July 13, 2010 -- The Obama administration on Tuesday committed itself to cutting the nation's stubborn HIV infection rate by 25% over the next five years.
The goal is part of a new national HIV and AIDS strategy released by the White House. It seeks to stem the spread of the virus and extend effective AIDS drugs to more of the estimated 1.1 million Americans living with the disease.
The strategy calls for an intensified effort to target HIV prevention to communities hardest hit by HIV. The vast majority of new infections are now in African-Americans, and officials suggested demographic shifts have been moving more quickly than public health efforts.
But the pledge to cut new infections faces big hurdles. About 56,000 Americans are newly infected with HIV each year, a figure that has barely budged in the last decade despite education, testing efforts, and marketing campaigns.
Officials acknowledged that the 25% goal is modest compared to past pledges to reduce infections by half or more. But they also point out that those efforts failed to put any meaningful dent in the new infection rate.
"I wish I could tell you that we could set a goal of 50%, 75%. I just don't see how we would realistically do that," says Jeff Crowley, director of the White House Office of National AIDS Policy.
The administration is "trying to be honest about what we think is achievable," he says.
The policy also pledges to expand access to AIDS medication. It says that 85% of newly infected patients should have access to medications within three months of their diagnosis either with HIV infection or with full-blown AIDS.
That goal faces significant obstacles as well. Cost aside, many people lack easy access to clinics or qualified caregivers who can administer medications. The strategy calls for new rules broadening the types of health care workers who would be allowed to provide HIV and AIDS care.
Budget squeezes have forced states to curtail their programs providing treatment to low-income AIDS patients. Last week, the National Alliance of State and Territorial AIDS Directors said that an estimated 2,200 people in a dozen states were going untreated on waiting lists because of budget shortfalls.
Health and Human Services Secretary Kathleen Sebelius announced Tuesday that the Obama administration would free up $25 million from existing funds to stem the shortfall until the end of the year.
Funding beyond that $25 million remains an open question in Washington. The White House plan does not spell out funding levels or urge Congress to increase spending on the domestic HIV/AIDS epidemic. That has many experts worried.
In a statement, Kevin Carmichael, MD, co-chair of Ryan White Medical Providers Coalition, says that funding for certain public AIDS clinics has grown 9% since 2001 "while the number of patients who rely on these clinics has increased 59%."
"For the sake of our patients, we hope adequate resources are dedicated to help achieve this important new initiative's goals, and welcome opportunities to support a robust implementation plan that ultimately will determine its success," Carmichael says.