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National Summit on HIV and Viral Hepatitis Diagnosis, Prevention, and Access to Care

November 26, 2012
Washington DC

Thank you for that kind introduction. I am delighted to join this Summit which has played such an important role in shaping the national conversation about our fight against HIV/AIDS. 

And with World Aids Day coming up, I also want to thank you for your contribution to a truly global campaign. Please visit AIDS.gov to learn how you can participate in this year’s worldwide commemoration on December 1st.

We have made great progress together in recent years.  In the United States, infections among injecting drug users have dropped more than 80 percent. Pediatric cases of HIV are down more than 90 percent. And today, someone diagnosed with HIV, and treated before the disease is far advanced, can have a nearly normal life expectancy. These gains have been accompanied by major breakthroughs in science -- including the recent finding that treatment itself is among the best forms of prevention.

In the last few years, we have also brought long-overdue attention to the epidemic of viral hepatitis. FDA has approved a new rapid test for Hepatitis C. New treatments are now available to cure up to 75 percent of Hepatitis C infections. And even more promising treatments are in the pipeline. The addition of viral hepatitis to this Summit is, itself, a testament to a growing awareness of the disease.

But we also know we have a long way to go.

Right here in Washington, one in every 16 black men is HIV-positive.  Nationally, HIV infections have stopped falling, and are actually rising among young gay and bisexual men.  And death rates associated with Hepatitis C have risen dramatically.

That’s why President Obama has made our battle against HIV and viral hepatitis a top priority for this Administration.  

In the past, when we have supported other countries’ efforts to fight HIV/AIDS, the first thing we asked of them was to establish a comprehensive national strategy. 

But until President Obama came into office, we had never taken that basic first step here at home.

Now, we have.  Working with experts like you across the country, we developed a historic National HIV/AIDS Strategy that is guided by the latest science and focuses our resources where they can make the biggest difference.

Last year, we brought the same approach to viral hepatitis when our Department created its first-ever Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis.  

For too long, hepatitis had been virtually unknown to the general public and policy makers. Even many health care providers did not have a full understanding of the infection. Consequently, there was never any comprehensive effort to address its full impact – even as it claimed the lives of as many as 15,000 Americans every year.

Our new National Action Plan is changing that. To develop the plan, we brought together everyone who had a part in fighting viral hepatitis at the federal level -- from the CDC, FDA, and HRSA to the Bureau of Prisons and the VA. And they charted a path forward that begins by raising public awareness and focuses on high-risk populations like the large number of baby boomers living with Hepatitis C.

These plans have given us roadmaps for reducing the impact of both diseases. And I’m proud to say that both plans are being turned into action. 

I see it every day in the federal government where our efforts have kicked into a higher gear. But what’s even more heartening is to see the states, communities and organizations around the country that are embracing strategies to address HIV and viral hepatitis.

We’re also supporting these efforts with additional funding.  For roughly a decade before the President came into office, domestic HIV prevention funding had been flat.  Since President Obama has come into office, resources have increased every year. 

But we’re also targeting our investments so they will make the biggest impact.  Already, we’ve made key changes in how we distribute funds to health departments for prevention, moving to a new formula that better reflects the needs of today. 

We’re also supporting the interventions that are proven to have a high payoff like prevention with positives and condom distribution. And of course, we continue to focus on HIV testing – most recently recommended in draft guidelines for public comment from the U.S. Preventive Services Task Force for all Americans age 15 to 65.

We also know it is not enough to simply make testing and treatment available and then tell people to “go get it.”   If it were, we wouldn’t have 200,000 people with HIV who don’t know their status, another 200,000 who know their status but haven’t been linked with care, and another 250,000 on top of that who haven’t been retained in care.  Out of 1.1 million Americans living with HIV/AIDS, that is a big portion slipping through the cracks.  And we know we can do better.

So we’re supporting programs that build strong linkages at every step from testing and care to treatment. This summer, I visited an organization called Community Education Group that’s getting impressive results with a new approach to HIV testing and treatment. Instead of just handing patients a referral slip when they get a positive result, they immediately schedule a doctor’s appointment for sometime in the next day.  Then they provide transportation for the first five visits. And they’ve reported great results.

Nationally, our linkage to care rate is just 66% percent.  We need to scale up the proven practices that help close the gap between testing and treatment.

And that is also true for viral hepatitis where as many as 3 out of 4 people living with hepatitis B and C may not even know it. So we’re working to apply the lessons we’ve learned from the fight against HIV/AIDS. This year, for the first time, the CDC awarded $6.5 million from the Affordable Care Act to help communities implement hepatitis testing programs – with a special focus on linking patients to counseling, treatment and care.

This focus on prevention and care coordination runs like a common thread through so much of the Affordable Care Act. And it’s a big part of what makes the law one of the most important pieces of legislation in the history of our fight against HIV/AIDS and viral hepatitis.

In addition to supporting the work so many of you do at the community level, the law has also dramatically expanded access to coverage for people with HIV/AIDS and viral hepatitis. 

For years, we had a health insurance market in which insurers made profits by trying to avoid sick people.  This was great for insurance companies, but it was terrible for the people with the greatest health needs, including those with HIV/AIDS and viral hepatitis.  In effect, the people who needed health insurance the most were the ones shut out of the market.

This wasn’t right, and the health care law is bringing these days to an end. Starting in 2014, the law bans insurance companies from turning anyone away because of their health status.  

The law already provides protection from some of the worst insurance company abuses. For example, your insurance company can no longer put a lifetime dollar cap on your benefits, or cut your coverage when you get sick because of an error on a form. 

The law also expands Medicaid so that it will be available to many more Americans with HIV/AIDS and viral hepatitis, including adults without children.

Finally, the law invests in community health centers, increasing access to testing, treatment, and care -- especially in underserved areas. And over the last year, we’ve also made it a priority to give those health centers access to the training and support they need to identify and treat viral hepatitis.

These are big steps forward.  But we will continue to need ADAP and the Ryan White program to fill in the gaps of our health insurance system. As that system changes, we will keep reaching out for your perspective from the frontlines to make sure the program remains strong.

When this Summit convened for the first time 6 years ago, our nation’s fight against HIV/AIDS had nearly stalled. The number of new infections had plateaued while the general public’s concern about the disease continued to fade. Meanwhile, viral hepatitis remained a silent epidemic, even as nearly 100,000 people were newly infected each year.

But we are here today, because we refused to accept those trends.

We looked closely at how and where we were using our resources. And together, we made a commitment to help the best approaches reach those most in need. Out of that collaboration came our two powerful national plans. Today, they provide a roadmap for the months and years ahead. But in order to fulfill their promise, we must continue executing these plans. And we can’t do that without your leadership.

So I want to ask you to keep your foot on the accelerator.  

Now is not the time for easing up, or shifting our focus.  If we are going to reach our ultimate goal of an AIDS-free generation -- if we are going to eliminate the silent epidemic of viral hepatitis -- we must all challenge ourselves to do more.

We need your expertise, your best practices, and your model programs to make the most of the Affordable Care Act -- and to improve people’s lives at every point along the treatment cascade.

The federal government is committed to being a full partner in this fight. Together, we can raise awareness to new heights and make our programs even more effective. We can push the boundaries of science even further. And we can help even more people get the support, treatment, and care they need to live long and healthy lives.