February 2011 
Table of Contents 

Executive Summary................................................................................................................ iii 

Section 1: Background ............................................................................................................ 1 

Section 2: HHS Planning Process............................................................................................ 4 

Section 3: HHS HIV/AIDS Funding.......................................................................................... 7 

3.1: OVERVIEW.....................................................................................................................................................I

3.2: HIV/AIDS ACTIVITIES ............................................................................................................................... 8 

3.3: DEMOGRAPHIC FACTORS ........................................................................................................................10 

3.4: GEOGRAPHICAL AREA..................................................................................................................................I

3.5: FUNDING SUMMARY................................................................................................................................16 

Section 4: Bringing Programs to Scale in 12 High-Burden MSAs ...................................... 18 

4.1: PHASE ONE: PLANNING...........................................................................................................................19 

4.2: PHASE TWO: IMPLEMENTATION..............................................................................................................21 

Section 5: Key HHS Actions to Achieve the Goals of the NHAS.......................................... 25 

5.1: REDUCE NEW HIV INFECTIONS...............................................................................................................25 

5.2: INCREASE ACCESS TO CARE AND IMPROVE HEALTH OUTCOMES ............................................................30 

5.3: REDUCE HIV-RELATED DISPARITIES AND HEALTH INEQUITIES .............................................................35 

Section 6: Critical Change Issues.......................................................................................... 40 

Section 7: Unmet Needs and Knowledge Gaps...................................................................... 42 

Appendix 1: HHS NHAS Implementation Group...................................................................... 

Appendix 2: HHS Agency/Office Status Report .......................................................................

Appendix 3: Glossary of Acronyms ........................................................................................... 

 i 
Executive Summary 

Inspired and informed by the President’s National HIV/AIDS Strategy (NHAS), the U.S. Department of 

Health and Human Services’ (HHS) National HIV/AIDS Strategy Operational Plan is the result of a 4-

month, cross-departmental, collaborative effort on the part of all HHS agencies and offices to build on, 

better coordinate, and refocus our existing HIV/AIDS efforts. Prepared at the request of the President, 

the HHS Operational Plan reflects ongoing efforts to align existing activities with the NHAS and initiate 

new activities in support of Strategy goals: reducing new HIV infections; increasing access to care and 

improving health outcomes for people living with HIV; and reducing HIV-related disparities and health 

inequities. The Department-wide planning process that produced this Operational Plan will continue 

in the months ahead, requiring, as we move forward, heightened coordination within and beyond 

HHS. We will continue to assess progress and, in consultation with the Office of National AIDS Policy 

(ONAP) and other partners and stakeholders, work together to develop a refreshed plan for 2012. 

To develop the Operational Plan, HHS undertook a planning process that solicited input from within 

and outside the Department via a number of channels. A cross-agency working group, facilitated by 

the Assistant Secretary for Health (ASH) and the Deputy Assistant Secretary for Health, Infectious 

Diseases, convened multiple times and was responsible for developing the plan. Members of the 

working group were informed by significant external input received in writing, online, and through 

meetings with the community and the Presidential Advisory Council on HIV/AIDS. 

The HHS Operational Plan provides a detailed summary of the Department’s current level of domestic 

HIV/AIDS spending. This summary provides important baseline data against which to gauge unmet 

need and to assess any future resource realignment. 

A significant component of the HHS Operational Plan is the “HHS 12 Cities Project,” an effort to 

accelerate comprehensive HIV/AIDS planning and cross-agency response in the 12 U.S. jurisdictions 

hit hard by HIV/AIDS. The demonstration project embodies many of the overarching principles of the 

NHAS: innovate, concentrate resources where the epidemic is most severe, coordinate federal 

resources and actions across categorical program lines, and scale up effective HIV prevention, 

care, and treatment strategies. The project, under the direction of the Office of the ASH (OASH), 

actively engages HHS agencies, including the Centers for Disease Control and Prevention, the Centers 

for Medicare and Medicaid Services, the Health Resources and Services Administration, the Indian 

Health Service, the National Institutes of Health, the Substance Abuse and Mental Health Services 

Administration, and other HHS components in a collective effort to leverage departmental resources 

and assets. 

The remainder of the plan outlines key HHS actions that are underway—or planned for the near term 

(subject to the availability of resources)—to work towards achieving the goals of the NHAS. This 

outline does not detail every HIV/AIDS activity taking place within HHS, or even provide exhaustive 

detail on the priority activities highlighted. Rather, the Operational Plan emphasizes key action steps 

 iii 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

 iv 

that are integral to achieving the goals of the NHAS. These actions are organized by the three 

fundamental goals of the NHAS and indicate which agency or office has been designated the lead for 

this activity. In most instances, other partners from all sectors of society will be involved in carrying out 

these actions. The activities detailed are consistent with those tasked to HHS by the NHAS Federal 

Implementation Plan. 

Recognizing several cross-cutting critical change issues, the HHS Operational Plan identifies actions to 

help facilitate successful implementation of the Plan and realization of the Strategy’s goals. The Plan 

also explores some unmet needs and knowledge gaps that HHS will work to address as planning, 

implementation, and evaluation of activities continue in tandem. 

The U.S. Department of Health and Human Services is committed to working with federal, state, local 

and tribal governmental partners, nongovernmental organizations, communities, people living with 

HIV/AIDS, the private sector, and all sectors of society to realize the vision of the National HIV/AIDS 

Strategy: 

The United States will become a place where new HIV infections are rare and when they do 

occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender 

identity or socio-economic circumstance will have unfettered access to high-quality, life 

extending care, free from stigma and discrimination. 
Section 1: Background 

On July 13, 2010, the White House released the National HIV/AIDS Strategy (NHAS) for the United 

States, with an accompanying Federal Implementation Plan. The vision of the NHAS calls for the 

United States to “become a place where new HIV infections are rare and when they do occur, every 

person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socioeconomic circumstance will have unfettered access to high-quality, life extending care, free from 

stigma and discrimination.” 

The U.S. Department of Health and Human Services (HHS), along with five other “lead federal 

agencies” (i.e., the Departments of Justice, Labor, Housing and Urban Development, and Veterans 

Affairs, and the Social Security Administration), were called upon to develop and submit operational 

plans to the Office of National AIDS Policy (ONAP) and the Office of Management and Budget (OMB) 

“within 150 days” of the Strategy’s release date and the issuance of a Presidential Memorandum for 

the heads of Executive departments and agencies. The Memorandum directed that the operational 

plans include “appropriate actions to advance the Strategy,” as well as “steps to strengthen 

coordination in planning, budgeting for, and evaluating domestic HIV/AIDS programs within and 

across agencies.” 

 1 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

 2 
Section 2: HHS Planning Process 

Input into the HHS Operational Plan came from three major sources: a formally constituted, HHS crossdepartment working group (see Appendix 1, attached); detailed budget and program information 

provided online by each of the HHS agency and staff offices; and extensive community input received 

in writing, online (via AIDS.gov), and at various conferences and other venues in 2011 including the 

International AIDS Conference in Vienna, Austria (July 18-23); a meeting of women leaders hosted by 

the HHS Office on Women’s Health (September 10); the U.S. Conference on AIDS (September 13-16); 

two national Web conferences hosted by the Coalition for a National HIV/AIDS Strategy (September 2 & 

7); a meeting of the Presidential Advisory Council on HIV/AIDS (PACHA, September 30-October 1); and a 

community check-in meeting hosted by the Office of the Assistant Secretary for Health (October 13). 

On July 20, 2010, Secretary Sebelius sent an email to the heads of HHS Operating Divisions and Staff 

Divisions asking each to name a representative to a working group to be responsible for overseeing 

the development of the HHS Operational Plan. This NHAS Implementation Group met initially on 

August 18, 2010, at which time participants reviewed the requirements for the Plan, explored various 

format options, reviewed the timetable for completing the Plan, and discussed options for an 

innovative cross-HHS project. To further refine the template and reporting structures for the HHS 

Operational Plan, a smaller subset of the HHS NHAS Implementation Group held several 

teleconferences prior to the second meeting of the entire group, on September 27, 2010. During that 

meeting, group members were briefed on a revised format for collecting information online from HHS 

agencies and staff offices and were given an overview of the proposed cross-agency project. The final 

meeting of the HHS NHAS Implementation Group, a planning retreat, was held on October 21-22, 

2010. This meeting enabled HHS agencies and staff offices to highlight their priorities for achieving 

the goals of the NHAS, identify constraints, and obtain direct feedback from colleagues in other 

agencies and offices. 

 

The HHS Operational Plan is organized in sections. Background and a description of the planning process are 

found in Sections 1 and 2. Section 3 contains a detailed description of the current level of domestic HIV/AIDS 

funding within HHS. An innovative demonstration project (“HHS 12 Cities Project”) that embodies the 

principles of the NHAS is outlined in Section 4. Section 5 reports on key HHS actions that are underway or 

planned for the near term; these are organized by the three major goals of the NHAS. The HHS Operational 

Plan concludes with a listing of planned actions to support cross-governmental change (Section 6) and 

recognition of unmet needs and knowledge gaps (Section 7). 

 4 
EXECUTIVE SUMMARY 

 5 
Section 3: HHS HIV/AIDS Funding 

3.1: Overview 

An important element of the HHS 

Operational Plan is a detailed understanding 

of the current level of domestic HIV/AIDS 

funding within HHS. This section will 

summarize HHS' HIV/AIDS funding estimates

for fiscal year (FY) 2010 (actual expenditures 

are not available at the time of this report), as 

reported by HHS Operating and Staff 

Divisions. The details provided in Sections 3.2, 

3.3, and 3.4 are based on estimates provided 

by those Operating and Staff Divisions. 

