Providing services that support the shifting national HIV strategy; United States of America

President Obama Signs Health Insurance Legislation into law (credit: Official White House Photo by Pete Souza)

With the adoption of a comprehensive HIV/AIDS strategy in July 2010, the Obama administration charted a clear, high-priority course for the United States in responding to the epidemic. But health officials and providers must still make continual adjustments to their HIV/AIDS programs in light of rapidly changing legal, regulatory, and scientific circumstances.

Broadly stated, the national strategy has three objectives: reduce new infections; increase access to care and improve health outcomes for people living with HIV; and reduce HIV-related health disparities. Most importantly, the plan sets targets for achieving those goals.

The same goals have been at the heart of JSI's HIV/AIDS work over a quarter century in collaboration with numerous federal agencies, state and local health departments, clinics, and community-based organizations that have responded to the epidemic. "JSI works closely with clients to provide innovative technical expertise that is cognizant of and responsive to the shifting priorities in the response to HIV," says Andrew Fullem, director of JSI's Center for HIV & AIDS. "We have a record as trusted partners."

The legal framework surrounding many HIV programs is changing as provisions of the Patient Protection and Affordable Care Act take effect. The law has far-reaching implications for many people living with HIV—as well as for the health organizations that serve them. Phased in over four years, starting in 2011, for example, are provisions that increase access to care for low- and middle-income people who are living with the disease but lack adequate health insurance coverage.

Further, changes in the Ryan White HIV/AIDS Program, which Congress has amended four times since 1996—most recently, in 2009—have added new legal requirements. Reconciliation of the Ryan White program and evolving Affordable Care Act specifications will pose further challenges.

A demanding new feature of the Ryan White program—which seeks to provide a safety net of drugs, medical care, and other kinds of support to people living with HIV—requires grantees to identify individuals with the disease who do not know they are infected. Jurisdictions receiving Ryan White funds must not only undertake new HIV testing initiatives but also ensure that infected persons are rapidly enrolled for treatment and maintained in care.

Meanwhile, scientific breakthroughs, such as recent research findings about the benefits of using HIV treatment drugs as a prevention strategy for those not infected, are pointing to new and more effective approaches to HIV prevention. The success of this approach may hinge on close coordination of prevention and treatment programs—another level of complexity to realize the benefits of emerging scientific discoveries.

Reducing New HIV Infections

The national HIV/AIDS strategy itself is also subject to changes in emphasis, if not in its broad goals. As refined by the Office of National AIDS Policy in Spring 2011, the strategy sharpens efforts to make new HIV infections "rare" in the United States. The focus will be on enhanced prevention among men who have sex with men (MSM), especially people of color and young men, groups that account for the majority of new infections in the U.S.

That's the focus of the capacity building assistance that JSI has been providing to community-based organizations around the country under a contract with the Centers for Disease Control and Prevention (CDC). Since 2005, JSI has worked with more than 50 government and community-based organizations that provide health services to populations at high risk of HIV infection, strengthening capacity in areas such as evidence-based programs and monitoring capability.

Strengthening Services

Under a recently-awarded CDC contract, JSI is evaluating the 12 Cities Projects, a key program of the U.S. Department of Health and Human Services (HHS) to intensify comprehensive HIV planning and cross-agency response in the nation's 12 areas that bear the greatest burden of the epidemic.

To promote a coordinated, timely response by government and community partners to developments in HIV policy and science, JSI manages the website and blog in concert with HHS. The site communicates the latest federal information about HIV prevention, testing, treatment, and care.

Increasing Access to Quality Services

In a project aimed at understanding the needs of people living with HIV in Boston and southern New Hampshire, JSI conducted a consumer survey for the Boston Public Health Commission (BPHC) and the Massachusetts Department of Public Health (MDPH). Likewise, a comprehensive quality assurance and continuous quality improvements plan, which JSI developed for the Massachusetts Department of Public Health, is helping to improve health care for people living with HIV. JSI has implemented the plan at publicly-funded HIV clinics around the state.

Reducing Disparities

To help reduce disparities in HIV care and prevention, JSI assisted the Colorado Department of Public Health and Environment by conducting focus group interviews to assess the needs of Hispanic and Latino MSM. Another study conducted for the Health Resources and Services Administration (HRSA) within HHS looked for ways to expand access to quality HIV care for another group disproportionately affected by the epidemic: women of color. JSI's report to HRSA, based on informant interviews and other research, led to the agency's funding of best-practices demonstration projects at selected sites.

"JSI's staff have been on the front lines of the epidemic since the 1980s," says Fullem. "Our broad range of real world experience enables us to offer unique, sophisticated HIV expertise."

For more information, contact Andrew Fullem