The Office of HIV Planning is a member of the Federal AIDS Policy Partnership (FAPP), a coalition of organizations from all over the country that advocate for people living with HIV and the organizations that serve them. You can learn more about FAPP and how to become a member organization here. Individuals living with HIV are also encouraged to join.  The group meets about four times a year, our last meeting was on February 12th. At that meeting we had some informative discussions with Dr. Jonathan Mermin, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC) and Dr. Laura Cheever, Associate Administrator for HRSA's HIV/AIDS Bureau.  We also discussed updates on implementation of the Affordable Care Act (ACA) and the reauthorization fo the Ryan White Program.

Dr. Mermin's presentation is well worth your time to review (slides here). He shared information on HIV prevention funding, national progress on the National HIV/AIDS Strategy (NHAS), and how the CDC is addressing HIV prevention in terms of the care continuum.  A few things really stuck with me. When talking about new HIV cases, Dr. Mermin mentioned that although incidence has been stable over all, there have been increases in the number of new HIV cases for men who have sex with men and young men who have sex with men, 12% and 22%, respectively. The CDC and it's partners are focusing on High Impact Prevention, as the future of HIV prevention. The keys to High Impact Prevention are aligning HIV prevention resources to the geographical areas and populations most affected by HIV, using cost-effective and evidence-based methods, maximizing the number of people living with HIV/AIDS with a suppressed viral load, and using data monitoring, dissemination and feedback to improve outcomes for organizations and jurisdictions.The CDC is also working closely with HRSA to align as much of the HIV care and prevention activities as possible; including community planning, data reporting, and policies.

A major topic of discussion with Dr. Cheever was the future of the Ryan White program, in the era of health reform (ACA). Much of the conversation was informed by the discussion  at the Ryan White Working Group meeting (the day before). That discussion focused mostly on when and how to advocate for the reauthorization of the law, and what it might include. Consensus from that discussion was it would be best for the community to wait until 2015 to push for reauthorization because so much is still unknown about how Ryan White programs will work in the context of expanded health coverage and other reforms of the ACA. The community of Ryan White providers and consumers need to collect stories of the successes of the program from the local levels: who is served, how their lives are improved, and what benefits and outcomes do we see on an aggregate level. There was also consensus that the next version of the Ryan White law will be transformative, in other words, it will include a lot of changes to how the program works, what services are provided and who is eligible.

Dr. Cheever also recommended that we need to focus our efforts to help people start and stay in HIV care. The local communities need to provide qualitative data (stories) about how and why people get lost and also linked to care. These qualitative data can work with the quantitative data (surveillance, program data) to develop effective plans for our HIV care systems, including Ryan White. Local communities, like the Philadelphia EMA, should focus on those who need the most help accessing and maintaining care and provide the supports they need. Those supports might include housing, mental health treatment, substance abuse treatment, child care, transportation or social support. The Ryan White program has the ability to meet these needs, but we have to direct resources to where they are most needed. We need to adapt the Ryan White system to work with the larger health care systems, not apart from them.

If I come away from these two meetings with any theme, it's "adapt or perish". We all need to become knowledgeable about the ACA and other changes in the science and policy world of HIV/AIDS. We have, as always, to do more with less. So we have to be informed, proactive, and deliberate.