Although the precision of these estimates 

may vary, arraying funding resources in this manner provides important baseline data against which 

to gauge unmet need and to assess any future resource realignment. Please note that all numbers 

have been reported to the nearest million. Also note the NIH funding depicted in Figure 1a does not 

include approximately $454,000,000 in international HIV/AIDS research. 

Figure 1a. HHS FY 2010 HIV/AIDS Funding by Agency/Office: 

Discretionary and Entitlement, $15,900,000,000 (in millions) 

The HHS FY 2010 HIV/AIDS 

funding estimates, including 

discretionary and entitlement 

funding, total approximately 

$15,900,000,000 (Figure 1a). Most 

of this funding (77%) is associated 

with HIV/AIDS care and treatment 

services as follows: 62% through 

the Centers for Medicare and 

Medicaid Services (CMS, 32% to 

Medicare and 30% to Medicaid) 

and 15% through the Health 

Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program. The National Institutes of 

Health (NIH) received 17% of the budget for HIV/AIDS-related research activities (described later). The 

remaining ~6% of the HHS FY 2010 HIV/AIDS budget went to: the Centers for Disease Control and 

Prevention (CDC, 5%); the Substance Abuse and Mental Health Services Administration (SAMHSA, 1%); the 

Food and Drug Administration (FDA, <1%); and others (<1% combined for the Indian Health Service (IHS), 

the Agency for Healthcare Research and Quality (AHRQ), the Office of the Secretary (OS) offices including 

the Offices of Civil Rights (OCR), HIV/AIDS Policy (OHAP), Minority Health (OMH), Population Affairs (OPA), 

Figure 1b. HHS FY 2010 HIV/AIDS Funding: Discretionary Type within 

Agency/ Office, $6,553,000,000

 7 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

Women’s Health (OWH), and the Regional Health Administrators (RHA)). Included in the OS funding is the 

$53,900,000 Secretary’s Minority AIDS Initiative (MAI) funding, which is competitively distributed to OS 

offices (60%) and HHS agencies (40%). Approximately one-third ($62,000,000) of the SAMHSA HIV/AIDS 

budget comes from the Substance Abuse Block Grant set-aside. 

HHS FY 2010 HIV/AIDS discretionary spending ($6,553,000,000) is shown in Figure 1b. Please note this 

amount includes an additional $454,000,000 in NIH funding (not shown in Figure 1a) to support 

international HIV/AIDS research, which directly benefits domestic efforts. The recently released iPrEX study 

(pre-exposure prophylaxis for high-risk men who have sex with men) is an excellent example of this point. 

Figure 1b presents discretionary funding by three categories: intramural/organizational (i.e., administrative), 

intramural/research, and extramural; the vast majority of discretionary funding supports extramural efforts. 

Except for FDA, which reports that 78% of its HIV/AIDS budget supports intramural/administrative activities, 

the reported percentage of intramural/administrative spending ranged from 0-11%. 

3.2: HIV/AIDS Activities 

Looking at HHS discretionary funding (i.e., excluding intramural/organizational funding, hereafter 

referred to as “discretionary extramural funding”) for HIV/AIDS ($6,332,000,000) by activity (Figures 2af), we note that overall activities tend to parallel the mission of the agencies (Figure 2a): 47% to 

research and dissemination (largely NIH), 27% for HIV medical/health care services (largely HRSA), and 

7% for prevention and education (largely CDC). Six percent (6%) of extramural discretionary funding 

supports capacity building and technical assistance, and 1% each for surveillance and HIV testing. 

Figures 2b, 2c, and 2d depict, respectively, CDC, HRSA, and SAMHSA’s discretionary funding by activity 

type. Over half (58%) of CDC’s funding supports prevention and education, three-quarters (76%) of 

HRSA’s funding supports HIV medical and health care services and over one third (35%) of SAMHSA’s 

budget derives from the Block Grant Set-Aside. 

Figure 2b. CDC FY 2010 HIV/AIDS Discretionary Funding 

(Extramural and Intramural Research) by Activity Type, 

$705,000,000

Figure 2a. HHS FY 2010 HIV/AIDS Funding: Discretionary 

Extramural by Activity Type, $6,332,000,000

 8 
HHS HIV/AIDS FUNDING 

 

Figure 2c. HRSA FY 2010 HIV/AIDS Discretionary Funding 

(Extramural and Intramural Research) by Activity Type, 

$2,220,000,000

Figure 2d. SAMHSA FY 2010 HIV/AIDS Discretionary 

Funding (Extramural) by Activity Type, $177,800,000

Figure 2e. NIH FY 2010 HIV/AIDS Funding (Intramural & 

Extramural) by Research Type, $3,086,000,000 

Figure 2f. FDA FY 2010 HHS HIV/AIDS Funding by Activity 

Type, $109,000,000 

 9 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

Further breakdown of the NIH domestic and international intramural and extramural research funding 

($2,631,000,000 domestic and $454,000,000 international; see Figure 2e) shows that prevention 

research, including microbicides (4%), vaccine development (18%) behavioral and social science (14%) 

and treatment as prevention (3%) account for 39% of NIH research funding. Twenty percent supports 

drug discovery, development, and treatment. HIV/AIDS etiology and pathogenesis, the basic science 

that supports all HIV research, receives 24%; 9% supports studies for natural history and epidemiology, 

and 6% goes for training, infrastructure, and capacity building. Over 90% of the FDA HIV/AIDS budget 

($109,000,000; see Figure 2f) goes to support human drugs (35%), biologics (30%) and HIV/AIDSrelated field activities (30%). 

3.3: Demographic Factors 

The HHS FY 2010 HIV/AIDS discretionary extramural budget was further analyzed by key demographic 

factors of the intended recipients/target audiences. It is not possible to describe fully how HHS 

resources are specifically utilized at the client level for a number of reasons, including: there is no 

common system of reporting on the specific uses of HIV funding across HHS agencies and offices; HHS 

resources may be directed to state and local governments which, in turn, distribute resources based 

on state- or local-level planning processes; and resources may fund research and other enterprises 

that will broadly benefit the general population (e.g., funding to support microbicide development), 

as well as activities serving those from multiple risk groups. Nevertheless, this initial description 

provides an important baseline from which to build future efforts. It should be noted that we use the 

term “multi-targeted” to describe funding that supports services for more than a single, defined 

subgroup or population. Please note the following distinctions for demographic funding descriptions 

for HRSA, CMS, and NIH. HRSA demographic funding information is presented in terms of number of 

Ryan White HIV/AIDS service visits. CMS information in this section is presented in terms of number of 

HIV/AIDS beneficiaries, based on actual expenditures in calendar year (CY) 2008 for Medicare and in 

CY 2007 for Medicaid, thus differing from the CMS data presented in Figure 1a. NIH demographic 

funding information is presented only for HIV/AIDS-related behavioral and social science research, 

both domestic and international. 

3.3a: Risk Groups 

Approximately $910,000,000 was spent on HHS discretionary extramural activities in FY 2010 for 

HIV/AIDS activities funded by CDC/SAMHSA/IHS/OS offices. This figure does not include HRSA and NIH 

funding, which will be presented separately. Figures 3a-c illustrate this funding by risk group. Most 

(90%) of the CDC/SAMHSA/IHS/OS Office funding was multi-targeted (Figure 3a). Of the remaining 

funds, 43% went to programs for substance users, 33% for men who have sex with men (MSM), 20% 

for high-risk heterosexuals, and 4% to reduce perinatal transmission. 

 10 
HHS HIV/AIDS FUNDING 

As mentioned, HRSA data are presented in 

terms of number of Ryan White HIV/AIDS 

service visits in FY 2010 (Figure 3b). 

Thirty-six percent (36%) of Ryan Whitefunded visits were for high-risk 

heterosexuals, and 34% were for MSM; 9% 

of visits served substance users and 13% 

of HRSA-funded visits served persons 

whose behaviors and circumstances 

placed them in multiple risk groups. For 

NIH-funded intramural and extramural 

behavioral and social science research 

(Figure 3c; $441,000,000), well over half 

(61%) of the research was multi-targeted; 

of the remaining funds, 50% was targeted specifically for substance users, 34% for high-risk 

heterosexuals, and 16% for MSM. 

Figure 3a. HHS FY 2010 HIV/AIDS Funding: Discretionary Extramural by 

Risk Group (CDC, SAMHSA, IHS, OS) 

 $910,000,000 $91,000,000

Figure 3b. HRSA FY 2010 HIV/AIDS Service Visits 

by Risk Group, n=388,835 visits 

Figure 3c. NIH FY 2010 HIV/AIDS Funding: Behavioral and Social Science 

Research (Intramural and Extramural) by Risk Group, $441,000,000 

 11 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

3.3b: Race/Ethnicity 

Most of the HHS FY2010 discretionary 

extramural funding for CDC/SAMHSA/ 

IHS/OS ($910,000,000) was categorized as 

multi-targeted in terms of race and 

ethnicity (Figures 4a and 4b). For those 

programs that were not multi-targeted, 

70% served African Americans, 22% 

served Whites, 6% served American 

Indian/Alaska Natives, 2% served 

Asian/Pacific Islanders (Figure 4a), and 

17% served Hispanic or Latino populations 

(Figure 4b). HRSA Ryan White service visits 

by race/ethnicity (Figure 4c) were 

distributed as follows: 47% Blacks, 27% 

Whites, 23% Latinos, 2% Asian/Pacific Islanders, and 1% American Indian/Native Alaskans. 

