus; expand voluntary HIV counseling and testing; link infected individuals to appropriate care and treatment; and strengthen the nation's ability to monitor the epidemic and respond effectively. Key aspects of HHS' overall prevention efforts include:
HIV Prevention Strategic Plan Through 2005. In 2001, CDC's National Center for HIV, STD and TB Prevention released its strategic plan for protecting the nation's health against HIV infection. The plan's overarching national goal is to reduce the number of new HIV infections in the U.S. from an estimated 40,000 to 20,000 per year by 2005, with a particular focus on eliminating racial and ethnic disparities in new HIV infections. See http://www.cdc.gov/hiv/dhap.htm.
Prevention and education campaigns. Through CDC, HHS funds HIV prevention programs for high-risk populations in collaboration with 65 state and local health departments, 22 national and regional minority organizations, 10 national business, labor, and faith partnerships, and 94 community-based organizations. See http://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://www.surgeongeneral.gov/aids/tlcapage1.html); the Maternal HIV Consumer Information Project (http://www.hcfa.gov/hiv/); and the Minority HIV/AIDS Initiative (http://www.omhrc.gov/omh/aids/aidshome_new.htm)
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 http://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 AIDS, behaviors that place people at risk and HIV-related knowledge and testing behaviors. This information is designed to provide communities the most complete and timely information possible about ongoing and emerging trends. More information on surveillance is available at http://www.cdc.gov/hiv/surveillance.htm
HIV among healthcare workers. While the risk of occupational HIV transmission is low, HHS works with state and local health departments, hospitals, and professional organizations worldwide to prevent and control HIV infections in hospitals and other health care settings. For more information, visit http://www.cdc.gov/hiv/dhap.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 (1-800-342-AIDS) and Spanish (1-800-344-7432). More information is available at http://www.cdc.gov/hiv/hivinfo/nah.htm.
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.
Ryan White CARE Act Program. The Ryan White CARE program provides HIV/AIDS primary health care treatment and support services for low-income individuals, including programs specifically designed to provide medications that fight HIV. Program funds go to eligible metropolitan areas hit hardest by the epidemic, states and U.S. territories, and community-based organizations with demonstrated need. The Ryan White CARE Act also provides professional clinical training nationwide to improve the quality of health care and treatment services. (See http://www.aids-ed.org.) Administered by HHS' Health Resources and Services Administration (HRSA), it is one of the largesst federal programs providing treatment aimed at a single disease. HHS' fiscal year 2002 budget for Ryan White provides $1.9 billion to provide care and services to an estimated 500,000 Americans. More information on Ryan White programs is available at http://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 AIDS in the U.S. Medicaid alone pays for more than 50 percent of care to persons with AIDS, and provides care to 90 percent of children with AIDS. 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 http://www.hcfa.gov/medicaid/obs11.htm.
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 http://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. Overall, SAMHSA's fiscal year 2002 budget provides an estimated $168.9 million for HIV/AIDS programs and services. More information is available at http://www.samhsa.gov/.
International Efforts to Fight HIV/AIDS
The Bush administration is committed to helping lead 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.
Supporting multilateral global AIDS efforts. President Bush has now committed $500 million over three years to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. See http://www.hhs.gov/news/press/2002pres/20020128.html.
Global AIDS initiatives. HHS this fiscal year will dedicate $144 million for the Global AIDS Program at CDC to promote prevention strategies and programs in 25 countries. For more information, see http://www.cdc.gov/nchstp/od/gap. To address the increasing urgency of the global AIDS pandemic, NIH's Office of AIDS Research established the Global AIDS Initiative and released the first strategic plan for international AIDS research in December 2000. The plan is updated annually. See http://www.nih.gov/od/oar.
Addressing HIV/AIDS Among Minorities
HIV and AIDS have a disproportionately large impact on racial and ethnic minorities, with blacks and Hispanics accounting for more than half of the nation's AIDS cases although they represent only about 21 percent of the population.
HHS Commitment. HHS' fiscal year 2002 budget includes $412 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, $116 million for community-based prevention activities at the CDC, and other resources at the NIH and other HHS offices and agencies.
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 (http://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 http://www.omhrc.gov.
Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.