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July 10, 2002 Contact: HHS Press Office
(202) 690-6343

HHS' COMPREHENSIVE FIGHT AGAINST HIV/AIDS


Overview: In the United States, more than 460,000 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 over 70 percent of new HIV infections. Gay and bisexual men continue to have high rates of infection nationally, but nearly a third of new HIV infections are now in women. Minority women make up more than 80 percent of that increase.

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 $16 billion to address HIV and AIDS at home and abroad -- a $1 billion increase, seven percent more than this year's appropriation. In the President's plan, HHS would receive $12.9 billion, up seven percent from 2002.

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

HHS' National Institutes of Health (NIH) provides the largest and most significant public investment in AIDS research in the world and supports cutting-edge research into HIV and AIDS, including basic science, vaccine development, discovery and development of drug therapies and prevention interventions. HHS' fiscal year 2003 budget includes $2.8 billion for NIH research on HIV/AIDS, a 10 percent increase over the previous year.

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 and test an effective vaccine. HHS' budget plan for fiscal year 2003 includes $422 million for AIDS vaccine research. In the past five years funding for AIDS vaccine research has tripled. More information is available at www.niaid.nih.gov/daids/vaccine.

Prevention Research. NIH supports research to develop improved biomedical and behavioral strategies to prevent: mother-to-child transmission of HIV; sexual transmission, including topical microbicides and management of other sexually transmitted diseases and risk related to drug and alcohol use. More information may be found at www.nih.gov/od/oar.

Clinical trials. NIH conducts clinical trials of potential therapies, vaccines, microbicides and diagnostics. 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. The AIDS Clinical Trials Information Service Information Service is available to both clinicians and the public at www.aidsinfo.nih.gov/. HIV treatment guidelines can be found at the HHS-supported site -- www.aidsinfo.nih.gov/.

Effective drugs. Since the epidemic began, HHS' Food and Drug Administration (FDA) has approved 47 drugs for the treatment of HIV/AIDS. This includes 19 antiretroviral drugs for use singly or in combination therapy for HIV/AIDS. Combination drug therapy is a major factor in reducing the number of AIDS deaths from the mid-1990s to the present. More information is available at 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. The 2003 budget includes $939 million for the CDC 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 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 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 ( www.surgeongeneral.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).

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. This information is gathered to provide communities with the most complete and timely information possible about ongoing and emerging trends. 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 (1-800-342-AIDS) and Spanish (1-800-344-7432). More information is available at www.ashastd.org/nah/.

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. 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 Program. HRSA administers the Ryan White CARE Act which provides HIV/AIDS primary health care treatment and support services for low-income individuals, including programs specifically designed to provide medications that fight HIV. Ryan White funds go to eligible metropolitan areas hit hardest by the epidemic, to states and U.S. territories, and to community-based organizations with demonstrated need. HHS' fiscal year 2003 budget for Ryan White proposes $1.9 billion to provide care and services to an estimated 500,000 Americans. More information is available at www.hab.hrsa.gov/. The Ryan White CARE Act also provides professional clinical training nationwide to improve the quality of health care and treatment services. See www.aids-ed.org.

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 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. Overall, SAMHSA's fiscal year 2003 budget provides an estimated $169 million for HIV/AIDS programs and services. More information is available at www.samhsa.gov/.

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. President Bush proposed $1.1 billion in global HIV/AIDS assistance in fiscal year 2003 -- a 13 percent increase over 2002. More recently, President Bush has proposed an additional $500 million for the International Mother and Child HIV Prevention Initiative aimed at reducing mother-to-child HIV transmission by 40 percent within five years in 12 African countries and the Caribbean region.

HHS Global AIDS Budget. HHS' fiscal year 2003 budget proposes $222 million for NIH and $11 million for CDC research on HIV/AIDS conducted at international sites, and $144 million for the Global AIDS Program at CDC to promote prevention strategies and programs in 25 countries, see www.cdc.gov/nchstp/od/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 21 percent of the population.

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: June 19, 2003