Figure 4a. HHS FY 2010 HIV/AIDS Funding: Discretionary Extramural by 

Race (CDC, SAMHSA, IHS, OS) 

 $910,000,000 $191,000,000 

Figure 4b. HHS FY 2010 HIV/AIDS Funding: Discretionary Extramural by 

Ethnicity (CDC, SAMHSA, IHS, OS)

Figure 4c. HRSA FY 2010 HIV/AIDS Service Visits 

by Race/Ethnicity, n=855,230 visits 

$910,000,000 $200,000,000 

CMS data are presented in terms of the number of HIV/AIDS beneficiaries (including approximately 

76,000 dual beneficiaries in 2007) separately for Medicare (114,041 in CY 2008, the most recent data 

available) and Medicaid (172,541 in CY 2007, the most recent data available). For Medicare (Figure 4d), 

45% of HIV/AIDS beneficiaries were White, 39% were Black, and 14% were Hispanic; 2% “other” 

includes Asian/Pacific Islander and American Indian/Alaska Native. For Medicaid (Figure 4e), 47% of 

 12 
HHS HIV/AIDS FUNDING 

HIV/AIDS beneficiaries were Black, 29% were White, and 17% were Hispanic; 3% “other” includes 

Asian/Pacific Islander and American Indian/Alaska Native. 

Figure 4e. CMS/Medicaid CY 2007 Number of HIV/AIDS 

Beneficiaries by Race/Ethnicity within Program, n=172,541 

Figure 4d. CMS/Medicare CY 2008 Number of HIV/AIDS 

Beneficiaries by Race/Ethnicity within Program, n=114,041 

3.3c: Gender 

Figure 5a presents gender information on discretionary extramural activities for CDC/SAMHSA/IHS/OS 

offices. The majority of activities were multi-targeted for gender. Among the remaining 17% of 

extramural funding, 61% was for males, 38% for females, and 1% for transgender individuals. Twot nearly one-third (32%) for females, and 

1% for transgender persons (Figure 5b). 

hirds of HRSA's Ryan White service visits were for males (67%), 

Figure 5a. HHS FY 2010 HIV/AIDS Funding: Discretionary Extramural by 

Gender (CDC, SAMHSA, IHS, OS) 

 $910,000,000 $172,000,000

Figure 5b. HRSA FY 2010 HIV/AIDS Service Visits by 

Gender, n=876,987 visits 

 13 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

CMS HIV/AIDS Medicare beneficiaries (CY 2008) were 77% male and 23% female (Figure 5c). CMS HIV/AIDS 

Medicaid beneficiaries (CY 2007) were 63% male, 37% female, and <1% unknown persons (Figure 5d). 

Figure 5c. CMS/Medicare CY 2008 Number of HIV/AIDS 

Beneficiaries Gender within Program, n=114,041 

Figure 5d. CMS/Medicaid CY 2007 Number of HIV/AIDS 

Beneficiaries by Gender within Program, n=172,541 

3.3d: Age Groups 

Figure 6a illustrates CDC/SAMHSA/IHS/OS offices discretionary extramural funding ($910,000,000) for 

which the specific age group of intended recipients was known (16%). Over a third each were for ages 

18-29 (35%) or for ages 30-49 (35%). Seventeen percent (17%) was for ages 50-64, and 12% was for 

individuals under age 18. For HRSA (Figure 6b), 45% of Ryan White service visits were for adults aged 45–

64; 42% of visits were for adults aged 25-44; 7% of visits were for youth and young adults aged 13-24. 

Figure 6a. HHS FY 2010 HIV/AIDS Funding: Discretionary 

Extramural by Age Group (CDC, SAMHSA, IHS, OS)

 $910,000,000 $146,000,000

Figure 6b. HRSA FY 2010 HIV/AIDS Service Visits 

by Age Group, n=876,552 

 14 
HHS HIV/AIDS FUNDING 

Over half (59%) of CMS HIV/AIDS Medicare (CY 2008) beneficiaries were aged 45-64, 26% were aged 

21-44, 11% were aged 65-74, and 4% were 75 years or older (Figure 6c). The age breakdown of CMS 

HIV/AIDS Medicaid (CY 2007) beneficiaries (Figure 6d) was distributed as follows: 51% were aged 45-

64, 39% were 21-44, 5% were under 21, 4% were 65-74, and 1% were 75 years or older. 

Figure 6d. CMS/Medicaid CY 2007 Number of HIV/AIDS 

Beneficiaries by Gender within Program, n=172,541 

Figure 6c. CMS/Medicare CY 2008 Number of HIV/AIDS 

Beneficiaries Gender within Program, n=114,041 

Figure 7. HHS FY 2010 Funding by US Region: CMS/Medicare, HRSA and Other HHS

(CDC, SAMHSA, OS), $5,700,000,000 

3.4: Geographical Area 

The geographical area of 

funding distribution (Figure 7) 

was among the most complete 

data available for HIV/AIDSrelated funding estimates across 

HHS agencies and offices. For 

simplification, we present 

aggregate information from 

CMS/Medicare, HRSA, and 

CDC/SAMHSA/OS offices at the 

HHS regional level1

. Listed 

below (Table 1) are the 

cumulative AIDS cases by area of 

 

1

 Region 1 (CT, ME, MA, NH, RI, VT); Region 2 (NJ, NY, PR, VI); Region 3 (DE, DC, MD, PA, VA, WV); Region 4 (AL, FL, GA, KY, MS, NC, SC, TN); 

Region 5 (IL, IN, MI, MN, OH, WI); Region 6 (AR, LA, NM, OK, TX); Region 7 (IA, KS, MO, NE); Region 8 (CO, MT, ND, SD, UT, WY); Region 9 

(AZ, CA, HI, NV, American Samoa, Northern Mariana Islands, Micronesia, Guam, Marshall Islands, Palau); Region 10 (AK, ID, OR, WA).

 15 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

residence through 2008, as reported by CDC2

. 

Table 1. Cumulative AIDS cases through CY 2008, by area of residence 

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Region 9 Region 10

43,229 280,483 118,581 227,287 91,482 110,165 19,183 13,335 181,865 20,786 

Figure 7 shows HIV/AIDS FY 2010 funding estimates for HRSA, CMS/Medicare (CY 2008), and 

CDC/SAMHSA/OS offices combined for the 10 regions. Comparing Figure 7 to Table 1, regions with the 

largest cumulative number (through 2008) of AIDS cases (i.e., Regions 2, 4, and 9) also had the most 

HHS HIV/AIDS funding. Conversely, regions with the least number of cumulative AIDS cases had less 

HHS funding. Additional information about HIV/AIDS resource distribution, including resources to 

tribal nations, was reported by HHS agencies and offices, but is not described here. 

3.5: Funding Summary 

The vast majority of HHS’s nearly $16 billion HIV/AIDS funding supports extramural prevention, care, 

treatment, and research activities for people at risk for, or living with, HIV/AIDS. Over three-quarters 

(77%) of HHS' HIV/AIDS funding goes to care and treatment, nearly two-thirds of which supports 

Medicare and Medicaid funding for HIV/AIDS beneficiaries. Less than one-fifth (17%) of HHS funding 

supports HIV/AIDS-related research at NIH and 5% supports prevention activities administered by the 

CDC. SAMHSA, FDA, AHRQ, IHS, and OS staff offices each receive 1% or less of the HHS HIV/AIDS 

budget to support their HIV/AIDS activities. Because of differences in reporting practices at the 

program level, and given the broad array of diverse activities supported, it is not possible to provide 

comprehensive, client-level data across HHS for all of the intended recipients/beneficiaries of these 

programs. Nevertheless, this summary provides important baseline data and identifies areas where 

enhanced reporting practices will provide a more detailed picture of how these funds are serving their 

intended target populations. 

Based on this experience, prior to the development of the next HHS Operational Plan in FY 2012, the 

HHS OS will work with budget and program leads from each agency and staff office to develop 

standardized definitions and processes to report on specific uses of HIV funding. Future reports will 

also include information about funding formulas and policies used to allocate prevention, treatment 

and care resources as a means of demonstrating that resources are allocated to the highest 

prevalence populations and communities. 

 

2

 CDC HIV/AIDS Surveillance Report – through 2008 (http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/table20.htm

 16 
HHS HIV/AIDS FUNDING 

 17 
Section 4: Bringing Programs to Scale in 12 

High-Burden MSAs 

A significant component of the HHS Operational Plan is the “HHS 12 Cities Project,” an effort to 

support comprehensive HIV/AIDS planning and cross-agency response in 12 communities hit hard by 

HIV/AIDS. In many ways, the 12 Cities Project is a microcosm of the NHAS itself. Namely, this 

demonstration project embodies many of the overarching principles of the NHAS: concentrate 

resources where the epidemic is most severe, coordinate federal resources and actions across 

categorical program lines, and scale up effective HIV prevention and treatment strategies. 

