NHAS Implementation Recommendations

This email is from the Executive Director of NMAC and not a co-chair of Federal AIDS Policy Partnership (FAPP). Below is a letter to Dr. Howard Koh, the Assistant Secretary for Health, providing recommendations on the implementation of the National HIV/AIDS Strategy (NHAS). The letter is from FAPP and its affiliated working groups (see the letter at the end of my email). I particularly like the sentence “we urge the Administration to reach toward a bold initiative that goes beyond current investments – both financial and programmatic – and seeks systemic change.”

Some of you may not know about FAPP, we are a Washington, DC based coalition that coordinates federal policy strategies between organizations who have a presence on Capitol Hill. I am sharing information on FAPP with NMAC’s constituents in hopes that you can develop something similar at your city or state. We operate on an opt-in/opt-out process. We have 7 working groups:

1. AIDS budget and Appropriations Coalition (ABAC)
2. Global AIDS Roundtable (GAR)
3. HIV Healthcare Access Working Group
4. HIV Prevention Action Committee (HPAC)
5. Housing Working Group
6. Research Working Group
7. Ryan White Working Group

Most of the heavy lifting for FAPP happens in the Working Groups (WG). You may not know the individuals in these groups, but they are the ones who fight for more funding and better policies on Capitol Hill and with the Administration. They are not the only ones who fight for us, but I have to tell you, they are among the best. If you are interested in participating in one of the working groups, please email pkawata@nmac.org and we will make the connection.

In addition to the letter to Dr. Koh, some of the WG also made specific implementation recommendations. These are longer documents that I’ve put on a web page for you to download.

1. Care ( http://tinyurl.com/2buvthy)
2. Housing ( http://tinyurl.com/2dkchwp)
3. Prevention ( http://tinyurl.com/242np5s)
4. Research ( http://tinyurl.com/25qu7f4)

I have the privilege of being one of 3 co-chairs for the FAPP. The other co-chairs are Laura Hanen (NASTAD) and William Smith (NCSD). My work in FAPP is a symbol of my commitment to the legacy of Gene Copello (AIDS Institue). Gene was the driving force that made FAPP real, he was also my friend.

I recently asked you to tell me your policy priorities, an overwhelming number selected Fixing AIDS Drug Assistance Program (ADAP) as the first priority. Please see the results of this survey:

1. Fixing ADAP—484
2. HIV Cure-373
3. Test & Treat--360
4. HIV Prevention Targeting Women--312
5. HIV Prevention Targeting Gay--311
6. Medical Infrastructure--307
7. HIV Prevention Media Campaign--298
8. Housing—282
9. NHAS--229
10. Research—202
11. Global HIV Treatment—196
12. HIV Prevention Targeting Trans Community--179
13. HIV Prevention Targeting Drug Users—177
14. Vaccines--173
15. Global Fund-159
16. Global HIV Prevention—151
17. Microbicides—139
18. Prep—102

It was a small sample and probably not statistically significant; however, I do think the results are interesting. What do you think of the results?

If we are going to raise the money necessary to implement the NHAS and to fully fund ADAP we need strong city and state coalitions in at least 30 states. For these coalitions to work, they must be organized by people in that city or state. You don’t want Washington telling you what to do. The AIDS Foundation of Chicago is part of a strong state and national coalitions covering Chicago, Illinois and federal policy making. Contact them to help build your coalition. Register for AIDS advocacy updates at http://www.doseofchange.org or contact Jim Merrell (Jmerrell@aidschicago.og) or David Munar (dmunar@aidschicago.org). We can’t do it for you, this is something that you need to organize or re-organize. The DOSE of CHANGE website is a resource to expand local and national AIDS advocacy efforts.

Keep me informed of the policy work you are doing. I will forward your information to FAPP members. Washington needs to understand the realities of working on the frontlines. We also need to know who to contact when we need pressure from the field. This is particularly true in some key Congressional Districts. Far too often, members tell us they are not hearing from their constituency. So why should they care?

Email me at pkawata@nmac.org Tell me your stories. I know you are tired, I know that we ask too much of you, but without your pressure, I am concerned about our ability to raise the money necessary to implement the NHAS and fully fund ADAP. As they say in High School Musical, “We Are All In This Together!”

---Paul Kawata

Letter from the FAPP
October 15, 2010

Howard Koh, MD, MPH
Assistant Secretary for Health
Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201

Dear Assistant Secretary Koh,

The Federal AIDS Policy Partnership (FAPP) and its affiliated working groups would like to commend the Administration for its leadership in developing and setting forth the National HIV/AIDS Strategy (NHAS). President Obama’s leadership has been laudable and we hope he will stay at the visible forefront of this effort going forward.

