PACHA Meeting Examines Women and HIV, Other Issues at Winter Meeting

At the end of last month, the Presidential Advisory Council on HIV/AIDS (PACHA) convened for its first meeting of 2012. It was my privilege to lead that meeting, my first as PACHA’s new chairperson. Our agenda was a very full one and the discussions thoughtful, rich, and informative. As we embarked on our work, we were all mindful of and inspired by the President's historic commitment to end the HIV/AIDS epidemic, which he made on World AIDS Day 2011—just several weeks before we met. This Administration's commitment to that goal informed and fueled all of our discussions during our two-day meeting. Here are a few highlights:

We were especially pleased to hear from three key leaders from the Administration:

• Dr. Howard Koh, Assistant Secretary for Health, reflected on the many significant advances of the past year, including new HIV research findings, budget realignment, implementation of more provisions of the Affordable Care Act, and launch of the Viral Hepatitis Action Plan which serves as an important complement to HIV/AIDS prevention, care and treatment efforts. He urged the Council to be thoughtful in our efforts to identify ways to leverage these advances.

• Health and Human Services Secretary Kathleen Sebelius thanked the members of PACHA for their thoughtful ideas and active engagement, noting that the impact of their efforts is evident in many of the advances of the past year. She shared that progress on the National HIV/AIDS Strategy will be an opportunity to “turn up the volume” on the national conversation about HIV/AIDS, reminding Americans of its continued impact here in the U.S., and the need to sustain and strengthen efforts to bring the epidemic to an end. Finally, the Secretary reiterated the important role PACHA will play in ending the epidemic in the U.S. through their advice about programs and policies that will ensure more people living with HIV are diagnosed, linked to and maintained in high quality HIV care and treatment.

• Cecilia Muñoz, the President’s Domestic Policy Advisor and the Director of the Domestic Policy Council, also addressed the PACHA. “Its important to reflect on how far we’ve come, but this fight isn’t over for families, communities, or this President,” Ms. Muñoz observed. She shared that as the mother of daughters she was especially pleased that the PACHA was focusing on issues of women and HIV/AIDS at this meeting. The White House, she announced, would be continuing this examination in March with a symposium complementing the observance of National Women and Girls HIV/AIDS Awareness Day.

Examining Women and HIV

The PACHA spent most of the first day of our two-day meeting listening to experts on dimensions of women and HIV. Researchers, providers, and advocates shared perspectives on unique risks for HIV among women as well as distinct care and treatment issues. The presenters and the members of PACHA who organized the session all sought to ensure that the nation’s HIV systems, services and policies work for everyone, including women. Several speakers underscored the principle that ensuring that the unique needs of women are addressed need not become a question of “either women, or some other population,” but a case of “both women, and other populations.” Among the themes that emerged during the daylong discussion were the importance of:

• Focusing on the social determinants of HIV vulnerability for women;
• Studying further the intersection of childhood and adult sexual violence as a risk factor for HIV infection in both women and men;
• Understanding the impact of geographic hot spots of HIV on the likelihood of HIV infection among women;
• Incorporating HIV prevention and care into reproductive health care for women;
• Supporting efforts to sustain and continue the reductions in mother-to-child transmission;
• Strengthening efforts to study and improve care for women with HIV as they age; and
• Identifying effective models for connecting and retaining women in care, which may include family-centered or gender-specific approaches.

Other Topics Discussed

• HOPWA Modernization—Mr. David Voss of the U.S. Department of Housing and Urban Development discussed plans for modernizing the Housing Opportunities for People with AIDS (HOPWA) program. Noting that the current formula for distributing HOPWA funds does not reflect the current nature of the epidemic, Mr. Vos explained that HUD is working on an updated formula based on the number of people living with HIV and adjusted for an area’s fair market rent and poverty rates. This will result in better focusing HOPWA resources on the areas with the most need.
• Expansion of Behavioral Health Services Under the Affordable Care Act—The PACHA also heard from SAMHSA representatives about activities underway to ready states and the behavioral health field for the approximately 11 million currently uninsured individuals with mental health and substance abuse conditions who will become eligible for care in 2014 under the Affordable Care Act (ACA), either under Medicaid expansion or through the insurance exchanges. This expansion of behavioral health services will have significant potential for improving treatment for persons living with HIV who also have mental illness or substance abuse issues. Members of PACHA were interested in seeing a similar analysis of the number and characteristics of people living with HIV/AIDS whose eligibility for healthcare will change with implementation of the ACA.

After hearing these and other presentations the members of the PACHA and I were left with much to consider. I urged the Council to be thoughtful and specific in our work, pressing them to be the PACHA that fully embraces the vision of the National HIV/AIDS Strategy to bring AIDS to an end in America. I acknowledged that there may not always be enough information or resources; but, it is up to the Council—and all working in the HIV/AIDS field—to make the best possible use of everything that is now available, targeting it for the best possible impact for people at risk for and living with HIV.