The project builds on a funding opportunity announcement (FOA) released by the CDC on August 13, 

2010 (“Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan 

Statistical Areas Most Affected by HIV/AIDS” (ECHPP)). ECHPP identifies the 12 U.S. jurisdictions with 

the highest estimated AIDS prevalence (Atlanta, Baltimore, Chicago, Dallas, Houston, Los Angeles, 

Miami, New York City, Philadelphia, San Francisco, San Juan, and Washington, DC) and requires the 

relevant grantees in those jurisdictions (Georgia, Maryland, Chicago, Texas, Houston, Los Angeles, 

Florida, New York City, Philadelphia, San Francisco, Puerto Rico, and Washington, DC) to undertake 

“enhanced” HIV prevention planning so as to identify and address gaps in scope and reach of HIV 

prevention interventions and strategies among high-risk populations, especially “gay and bisexual 

men and transgender persons, Black Americans, Latino Americans, and substance users.” These 12 

MSAs account for a large proportion (44%) of the total estimated persons living with AIDS in the 

United States. 

Although this cross-agency initiative purposely builds upon the platform established by the CDC 

funding announcement, its goals, scope, oversight, and, potentially, funding, are broader than those 

outlined in the original CDC FOA. Specifically, by actively engaging HRSA, SAMHSA, NIH, IHS, CMS, and 

other federal partners, we intend to leverage departmental resources and assets so as to: 

 support coordinated planning for HIV prevention, care, and treatment in each of the 12 

jurisdictions, including a complete mapping of federally funded HIV/AIDS resources in each 

jurisdiction; 

 assess the current distribution of HIV prevention, care, and treatment resources in each of the 

12 jurisdictions with special emphasis on program coverage, scale, and efficacy; 

 identify and address local barriers to coordination across HHS grantees; 

 develop cross-agency strategies for addressing gaps in coverage and scale of necessary HIV 

prevention, care, and treatment services; 

 coordinate the implementation of and develop the capacity to deliver strategies and 

interventions addressing HIV prevention, care and treatment; 

 18 
BRINGING PROGRAMS TO SCALE IN 12 HIGH-BURDEN MSAS 

 develop common measures and evaluation strategies to assess process and outcomes as they 

relate to the goals of the NHAS; 

 actively promote opportunities to blend services and, where appropriate, funding streams 

across federal programs; and 

 develop and apply lessons learned in these 12 jurisdictions to federally funded activities in 

other jurisdictions, including creating technical guidance on the development of statewide 

plans, as called for in the NHAS. 

Phase I of this project (October 2010 through April 2011) will focus on data collection and planning, 

with an explicit focus on identifying gaps in coverage in terms of populations, interventions, and 

services. The second phase of this project (May 2011 through September 2011 and beyond) will focus 

on responding to the results of the enhanced planning process, including making recommendations 

about redirecting resources so as to optimize outcomes. 

This project will be managed through a collaborative governance structure. The overarching 

governance will be provided by a Steering Committee chaired by the Deputy Assistant Secretary for 

Health, Infectious Diseases (DASH, ID) and composed of principals from CDC, HRSA, SAMHSA, NIH, IHS, 

CMS, and other staff offices as appropriate. CDC will chair a working group composed of staff-level 

personnel from each of the agencies and offices cited above to address day-to-day operational issues. 

4.1: Phase One: Planning (October 2010 through April 2011) 

 OASH: The DASH, ID will convene the Steering Committee on a regular basis to identify and 

address emerging policy issues and provide ongoing oversight. 

 CDC actions during the planning phase: a detailed description is provided in the FOA 

“Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan 

Statistical Areas Most Affected by HIV/AIDS.” 

 HRSA actions during the planning phase: 

– identify all Ryan White-funded HIV/AIDS programs in the 12 cities and all sub-grantees 

that provide medical care and support services; 

– provide information on unmet HIV/AIDS need calculations, needs assessments, etc., in the 

12 cities; 

– identify staff contacts in the HHS Regional Offices for each of the 12 cities; 

– educate Part A Ryan White HIV/AIDS Program grantees in each of the 12 cities about the 

project and ask them to actively participate; 

– educate the leadership of community health centers in each of the 12 cities and actively 

enlist their support and engagement; 

 19 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

– describe and share HRSA-funded data collection (HIV/AIDS Bureau, Bureau of Primary 

Health Care, other programs) taking place in the 12 jurisdictions; 

– collaborate with CDC and other partners to help define denominator size for populations 

of interest in each of the 12 cities; and 

– participate with CDC and other partners in efforts to identify common, cross-agency 

performance metrics. 

 SAMHSA actions during the planning phase: 

– identify all SAMHSA-funded grantees in each of the 12 jurisdictions and request that they 

provide information about their target populations, service areas, and service capacity; 

– describe SAMHSA-funded data collection taking place in the 12 jurisdictions and share 

data relevant to planning efforts; 

– actively engage Single State Authorities (the state agency responsible for distributing the 

Block Grant funds) and SAMHSA grantees and technical assistance providers to support 

this project in each of the 10 states where the 12 cities are located; 

– engage the 14 Addiction Technology Transfer Centers (ATTCs) in these 12 jurisdictions to 

support this project; and 

– participate with CDC, HRSA, and other partners to determine common, cross-agency 

performance metrics. 

 IHS actions during the planning phase: 

– map current resources in terms of location and budget; 

– share any relevant data/information relevant to American Indian/Alaska Native 

populations with the planning group; and 

– participate in the development of common performance metrics. 

 CMS actions during the planning phase: provide demographic data for each of the 12 

jurisdictions. on Medicare and Medicaid clients who are receiving HIV/AIDS services 

 NIH actions during the planning phase: notify the Directors of the Centers for AIDS Research 

(CFARs), located in 9 of the 12 MSAs, and ask that they work with the health department 

leadership to define evaluation strategies for the 12 city program. Where applicable CFARS 

can also build and expand the bridge between public health programs for testing, linkage to 

care, treatment, and the local research community. 

 HHS staff offices supporting HIV/AIDS-related activities in some or all of these 12 MSAs (e.g., 

ACF, OAH, OHAP, OMH, OPA, OWH) will provide information to each of the planning groups. 

 20 
BRINGING PROGRAMS TO SCALE IN 12 HIGH-BURDEN MSAS 

4.2: Phase Two: Implementation (May 2011 through September 2011 and 

beyond) 

 OASH/OHAP will set aside $15 million in FY 2011 Secretary’s MAI funds to support 

services/programs for racial/ethnic minority populations found to be in need of scale-up 

during Phase I. 

 OASH will work with CDC, HRSA, SAMHSA, CMS, IHS, and other agencies and offices to develop 

specific recommendations encompassing the following domains: 

– harmonizing and, where feasible, streamlining reporting requirements for federally 

funded HIV/AIDS prevention, treatment, and care programs; 

– blending and/or braiding federal HIV/AIDS funding streams; 

– assuring that federal HIV/AIDS resources go to the states and localities with the greatest 

need; and 

– developing guidance for statewide HIV/AIDS planning processes that cuts across 

categorical, programmatic, and jurisdictional lines. 

 CDC actions: as outlined in the FOA. Please note that a subset of the 12 cities will be selected 

by CDC to receive CDC funding in Phase II. Selection will be competitive, based on 

performance in Phase I. 

 HRSA actions during the implementation phase: 

– direct the AIDS Education and Training Centers (AETCs) to provide care-related training in 

subject areas found to be lacking or inadequate as a result of the assessment in Phase I; 

– develop and deliver targeted technical assistance packages to community health centers 

in each of the 12 jurisdictions to expand HIV/AIDS care and treatment capacity through 

the AETC Capacity-Building Assistance to Community Health Centers Cooperative 

Agreement; 

– develop and provide training for Project Officers monitoring community health center 

grantees in each of the 12 jurisdictions regarding HIV/AIDS Performance Improvement 

Activities (PIA) for grantees, including: enhancing local needs-assessment activities for 

hard-to-reach and high-risk populations; addressing HIV/AIDS care in ongoing quality 

assurance activities; supporting the involvement of people living with HIV/AIDS on health 

center boards of directors; and establishing, as necessary, formal referral agreements for 

HIV/AIDS care and treatment; and 

– identify lessons learned and leading practices from the implementation phase of this 

activity and integrate these elements into HIV/AIDS PIAs for community health centers 

outside of these 12 jurisdictions. 

 SAMHSA actions during the implementation phase: 

 21 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

 22 

– explore the feasibility of developing a treatment-on-demand referral network of treatment 

providers who can collaborate with local HRSA and CDC grantees in some or all of the 12 

jurisdictions; 

– direct SAMHSA grantees and technical assistance providers to identify training, 

educational activities, and technical assistance activities in the 12 jurisdictions and 

proactively share information with local partners engaged in this project; and 

– explore the feasibility of Single State Authorities allowing states to use block grant funds 

to fill service gaps for injection drug users (IDUs) and other drug users identified during 

Phase I. 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

 24 
Section 5: Key HHS Actions to Achieve the 

Goals of the NHAS 

Reducing the occurrence of infectious diseases and supporting the NHAS are two explicit objectives of 

the HHS FY 2010-2015 Strategic Plan. The following section of the HHS Operational Plan will highlight 

key actions that are underway—or planned for the near term—in order to achieve the NHAS goals. 

They are organized by the three fundamental goals of the Strategy: reduce HIV incidence, improve 

access to care and health outcomes for people living with HIV, and reduce HIV-related disparities and 

health inequities. Given that “achieving a more coordinated national response” to the U.S. epidemic is 

expressly stated as integral to achieving the goals of NHAS, each section will highlight specific actions 

to improve coordination within HHS. Many of these actions will also require improved coordination 

with other federal departments, such as working with the Department of Justice to better address the 

prevention and care needs of incarcerated populations and working with the Department of Housing 

and Urban Development (HUD) to improve access to housing for homeless, HIV-infected persons. 