As a community of organizations working to further federal policy and to secure sufficient resources to support HIV/AIDS prevention, treatment, and care, we believe the NHAS represents an important step forward. As federal agencies develop operational plans, we urge the Administration to reach toward a bold initiative that goes beyond current investments – both financial and programmatic – and seeks systemic change. Greater coordination of efforts across agencies is certainly needed, but it alone will not lead us to a reduction in new incidence.

To this end, the affiliated working groups of FAPP have each developed their own priorities for what ought to be operationalized as the NHAS moves forward. You will find each group’s plans under this cover. In brief:

• On prevention, it is clear that a 25% reduction in new infections will not be achieved without a greater focus on those populations most disproportionately impacted by infection. Prevention efforts must be targeted and driven by the epidemiological data.
• On care, while healthcare reform holds out hope to address many issues related to care, a planned focus on ensuring that those living with HIV/AIDS have access to Medicaid or high-risk insurance pools must occur before 2014 to ensure continuity of coverage and care. Also, we must continue to view the Ryan White program as a key safety net program for those who need it – even after 2014. Finally, the ADAP crisis is fundamentally a crisis of resources that continues to deny too many people access to life sustaining drugs. It requires a permanent solution.
• On housing, we need a comprehensive solution to ensure that those living with or are affected by HIV/AIDS have high-quality housing. Housing is essential to maintaining treatment adherence, keeping people in care, and remains a proven structural intervention.
• On research, we need implementation research to evaluate and test programs and their effectiveness in achieving the goals of the NHAS. Additional research is necessary to develop and improve interventions to engage the populations prioritized for HIV prevention and improved access to care under the NHAS.
  

Each of these areas is expanded upon in the following pages. We also, however, reiterate broad community consensus that successful implementation and ongoing leadership for the success of the NHAS must be accompanied by a scale up in financial resources. It is not acceptable to ask agencies what they can do with existing resources to meet the NHAS goals and objectives. Instead, what must be asked is what agencies need in terms of resources to meet the goals and objectives of the NHAS. Without additional financial resources, the goals and objectives of the NHAS will not be achievable.

The community of groups within FAPP, its affiliated working groups, including people living with HIV/AIDS, are partners with you in achieving the Strategy’s goals. Consequently, we look forward to seeing the agency operational plans and working with you to develop appropriate and complimentary roles for national, state and local groups.

Finally, accountability must be a key factor in achieving the goals and objectives of the NHAS and a regular process to ensure accountability of all agencies’ commitments in operational plans must be systemized.

Again, we want to thank you for your continuing commitment to combat HIV/AIDS in this country and we look forward to working with you to ensure the vision of the National HIV/AIDS Strategy is achieved.

Sincerely,

Members of the FAPP Convening Group
Nancy Bernstine, NAHC, Housing Working Group Co-Chair and Liaison
Christopher Brown, Chicago Department of Health
Guillermo Chacon, LCOA
Chris Collins, amfAR
Donna Crews, AIDS Action, AIDS Budget and Appropriations Coalition (ABAC) Co-Chair and Liaison
Julie Davids, CHAMP
Kevin Fisher, AVAC, Research Working Group Liaison
Laura Hanen, NASTAD, FAPP Co-Chair and HIV Healthcare Access Working Group Co-Chair
Kathie Hiers, AIDS Alabama, FAPP Treasurer
Ernest Hopkins, SFAF
Paul Kawata, NMAC, FAPP Co-Chair
Naina Khanna, WORLD and U.S. Positive Women's Network
Matthew Lesieur, VillageCare and NAPWA
Kali Lindsey, Harlem United, Housing Working Group Co-Chair
William McColl, AIDS Action, Ryan White Working Group Co-Chair and Liaison
Jennifer Redner, Good Works Group, Global AIDS Roundtable Liaison
Carl Schmid, The AIDS Institute, HIV Prevention Action Committee (HPAC) Co-Chair and Liaison
William (Bill) Smith, NCSD, FAPP Co-Chair
Rona Taylor, The Ms. Foundation
Ed Tepporn, APIAHF, FAPP Secretary

Additional Co Chairs of FAPP Affiliated Working Groups
Lola Adele-Oso, NAHC, Housing Working Group Co-Chair
Robert Greenwald, TAEP, HIV Healthcare Access Working Group Co-Chair
Coco Jervis, TAG, Research Working Group Co-Chair
Ann Lefert, NASTAD, Ryan White Working Group Co-Chair
Suzanne Miller, National Coalition of STD Directors (NCSD), HPAC Co-Chair
Jen Yakush, SIECUS, HPAC and ABAC Co-Chair

cc:

• Ronald Valdiserri, Deputy Assistant Secretary for Health HHS National HIV/AIDS Strategy Implementation Group
• David Vos, HUD HOPWA