Working toward an AIDS-free generation
BY STEVE LEE
Grant Colfax, M.D. is the director of the Office of National AIDS Policy (ONAP). In this role, he is President Barack Obama’s lead advisor on domestic HIV/AIDS policy and he is responsible for coordinating HIV/AIDS policy issues for the Domestic Policy Council.
Announcing Dr. Colfax’s appointment in March of this year President Obama said, “Grant Colfax will lead my administration’s continued progress in providing care and treatment to people living with HIV/AIDS. Grant’s expertise will be key as we continue to face serious challenges and take bold steps to meet them. I look forward to his leadership in the months and years to come.”
ONAP coordinates with the National Security Council and the Office of the Global AIDS Coordinator, and works with international bodies to ensure that America’s response to the global pandemic is fully integrated with other prevention, care and treatment efforts around the world.
Dr. Colfax was most recently director of the HIV Prevention Section in the San Francisco Department of Public Health.
A graduate of Harvard Medical School, Dr. Colfax completed his medical residency at the University of California, San Francisco. His work focuses on collaborating with community stakeholders to implement sustainable, evidence-based HIV prevention and treatment interventions and policies in public health settings and measuring their effectiveness. Under his leadership, San Francisco greatly expanded HIV testing and treatment support efforts.
Until assuming his ONAP role, Dr. Colfax was also a National Institutes of Health and Centers for Disease Control and Prevention supported scientist studying HIV testing strategies, clinical trials of medications to treat substance dependence and biomedical HIV prevention interventions. Dr. Colfax was a practicing clinician at the Positive Health Program, San Francisco’s premier public HIV clinic.
On the eve of World AIDS Day Dr. Colfax very graciously took time out of his busy schedule to talk to San Diego LGBT Weekly about the impact of HIV/AIDS in America, the prevention and treatment strategies going forward and the significance of Worlds AIDS Day.
San Diego LGBT Weekly: Dr. Colfax, congratulations on your appointment by President Obama. Can you tell us about the state of HIV/AIDS in the USA today?
Dr. Grant Colfax: This is a transformative time in the domestic epidemic. Research breakthroughs in HIV prevention and care have been dramatic, including improved treatment regimens, more efficient testing methods, and more evidence about what prevention interventions are most effective at the community level. We have reduced maternal-child transmission by 90 percent, and people living with HIV can be expected to live a near-normal lifespan on treatment. At the same time, there are approximately 50,000 new HIV infections each year, and only 25 percent of persons living with HIV in the United States have a suppressed viral load. More people need to get tested and access treatment.
We have mounted a comprehensive and aggressive response to refocus our collective efforts to respond to the domestic HIV epidemic. In July 2010, the president released the National HIV/AIDS Strategy (whitehouse.gov/administration/eop/onap/nhas), the nation’s first comprehensive plan to fight the domestic epidemic. Continued implementation of the strategy at the federal, state and local levels remains a priority. We have realigned our prevention and care investments to focus on populations where HIV is most concentrated, and are scaling up evidence-based interventions that improve both individual and population-level health.
A critical component of improving HIV prevention and care outcomes is implementation of the Affordable Care Act. The Affordable Care Act expands health insurance coverage to 30 million uninsured Americans – including the tens of thousands of people living with HIV. An estimated 7 million uninsured African Americans and 9 million uninsured Latinos, populations at highest risk for HIV, will have access to coverage in 2014. Linking people living and at risk for HIV to coverage made possible under the Affordable Care Act will help us meet the goals of the National HIV/AIDS Strategy.
Nationwide, approximately 50,000 Americans are becoming infected with HIV/AIDS each year. Although this number has remained relatively stable through the years it is still regarded as unacceptably high. What do you cite as the reasons for this?
Major factors include lack of frequent HIV testing among populations with high HIV rates, and lack of treatment among persons living with HIV. As mentioned earlier, these issues will be greatly helped by the Affordable Care Act.