Specific actions to enhance these interdepartmental collaborations will be detailed in subsequent 

updates of the HHS Operational Plan. Although this section does not describe every HHS activity 

addressing HIV/AIDS, it does, nevertheless, represent a substantial portfolio. 

Given the significance of this first operational plan, we have erred on the side of transparency and 

inclusion. Future operational plans will place greater emphasis on those highest-priority activities and 

efforts that will be most critical in achieving the goals of the NHAS. The current summary does not 

provide exhaustive detail on any of the highlighted activities. Greater detail, including timelines, is 

available from the lead HHS organizational unit identified in each item. In addition, the actions 

described in the plan are subject to the availability of resources. Finally, it should be noted that while a 

“lead HHS entity” is highlighted in each of the key actions below, many other partners will be involved 

in carrying out these actions, both governmental and nongovernmental—and in many instances 

partners from the private sector. For reference, Appendix 2 (attached) provides a brief agency/officelevel status report on each of the action steps outlined in the NHAS Federal Implementation Plan. 

5.1: Reduce New HIV Infections 

In order to reduce new HIV infections in the U.S., we must: intensify HIV prevention efforts in 

communities where HIV is most heavily concentrated; expand targeted efforts to prevent HIV infection 

using a combination of effective, evidence-based approaches; and educate all Americans about the 

threat of HIV and how to prevent it. Achieving this goal will require active steps to diagnose the nearly 

220,000 Americans who are infected with HIV yet unaware of their health condition. Our efforts to 

reduce HIV incidence must also include structural approaches to preventing HIV infection that 

recognize the broader social determinants of health and risk. 

 25 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

Intensify HIV prevention in communities where HIV is most heavily concentrated. 

 In FY 2011, CDC will continue to fund FOA PS10-10138 “Expanded Human Immunodeficiency 

Virus (HIV) Testing for Disproportionately Affected Populations.” This funding serves to 

increase HIV testing opportunities for African American and Hispanic men and women, MSM 

of all races/ethnicities, and IDUs of all races/ethnicities. Eligibility for funding (awarded 

September 2010) was based on combined AIDS diagnoses among African Americans and 

Hispanics. 

 In FY 2011, IHS will continue to work with health providers and tribal leaders to support 

streamlined HIV testing in IHS health care facilities. 

 In FY 2011, the HHS Office of Population Affairs (OPA) will continue to support routine HIV 

testing in Title X Family Planning Clinics, especially in those MSAs with the highest burden of 

HIV/AIDS. 

 In FY 2011, AIDS.gov will work across HHS and other federal Departments and agencies with 

HIV/AIDS programs to use new and social media to develop, deliver, and evaluate targeted HIV 

prevention and testing messages to the most at-risk populations, including MSM, IDUs, and 

African American and Latino men, women, and youth. 

 In FY 2011, CDC will undertake an extensive evaluation of the community planning process to 

determine whether, and to what degree, prevention resources are following the epidemic. HIV 

prevention planning processes should be streamlined and, where feasible, combined with 

HRSA’s Ryan White HIV/AIDS Program planning efforts. Policy changes will be incorporated 

into the upcoming revision of guidance to state and local health departments receiving HIV 

prevention funds. 

 In FY 2011, CDC will develop a prevention fact sheet recommending HIV prevention 

approaches for transgender persons. This fact sheet will be made available online and will be 

disseminated through a variety of channels to community partners and prevention 

stakeholders. 

 In FY 2011, HRSA will continue to work with Ryan White Program grantees to provide 

education/risk reduction messages aimed at reducing HIV high-risk behaviors, while, at the 

same time, delivering HIV care and treatment services to people living with HIV/AIDS who 

receive services through the Ryan White HIV/AIDS program. 

 In FY 2011, NIH will continue to support behavioral research exploring the factors associated 

with HIV risk among transgender youth and the cultural context of HIV-related risk and 

protective factors among transgender women. 

 In FY 2011, OASH will hold a series of public, technical consultations, involving multi-sectoral 

experts, to elucidate current funding policies for HIV resource allocation and, where 

appropriate, suggest policy and legislative changes to ensure better targeting of resources. 

 26 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 SAMHSA will work with the HHS OS, the Assistant Secretary for Legislation (ASL), and Office of 

the General Counsel (OGC) to develop a strategy for updating the criteria that allow states to 

use Substance Abuse Prevention and Treatment Block Grant funds for HIV/AIDS Services. 

 In FY 2011, OASH/OHAP will revise the criteria for the Secretary’s Minority AIDS Initiative (MAI) 

Fund internal guidance to the Operational Divisions so as to more specifically support 

activities, projects, and interventions that align with the goals of the NHAS. 

 In FY 2011, CDC, IHS, and NIH will convene one or more multi-disciplinary technical 

consultations to identify surveillance strategies and a research agenda to better characterize 

the extent and burden of HIV/AIDS among populations that represent a small share, 

nationally, of the U.S. epidemic, including: American Indians, Alaska Natives, Asian Americans, 

and Pacific Islanders. 

 In FY 2011, CDC will convene several stakeholder consultations (by teleconference, webinar, 

and in-person) to discuss a new formula for the “flagship” cooperative agreement with states 

to ensure that all funds are directed to the communities and populations at highest risk for the 

most effective interventions. 

Expand targeted efforts to prevent HIV using a combination of effective approaches. 

 After the planning phase is completed, lessons learned from CDC’s “Enhanced Comprehensive 

HIV Prevention Planning and Implementation” effort in the 12 MSAs most affected by 

HIV/AIDS will be documented and work will begin on translating these lessons into technical 

guidance for the remaining U.S. jurisdictions, so that other areas can adjust their prevention 

portfolios to obtain maximal reductions in HIV incidence. (See below: “Bringing Programs to 

Scale in 12 High-Burden MSAs”) CDC will continue to fund the Enhanced Comprehensive HIV 

Prevention Planning and Implementation grant in FY 2011. 

 In FY 2011, CDC will prioritize those Diffusion of Effective Behavioral Interventions (DEBI) in the 

existing compendium that have biologic outcomes (e.g. reduced rates of sexually transmitted 

disease (STD) acquisition), are scalable to produce a community-level impact, and have 

documented “long-term” (i.e., 6 months or longer) success in reducing risk behaviors. 

 In FY 2011, SAMHSA will conduct a needs assessment of HIV testing capacity and frequency in 

SAMHSA-funded drug-treatment and appropriate mental health centers and will use the 

results from the assessment to determine areas for expanding HIV testing capacity in SAMHSA 

funded drug-treatment and appropriate mental health centers. 

 In FY 2011 HRSA will support an assessment of HIV testing capacity and frequency in 

community health centers across the United States. Results from this assessment will be 

presented to the OASH, along with specific, time-phased recommendations for expanding HIV 

testing capacity in federally funded community health centers. 

 27 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

 In FY 2011, the HHS OS will work with its respective Operating and Staff Divisions to 

harmonize federal recommendations on routine HIV screening in support of achieving the 

goals of the NHAS. 

– AHRQ will request that the U.S. Preventive Services Task Force (USPSTF) undertake a new 

review of data/studies related to routine screening for HIV among adults and adolescents 

receiving services in U.S. health care settings. 

 In FY 2011, CDC, SAMHSA, NIH, and AHRQ will collaborate to review the existing knowledge 

base and develop technical guidance outlining best public health practices related to syringe 

services programs for IDUs who are at risk for, or infected with, HIV. Knowledge/research gaps, 

including operational research, should be explicitly identified as part of this effort. 

 Based on new and emerging findings, NIH and CDC will collaborate in FY 2011 to develop 

research opportunities to investigate the social and behavioral factors that are likely to 

influence the roll-out, uptake, effectiveness, and long-term impact of biomedical interventions 

like pre-exposure prophylaxis (PrEP), microbicides, and Test, Linkage to Care and promotion of 

adherence (“Test and Treat”). 

 In FY 2011, NIH and CDC will support a study to pilot the evaluation of combinations of 

effective strategies for preventing HIV acquisition, encouraging testing for HIV, and ensuring 

access to treatment and appropriate care—especially for vulnerable populations. 

 In FY 2011, CDC will continue to support the evaluation of new and innovative HIV prevention 

approaches, including: 

– four sites that are evaluating prevention outcomes (including behavioral and biomedical 

outcomes) of previously evaluated HIV prevention interventions that have been adapted 

to address the local needs and circumstances of high-risk populations. Target populations 

include African American adolescents, incarcerated female populations, and HIV-positive 

MSM who report episodic substance use. 

– the evaluation of locally-developed (“homegrown”) HIV prevention interventions for 

African American and Hispanic/Latino MSM. Three interventions under evaluation were 

developed by community-based organizations (CBOs) with substantial input from the 

served communities. Organizations with research capacity are partnering with the 

respective CBOs to evaluate these interventions. 

– share methods and best practices derived from locally developed (“homegrown”) HIV 

prevention interventions for unique, at-risk populations, including: transgender persons; 

American Indian/Alaska Native MSM; recent immigrants (both legal and non-) exposed to 

high-risk circumstances and/or engaging in high-risk behaviors; incarcerated, sexually 

active populations; disabled Americans at high risk for HIV; at-risk populations with limited 

English proficiency, especially Asian Americans and Latino Americans; and homeless 

persons, including homeless youth. 

 28 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 In FY 2011 and beyond, NIH will continue to invest in AIDS vaccine research by supporting a 

broad AIDS vaccine research portfolio encompassing basic, preclinical, and clinical research, 

including studies to identify and better understand potentially protective immune responses 

in HIV-infected individuals. 

 In FY 2011 and beyond, NIH will continue to support a comprehensive microbicide research 

program that includes the screening, discovery, development, preclinical testing, and clinical 

evaluation of microbicide candidates for both vaginal and rectal use, as well as behavioral and 

social science research on acceptability and use of microbicides in different populations. 

 In FY 2011 and beyond, NIH will continue to support studies evaluating the use of 

antiretroviral therapy to prevent HIV acquisition (“treatment as prevention”), including preand post-exposure prophylaxis, prevention of mother-to-child transmission, and communitywide HIV testing and treatment programs. 

 In FY 2011 and beyond, CDC, HRSA, SAMHSA, IHS, and HHS staff offices will actively develop 

opportunities and approaches to create and evaluate more holistic and “wellness-centered” 

approaches to HIV prevention that address the individual in the context of his/her emotional, 

mental, and physical health needs. 

 In FY 2011 and beyond, CDC, HRSA, SAMHSA, IHS, and HHS staff offices will make public 

existing results of evaluated activities and programs. HHS will also develop a comprehensive 

list of planned evaluations in FY 2011 and beyond. 

Educate all Americans about the threat of HIV and how to prevent it. 

 In FY 2011 and beyond, HHS Operating and Staff Divisions will actively engage social, civic, 

and business organizations that represent the broader interests of racial/ethnic minority 

populations and not just those organizations which have a specific HIV/AIDS focus—

emphasizing that HIV prevention is everyone’s responsibility. 

 In FY 2011 and beyond, OASH will engaged federal partners within and outside of HHS in a 

process to review and develop strategies to more effectively share, repurpose, cross-promote, 

and disseminate each other’s consumer-focused HIV/AIDS educational content, materials, and 

messages. 

 In FY 2011 CDC will continue to implement the Act Against AIDS campaign to provide all 

Americans with information about the threat of HIV and how to prevent it, and to improve the 

ability of health care providers to provide appropriate HIV screening and prevention services. 

Emphasis will be placed on efforts that reach communities that have been most heavily 

affected by HIV (i.e., Blacks, Latinos, and MSM). 

 CDC (including the Division of Adolescent and School Health, Division of STD Prevention, and 

Division of HIV/AIDS Prevention) will continue to work with state and local departments of 

health and education and other partners to ensure that school- and community-based health 

 29 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

educators have access to scientifically sound, age-appropriate HIV, STD, and pregnancy 

prevention information. 

 In FY 2011, OASH/OWH will launch a national STD awareness social marketing campaign to 

empower teen girls to make informed decisions about sexual activity so as to reduce STDs and 

minimize their serious health consequences, including cancer and infertility. 

 In FY 2011, OASH/OWH will publish and disseminate an “HIV Prevention Gender Toolkit” that 

will train providers to develop and implement gender-responsive programming at the 

community, state, and local level. Gender-responsive programming will serve to identify and 

proactively address the influence of gender in the mediation of risk for HIV among U.S. women 

and girls and men and boys. 

 In FY 2011, the HHS OS will continue to work with the Department of Education (ED) to 

identify opportunities to actively engage and partner with ED constituents (e.g., grantees, 

teacher organizations, parent-teacher organizations, student organizations) in efforts to 

educate all Americans about the threat of HIV/AIDS and how to prevent it. 

 In FY 2011, the HHS Office of Adolescent Health (OAH) will work with the grantees receiving 

teen pregnancy-prevention program funds to replicate evidence-based approaches and to 

identify new strategies and approaches to reduce teen pregnancies and improve health 

outcomes for adolescents. Many projects support comprehensive sex education. 

 In FY 2011, the Administration for Children and Families (ACF) will continue to support 

“personal responsibility” education programs for youth that include information on reducing 

high-risk sexual behavior, contraception, and information on HIV and other STDs. 

 In FY 2011, OPA will continue to support family planning and STD and HIV-related services and 

counseling, with the majority of services provided to low-income and uninsured or 

underinsured individuals. 

5.2: Increase access to care and improve health outcomes 

In order to improve access to care and health outcomes for all persons living with HIV/AIDS in the U.S. 

we must: ensure that persons who are newly diagnosed are immediately linked to high-quality and 

continuous care; increase the number and diversity of providers who are able to deliver high-quality 

HIV care; and support people living with HIV who have other health conditions and/or require basic 

support, such as housing. HHS must continue to actively support its operating divisions and engage 

with a broad variety of partners in implementing the Affordable Care Act (ACA) so that people living 

with HIV/AIDS can benefit from expansion of Medicaid, increased funding for prevention, and the 

creation of state-based health insurance exchanges. Equally critical is the need to develop new and 

better therapies and improved drug regimens. While the focus of this operational plan is on efforts 

within HHS, it is important to note that other federal departments (e.g., HUD, DOJ, VA) are critical to 

 30 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

achieving this goal, especially when considering the special needs of unique populations such as the 

incarcerated and the homeless. 

Create a seamless system to immediately link people to continuous and coordinated 

quality care when they learn they are infected with HIV. 

 In FY 2011, the HHS OS, including ASL, will work with HRSA and senior Department leadership 

to develop a detailed strategy—including legislative options, policy guidance, and 

programmatic steps—to support states and jurisdictions in better managing AIDS Drug 

Assistance Program (ADAP) and pharmacy access programs. Components of this strategy will 

include: 

– The Office of Health Reform (OHR) will issue guidance and work with other HHS staff 

offices and agencies to develop and provide technical assistance for states regarding 

provisions in the Affordable Care Act (ACA) that are of immediate benefit and could 

potentially reduce demand for ADAP (and other Ryan White HIV/AIDS Program) services. 

– HRSA will develop, issue, and provide technical assistance for guidance to maximize state 

ADAP support of Medicare Part D beneficiaries when the new Affordable Care Act ADAP 

contribution rule goes into effect on January 1, 2011. 

– CMS will develop and deliver technical assistance on the mechanics of the TrOOP (“true 

out-of-pocket expenses”) facilitation and coordination of benefits processes as per the 

ACA. 

 In FY 2011, HRSA and CDC will identify community health centers that provide “co-located” 

HIV testing and care and treatment services. Information about these “co-located” services will 

be actively disseminated to state and local health departments and other partners providing 

HIV/AIDS care, and strategies will be jointly developed to incentivize the co-location of 

services in communities with high HIV prevalence. 

 In FY 2011, CMS will publish a toolkit letter that will remind states and stakeholders about 

various Medicaid options (e.g., 1115 waiver option, 1915c options, health home option) they 

can use to increase access and improve care coordination for people with HIV/AIDS. The 

toolkit letter will be developed in conjunction with states to determine what would be most 

helpful to them in increasing access for this population. 

 In FY 2011, CMS will actively assist states in efforts to cover pre-disabled people living with HIV 

(State Medicaid 1115 waivers) through actions such as: providing waiver guidance simplifying 

the submission of waivers to cover people with HIV/AIDS; expediting the application review 

process; and providing technical assistance opportunities for state Medicaid directors and 

their staffs. 

 In FY 2011, in consultation with HHS OS, CMS will collaborate with HRSA and other key 

partners in the federal government and the private sector to explore options for evaluating 

 31 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

the key components of comprehensive, coordinated Ryan White HIV/AIDS program-funded 

care to determine if these elements can be identified and replicated within Medicare and 

Medicaid programs 

 In FY 2011 HRSA will translate and disseminate the findings of a 4-year Special Projects of 

National Significance (SPNS) project (“Enhancing Linkages to HIV Primary Care and Services in 

Jail Settings”) to develop technical guidance and training materials detailing “best practices” 

for promptly linking persons living with HIV/AIDS in jail settings, or those who have been 

recently released, into HIV care. 

 In FY 2011, HRSA and CDC will continue to support a six-clinic, multi-year evaluation of 

interventions designed to increase HIV-positive client appointment attendance among 

patients at risk for missing scheduled appointments. The current phase of this project is a 

randomized controlled trial that compares two interventions designed to increase retention in 

HIV care to standard HIV clinical care. 

 In FY 2011, OASH/OPA will facilitate linkages to HIV care for clients who test positive in Title X 

Family Planning Clinics (FPCs) by: 

– increasing the number of personnel who are trained to ensure linkage between FPC 

testing sites and HIV/AIDS care sites; 

– increasing the number of formal referral agreements in FPCs; and 

– improving systems and processes for documenting referral episodes. 

 In FY 2011, OASH/OMH will administer projects under the “Collaborative Technical Assistance 

and Capacity Development Program.” This effort is designed to improve the coordination and 

continuum of HIV prevention, treatment, and support services provided by organizations that 

serve minority communities heavily burdened by HIV/AIDS. 

 In FY 2011, FDA will continue to monitor antiretroviral clinical trials to ensure scientific 

integrity and ethical conduct. FDA will also collaborate closely with NIH and AHRQ in areas of 

research regarding optimal and safe combination therapies for HIV/AIDS. 

Take deliberate steps to increase the number and diversity of providers of clinical care and 

related services for people living with HIV. 

 The OASH, in consultation with HRSA, other federal partners, and relevant professional 

organizations will develop specific strategies to increase the number and diversity of clinical 

care providers serving persons living with HIV/AIDS. Special emphasis will be placed on 

underserved populations, including rural populations. Strategies will include a careful 

consideration of how HHS can work proactively with the National Health Care Workforce 

Commission to highlight and address the special needs of people living with HIV/AIDS. 