Knowing your HIV status is critical. HIV testing has enabled individuals with HIV to become aware of their health status and to take appropriate precautions to preserve their health. Moreover, studies show that individuals diagnosed with HIV take steps to reduce the likelihood of transmitting HIV to others, including through increasing condom use and reducing high-risk behaviors with HIV-negative persons. Studies also indicate that, in the setting of risk-reduction counseling and condom promotion, earlier treatment is not only beneficial for individual health, but also helps reduce transmission risk
To be most effective, our efforts must be concentrated in populations where HIV is most concentrated, including gay men and communities of color. As we implement the National HIV/AIDS Strategy, we are also working to educate all Americans about the threat of HIV and how to prevent it. Using evidence-based social marketing and education campaigns like CDC’s Act Against AIDS (cdc.gov/ActAgainstAIDS/) campaign, is an important part of these efforts.
A particular problem is that with 1.2 million people in the United States living with HIV/AIDS infection 1 in 5 (20 percent) are unaware of their infection. What can be done nationally to reduce this percentage?
In addition to lack of access to testing services, stigma is a key issue that we continue to address. The stigma associated with HIV remains extremely high and fear of discrimination causes many people to avoid learning their HIV status, disclosing their status, or accessing medical care. Making voluntary HIV testing a routine part of medical care will help decrease the stigma around HIV. Under the Affordable Care Act, in 2014 insurance companies will not be able to deny coverage based on pre-existing conditions, including HIV. This means that not only will thousands of people living with HIV gain medical coverage, but also that people will no longer need to delay getting tested for HIV out of the fear that a diagnosis will preclude them from getting insurance.
Stigma is also being addressed at the policy level. President Obama, building on efforts from the prior administration, formally lifted the HIV entry ban in 2009. In keeping with the goals of the broader Strategy, the Department of Justice has taken steps to enforce civil rights laws that protect the rights of persons living with HIV/AIDS, and has launched a website (www.ada.gov/aids) dedicated to fighting discrimination against people living with HIV/AIDS. While we still have work to do in this area, we’ve made meaningful, tangible progress.
Men who have sex with men (MSM), particularly young, African American MSM, are the most severely affected by HIV/AIDS. How do you address this specific demographic?
One of the main goals of the National HIV/AIDS Strategy is intensifying HIV-prevention activities in communities where HIV is most heavily concentrated. The strategy calls for implementing evidence-based, high-impact interventions to reduce new HIV infections, improve HIV-related health outcomes, and reduce HIV-related disparities. It focuses federal, state, and local efforts on a prevention approach for gay men and other populations at high risk that combines increasing HIV testing and increasing HIV treatment, because studies demonstrate that increasing diagnosis rates and reducing viral loads will significantly reduce new HIV infections in disproportionately affected communities. For instance, studies show that black MSM are more likely than white MSM to be diagnosed late in the course of HIV disease and less likely to start retroviral therapy and that these factors can be attributed to less health coverage among black MSM – a situation the Affordable Care Act’s coverage expansion will help to address. Addressing HIV in the context of the broader range of LGBT health issues is also very important. Finally, we need to further the discussion about how homo- and trans-phobia intersect with HIV-related stigma to increase HIV risk, and how addressing these factors together is paramount to reducing HIV health disparities in the LGBT community.
How does Obamacare impact those affected with HIV/AIDS?
People living with HIV have much to gain from the enactment of health care law. People with HIV have higher rates of uninsurance, they are more likely to face barriers in accessing medical care, and they often experience higher rates of stigma and discrimination than other groups. When it is fully implemented, thirty million Americans will gain health coverage as a direct result of the Affordable Care Act. Already, the increased emphasis on prevention means that millions of Americans can now get tested for HIV without additional cost sharing. Children can now stay on their parents’ insurance plan until they turn 26 years old, which has led to millions of young adults gaining or maintaining their health insurance coverage. And the AIDS Drug Assistance Program benefits are now considered contributions toward filling Medicare “donut hole” expenses, and the donut hole itself will be phased out over time.
World AIDS Day. This has been held for decades. What good does it do?
World AIDS Day marks a moment to celebrate the American leadership and efforts that have transformed the response to the epidemic, as well as a time to remember the lives lost to this disease. It is also an opportunity to educate Americans about HIV/AIDS to ensure that all Americans have the right information about the current HIV epidemic. Finally, it is a time to highlight the need for a collective response to the epidemic- – that only through governments at all levels, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and others working together to increase HIV prevention, care, and decrease HIV-related stigma and discrimination – can we realize the vision of an AIDS-free generation.