 32 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 In FY 2011, the HHS OS will convene CDC, HRSA, AHRQ, CMS, IHS, VA and other technical 

experts, including professional organizations, to begin the development of a scientifically 

sound and practical set of clinical performance measures to monitor quality of HIV care. 

– The HHS Office of the National Coordinator for Health Information Technology (ONC) will 

work to ensure that evolving electronic-health-record (EHR) standards are consistent with 

clinical performance measures to monitor quality of HIV/AIDS care and are supportive of 

monitoring relevant NHAS goals, especially as they relate to improving health outcomes 

for people living with HIV/AIDS. 

 In FY 2011, HRSA will work with the AETCs to expand training for HIV clinicians and provider 

organizations to address cultural competency, provider continuity, and other providerassociated factors that affect HIV treatment adherence. 

 In FY 2011, HRSA will explore the feasibility of designating Ryan White HIV/AIDS Programfunded clinical settings as eligible sites for National Health Service Corps programs. 

 In FY 2011, HRSA will fund eight regional AETCs to provide specific training, technical 

assistance, and ongoing consultation to providers who are caring for American Indian/Alaska 

Native populations. AETCs will collaborate with the IHS to achieve the following goals: 

improve/enhance HIV diagnostic opportunities; establish and maintain robust linkages to care 

and treatment; and help ensure high-quality, culturally competent treatment. 

 In FY 2011, HRSA’s Bureau of Health Care Professions will provide training on the NHAS and 

the Federal Implementation Strategy to all project officers and subsequently develop an 

action plan to work with schools of medicine, dentistry, nursing, pharmacy, and other allied 

health professions to implement changes that will improve the quality and content of HIVrelated curricula, with special emphasis on health disparities and evolving co-morbidities of 

various U.S. populations living with HIV/AIDS. 

 In FY 2011, SAMHSA will release an online curriculum for substance-use treatment providers 

serving minority MSM. 

 In FY 2011, NIH will continue to support research training opportunities designed to recruit 

individuals from under-represented populations into research careers and to build research 

infrastructure in minority-serving institutions in the United States. This effort will include the 

first HIV/AIDS-focused initiative for American Indian/Alaska Native health researchers. 

Support people living with HIV and co-occurring health conditions and those who have 

challenges meeting basic needs, such as housing. 

 In FY 2011, the OASH, on behalf of the HHS OS, should proactively consult with a broad array 

of public- and private-sector providers serving diverse populations of people living with 

HIV/AIDS, including those with co-morbid conditions, in order to better inform the subsequent 

definition of an essential health benefits package for persons living with HIV/AIDS. 

 33 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

 In FY 2011 and beyond, NIH will initiate new programs to support a comprehensive 

therapeutics research program to design, develop, and test drugs and drug regimens to: 

maintain long-term, undetectable viral load: overcome drug resistance and treatment failure; 

and eradicate persistent viral reservoirs that may lead to a potential or functional cure for HIV 

disease. 

 In FY 2011, and beyond, HRSA will increase the capacity of providers to prevent, diagnose, and 

treat viral hepatitis among persons living with HIV/AIDS. This will involve working with CDC, 

other federal partners, and professional organizations to develop and disseminate technical 

assistance tools and documents to assist HIV and other primary care providers in the 

diagnosis, treatment, and prevention of viral hepatitis. 

 In FY 2011, HRSA will develop and disseminate technical guidance on how to integrate 

buprenorphine treatment (for opioid abuse) into HIV primary care settings. 

 In FY 2011 and beyond, SAMHSA will work with state and local substance use agencies to 

develop policies and technical assistance materials for implementing “treatment on demand” 

for HIV-infected drug users in those jurisdictions (identified by CDC surveillance data) with a 

substantial percentage of HIV-infected drug users. 

 In FY 2011, SAMHSA will issue best-practice guidelines (“treatment improvement protocol” or 

TIP) for the diagnosis and treatment of hepatitis C among substance users, with particular 

focus on those who are co-infected with HIV. 

 In FY 2011, CDC will work with governmental and nongovernmental partners to identify and 

disseminate culturally competent and scientifically sound patient-education materials to 

improve health literacy about viral hepatitis among IDUs, including those who are infected 

with HIV. 

 In FY 2011, NIH will continue to support the National Institute on Drug Abuse’s (NIDA) Clinical 

Trials Network (CTN). The CTN provides an enterprise in which NIH, treatment researchers, and 

community-based service providers cooperatively develop, validate, refine, and deliver new 

treatment options to substance users (including those who are HIV-infected) in communitylevel clinical practice. These efforts include multi-site clinical trials to determine effectiveness 

across a broad range of community-based treatment settings. 

 In FY 2011 and beyond, NIH will initiate new programs of basic, preclinical, and clinical 

research on prevention and treatment of AIDS-related co-infections and co-morbidities, 

including malignancies, cardiovascular, neurological, metabolic, and other complications and 

side effects, including AIDS and aging issues. 

 In FY 2011 and beyond, NIH will continue to lead the process to develop, update, and 

disseminate federal treatment guidelines for the medical management of HIV. This process 

will include other federal partners (CDC, HRSA, FDA, VA), as well as a variety of HIV experts 

from across the U.S. 

 34 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 In FY 2011, the OASH/OMH will continue to support the “Linkage to Life” (L2L) and HIV/AIDS 

Health Improvement for Re-Entering Ex-Offenders (HIRE) programs. L2L funds communitybased organizations to identify and address gaps in available healthcare and social and 

supportive services for high-risk minority families living with HIV/AIDS (or at high risk for HIV) 

who are in transition from incarceration, domestic violence, and/or substance abuse 

treatment. HIRE funds community networks designed to bridge health care gaps and improve 

HIV/AIDS health outcomes for ex-offenders re-entering the mainstream population. 

5.3: Reduce HIV-Related Disparities and Health Inequities 

To support a concerted national effort to reduce health-related disparities and inequities in HIV care, 

the following steps must be taken: reduce HIV-related mortality in communities at high risk for HIV 

infection; adopt community-level approaches to reduce HIV infection in high-risk communities; and 

reduce stigma and discrimination against people living with HIV. 

Reduce HIV-related mortality in communities at high risk for HIV infection. 

 In FY 2011, the HHS OASH will work with CDC, HRSA, SAMHSA, NIH, IHS, and other agencies 

and offices to ensure that current HIV/AIDS social-marketing materials are accessible to target 

populations with limited English proficiency. 

 In FY 2011, HRSA will develop a guide with lessons learned on model practices for engaging 

and retaining underserved, hard-to-reach, HIV-positive persons in medical care. The content of 

this guidance will derive from the “Targeted Outreach and Intervention Model Development 

Initiative,” a 6-year, multi-site evaluation conducted in community and clinical settings. 

Training curricula will be developed and disseminated as a component of the guidance 

document. 

 In FY 2011, HRSA will identify and disseminate “best practices” in caring for male and female 

Hispanic/Latino clients obtained from a qualitative assessment of “exemplary” HIV service 

providers serving substantial populations of Hispanics/Latinos in six states. These best 

practices will encompass clinical strategies, administrative actions, and organizational 

practices. 

 In FY 2011, CDC will review and assess the quality of data measuring community viral load 

(CVL); following this consultation, technical guidance on the collection and use of CVL data 

will be developed and disseminated to health departments. Working with health-department 

and other public-health leadership, collaborative strategies will be developed to leverage 

resources so as to increase capacity to measure CVL. These strategies will include targeted 

training and technical assistance to health department grantees supporting the 

implementation and adoption of high-quality CVL monitoring. 

 In FY 2011, the IHS will continue to support partnerships between American Indian/Alaska 

Native (AI/AN) Tribes and institutions that conduct academic-level biomedical, behavioral, and 

 35 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

health-services research. The goal of this effort is to develop and evaluate effective AI/ANfocused interventions to prevent HIV and/or encourage early diagnosis and entry into 

treatment. 

 In FY 2011, NIH will continue to support a series of projects to study behavioral interventions 

to prevent HIV transmission in MSM populations, especially among adolescents and 

minorities. Ongoing efforts include: behavioral interventions; studies related to scale-up; and 

studies related to adherence to, and acceptability of, biomedical interventions such as 

circumcision, pre-exposure prophylaxis, and rectal microbicides. 

 In FY 2011, NIH will continue to support a research initiative designed to evaluate strategies to 

enroll IDUs and other drug users in frequent testing for HIV and link them into early care if 

they are found to be HIV-positive. This effort entails innovative strategies to engage, retain, 

and support IDUs and other drug users into HIV/AIDS care, including adherence strategies. 

 OASH/OMH will continue to support the “CHAT” (Curbing HIV/AIDS Transmission Among 

High-Risk Youth and Adolescents) program. Utilizing a peer-to-peer outreach model, this 

intervention supports community-based grantees in their efforts to increase HIV 

prevention/education, HIV testing, counseling, and referral into care for high-risk minority 

youth and adolescents. 

Adopt community-level approaches to reduce HIV infection in high-risk communities. 

 In FY 2011, CDC, HRSA, SAMHSA, IHS, NIH, and other HHS agencies and offices will continue to 

invest in strategies to enhance the capacity of high-risk and high-burden communities to 

implement and sustain effective HIV prevention, treatment, and care programs. These 

strategies should include: replication studies; intervention packaging and dissemination; 

training and capacity-building; and evaluation. 

 In FY 2011, CDC will continue to work with large, historically African American and 

Hispanic/Latino national organizations that have proven reach and credibility in their 

respective communities in order to integrate HIV prevention into ongoing communication, 

mobilization, and outreach activities (e.g., public service announcements, new media tools, 

community forums). 

 In FY 2011, OASH will host one or more technical consultations with leaders from national 

lesbian, gay, bisexual, and transgender (LGBT) organizations to develop strategies that reenvision HIV prevention in a broader, social context of health promotion/health equity. 

 In FY 2011, the OASH RHAs will continue, through the HIV/AIDS Regional Resource Network 

Program (RRNP) and other means, to provide technical assistance for communities to promote 

HIV prevention, opportunities for early diagnosis of HIV infection, and stigma reduction. 

 In FY 2011, HHS and CDC will publicize opportunities for communities that are at 

disproportionate risk for HIV/AIDS disease, on the basis of race, ethnicity, behavioral 

characteristics, or socioeconomic circumstances, to compete for appropriate public health and 

 36 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

wellness resources. For example, Community Transformation Grants (CTG) should be 

considered. 

 In FY 2011 and beyond, NIH will collaborate with other federal partners to support studies 

defining social processes (e.g., mobility, migration, resilience) and structural factors (e.g., 

housing, employment, access to substance-use treatment, access to health care) that mediate 

risk of HIV infection. 

Reduce stigma and discrimination against people living with HIV. 

 In FY 2011, CDC, HRSA, SAMHSA, IHS, and OS staff offices will actively explore opportunities for 

partnering with nongovernmental and private-sector partners to develop new approaches for 

addressing stigma related to HIV/AIDS, including HIV stigma, racism, sexism, and homophobia. 

 In FY 2011, the HHS OCR will continue to provide information to the public (via Web, 

brochures, national meetings, and other outreach events) on the civil rights and the healthinformation privacy rights of people living with HIV/AIDS. OCR will continue to investigate and 

take action on complaints alleging discrimination against people living with HIV/AIDS by 

health care providers and human service agencies and on complaints alleging violations of the 

health-information privacy rights of people living with HIV/AIDS by health care providers and 

health plans. 

 In FY 2011, the HHS Office of Disability will continue to advocate and educate on behalf of 

Americans with disabilities and HIV/AIDS. These efforts will include policy development, 

dissemination of research findings, and identification of knowledge gaps. 

 In FY 2011, NIH will continue to support a series of ongoing studies investigating how stigma 

and discrimination may prevent at-risk populations, including minorities, MSM, prisoners, 

formerly incarcerated individuals, and high-risk heterosexual men and women (including 

minority men and women who use drugs and women whose partners are in prison) from 

accessing HIV testing and treatment. The goal of these efforts is to develop culturally 

appropriate HIV prevention and treatment interventions to overcome these barriers. 

– One NIH-funded study is investigating longitudinal relationships between medication 

adherence and discrimination due to HIV serostatus, race, and sexual orientation among 

African American men living with HIV/AIDS. 

– Another NIH-funded effort is studying HIV stigma among medical students in Puerto Rico. 

This intervention utilizes the medical training model, combined with Social Cognitive 

theory to reduce HIV stigma among future medical providers. The study will follow the 

students as they enter medical residency and measure stigmatizing behaviors using 

standardized patient methodology. 

 In FY 2011, the HHS Center for Faith-Based and Neighborhood Partnerships and OASH, in 

partnership with counterparts from the Departments of Labor, Justice, Housing and Urban 

Development, Veterans Affairs, and Education, will develop a national outreach effort to 

 37 
ACHIEVING THE VISION OF THE NATIONAL HIV/AIDS STRATEGY 

engage faith- and community-based leaders, organizations, and members in promoting 

routine screening for HIV, with the primary goal of encouraging early diagnosis of HIV and a 

secondary goal of de-stigmatizing HIV and people living with HIV/AIDS, in order to promote 

early entry into care and support ongoing prevention efforts. 

 38 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 39 
Section 6: Critical Change Issues 

To achieve the goals of the NHAS, it will be necessary for HHS to align its policies, activities, and 

operations with the specific goals and objectives of the Strategy. Given the assumption that achieving 

the goals of the Strategy will, in some instances, eventually require the redirection of resources (both 

in terms of activities supported, as well as locales/entities funded), close, proactive communication 

with a variety of stakeholders, such as congressional offices, professional organizations, and 

community advocates—including persons living with HIV/AIDS—will be necessary at every stage of 

this process. 

Finally, given the reality of constrained resources and competing demands, evaluation becomes more 

important than ever. We must be able to demonstrate that the hard decisions we make and the tough 

actions we take are making a difference in the lives of Americans at risk for, and living with, HIV/AIDS. 

Listed below are several key actions that are planned to support this cross-governmental change. 

 Continue to use AIDS.gov as a credible source to provide, leverage, and syndicate information 

about the HHS Operational Plan and ongoing implementation of the NHAS. Also, continue to 

incorporate new/social media tools in HHS programs supporting NHAS to sustain 

implementation of the Strategy. 

 Following the submission of the HHS Operational Plan to ONAP on December 9, 2010, each 

HHS agency and staff office will identify a senior-level administrator to serve as a “champion” 

for the NHAS and to coordinate all implementation activities for that agency/staff office. 

 After the HHS plan has been reviewed by ONAP, and any required clarifications have been 

made, the contents of the plan will be shared publicly on AIDS.gov and with a wide variety of 

governmental and nongovernmental partners and stakeholders. (February 2011, exact date to 

be determined). 

 The 2011-2012 performance plans for all HHS senior staff should contain specific elements 

directly related to one or more of the goals of the NHAS. 

 In FY 2011 and beyond, the HHS OS must continue to identify existing and new mechanisms, 

including funding opportunities, which can be used to incentivize the organizational 

behaviors necessary to achieve the NHAS goals. 

 In FY 2011, any HHS Operating and Staff Divisions using discretionary HIV/AIDS funds to 

support intramural costs, including FTEs, will undertake an assessment and review of its 

current capacity to support the goals of the NHAS and realign personnel resources as 

necessary to best meet those goals. 

 All HHS Operating and Staff Divisions will review their strategic plans and emerging 

communications to ensure that the goals of the NHAS are included. 

 40 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 41 

 In FY 2011 and beyond, the OASH will serve as the central focus for coordination and 

monitoring of HHS activities outlined in this Operational Plan. Strategies for monitoring and 

gauging progress toward achieving NHAS goals will include: 

– development of metrics to measure progress at various levels (i.e., federal, state, local); 

– development of standardized tools that can help agencies/staff offices conduct rigorous 

program evaluation; 

– development of processes that will provide accurate information about how federal 

HIV/AIDS resources are being used at state and local levels; and 

– convening of a Department-wide retreat, in the third quarter of CY 2011, to assess and 

critically review progress made and gaps remaining. 

 In FY 2011 and beyond, OASH will actively explore policy, budgetary, and programmatic 

strategies to better align HHS domestic HIV/AIDS efforts with those being conducted in other 

federal departments. Programmatic and budget strategies will include joint funding 

announcements and other opportunities to blend or braid funding across programs. 

 In FY 2011 and beyond, the HHS Assistant Secretary for Planning and Evaluation (ASPE) will 

coordinate with HHS agencies to conduct program-evaluation activities and assist with 

refining strategies for monitoring the progress of HHS’ implementation of the NHAS. 

 In FY 2011, working closely with the OASH, the Office of Intergovernmental Affairs (IGA) will 

proactively engage key stakeholders in discussions related to HIV/AIDS funding realignment. 
Section 7: Unmet Needs and Knowledge Gaps 

Given the current economic situation, with shrinking state-level resources for HIV prevention and care, 

we recognize that many may characterize the goals of the NHAS as ambitious and that there may be 

some resistance to undertaking new approaches. 

While not shying away from the reality that new resources may be necessary to achieve the ultimate 

goals of the Strategy, it is also imperative that, as a Department, we work across agency, office, and 

program lines to ensure that we are targeting and coordinating resources to support the most costeffective interventions and strategies so as to serve the most severely impacted populations. The 

American public and the populations we serve deserve nothing less! Furthermore, HHS will use 

ongoing experience with implementation of the NHAS to identify priorities and incorporate them into 

the Department’s annual budget planning and legislation development process. This is an essential 

step in order to maintain momentum and institutionalize the changes we are putting in place. 

Without question, there are gaps in the knowledge we require in order to finally achieve the vision of 

the NHAS. Most often cited, perhaps, is the lack of an effective vaccine against HIV. But this is by no 

means the only obstacle we face in our efforts to achieve the NHAS vision. Different domains 

engender equally complex questions. What is the correct combination and scale of biomedical and 

behavioral interventions to result in optimal reduction of HIV incidence? How do we allocate resources 

equitably and effectively so that the major focus is on populations who bear a disproportionate 

burden of disease and poor health–while not ignoring the needs of communities and groups who 

represent small numbers, nationally, but suffer, nonetheless, from HIV disease? How do we combine 

client-level approaches to HIV prevention with those that embrace a broader social context and 

recognize the importance of structural and community-level interventions? How do we reconcile our 

need for improved client-level budget information with the absolute necessity of streamlining 

reporting and reducing administrative burden across state, local, tribal, and community grantees? 

None of these questions will be easily—or quickly—answered. But we can answer them. As we move 

forward with our implementation of this ambitious, albeit necessary, Strategy, let’s keep in mind the 

following. Change is necessary. Change is expected. And change is possible. 

 42 
KEY HHS ACTIONS TO ACHIEVE THE GOALS OF THE NHAS 

 43 
 

Appendix 

Please go to: www.AIDS.gov