Public policy

Opportunities and challenges for domestic HIV/AIDS programs in the 112th Congress

Leo RennieLeo Rennie
Public Interest Governmental Relations Office, American Psychological Association

While the United States has contributed to global efforts to reduce HIV infections and provide lifesaving antiretroviral medications to millions of individuals in recent years, most prominently through the president’s Emergency Program for AIDS Relief begun during the administration of President George H.W. Bush, the need for a more robust response to the domestic HIV/AIDS epidemic has become clear. Each year, 56,000 individuals are newly infected with HIV in the United States, and more than 1.1 million individuals are living with HIV.

The new health reform law (P.L. 111-148), when fully implemented, promises to offer vast benefits for individuals living with HIV/AIDS. Signed into the law on March 23, 2010, the Patient Protection and Affordable Care Act (ACA) is a historic advancement in the provision of basic health care for all Americans. Among its many provisions, ACA prohibits insurance companies from using preexisting conditions, including HIV status, as a reason to deny health care coverage. ACA ends lifetime limits and phases out annual limits on coverage. The law provides access to insurance coverage through state-level insurance pools for uninsured individuals and those with chronic conditions. It also created the Prevention and Wellness Fund to provide an expanded and sustained national investment in prevention and public health programs. Additionally, the Centers for Disease Control and Prevention (CDC) received $30 million in FY 2010 to expand HIV prevention efforts under the president’s National HIV/AIDS Strategy (NHAS) (PDF, 1.2MB).

President Barack Obama’s election 2 years ago offered promise for a more robust response to the domestic HIV epidemic and renewed commitment to sustainable strategies to address HIV/AIDS abroad. Noteworthy accomplishments of the first 2 years of the Obama presidency include the elimination of the HIV entry ban, which will allow the 2012 International AIDS Conference to be held in the District of Columbia, the first time this conference has been hosted in the United States in over 20 years; lifting of the ban on the use of federal funding for syringe exchange; the Global Health Initiative, including continued commitments to the president’s Emergency Plan for AIDS Relief; and the completion of the NHAS.

In July 2010, President Obama unveiled his administration’s NHAS, surprisingly the first comprehensive national plan to address HIV/AIDS here at home. Developed by the White House Office of National AIDS Policy, the goals of the NHAS are to reduce HIV/AIDS incidence, increase access to care, and reduce HIV-related health disparities. After its release, the APA Public Interest Government Relations Office (PI-GRO), the Office on AIDS, and the Ad Hoc Committee on Psychology and AIDS collaborated to develop comprehensive recommendations to ensure that mental and behavioral health are prominent in NHAS implementation.

The document National HIV/AIDS Strategy: Prioritizing Mental and Behavioral Health In Federal Implementation Efforts (PDF, 880KB) highlights the important contribution psychology has and can continue to make in preventing new HIV infections, improving adherence to medications, and improving health outcomes of people living with HIV, especially those with mental health and/or substance use disorders. APA’s recommendations were discussed with senior officials in the White House, the Department of Health and Human Services, and key leaders on health and HIV/AIDS in both the House of Representatives and the Senate during a series of meetings in December 2010 coordinated by PI-GRO.

The first 2 years of the Obama administration coincided with the 111th Congress, where Democrats held majorities in both the U.S. House of Representatives and the Senate. However, the November 2010 mid-term elections resulted in divided leadership in the 112th Congress, with a smaller Democratic majority in the Senate and Republicans — who have made clear their intention to reduce discretionary spending — controlling the House. On January 20, 2011, House Republican leaders proposed $80 billion in budget reductions for FY 2011, the current fiscal year. If enacted, the proposal would take spending levels for nondefense, nonhomeland security, and nonveterans spending back to FY 2008 levels. The week before, the House voted to repeal the new health care reform law without offering any alternative health care improvement proposals.

The 111th Congress ended with a lame duck session last December, when the Obama administration reached agreement with Congress on several of its top priorities. These included an extension of the Bush-era tax cuts and unemployment insurance, ratification of the new START nuclear arms treaty with Russia, and repeal of the military’s “Don’t Ask, Don’t Tell” policy, which prohibits gays and lesbians from serving openly. It remains an open question at the beginning of the new Congress whether bipartisan compromises can be reached again given the political environment and the start of the presidential election season.

What then are the prospects for HIV/AIDS programs over the course of the 112th Congress, the last 2 years of Obama’s first term? The NHAS sets a framework for a more strategic coordinated response to the domestic HIV epidemic, which would direct or redirect resources to high-impact populations and geographic locations. Advocacy for HIV/AIDS programs must be cognizant of the pressures to reduce spending, coupled with the NHAS goal of finding effective and cost-effective programs.

In conjunction with the Office on AIDS and the Committee on Psychology on AIDS, PI-GRO will aggressively pursue two priorities over the next 2 years: 

  • Make resources available for rapid scaling up of mental health screening, brief intervention, and referral to treatment in HIV/AIDS programs. 

  • Focus research on highly impacted populations such as Black women — who account for more than 80 percent of new HIV infections among women — and Black gay men.

PI-GRO will also continue to focus on maintaining federal funding for core HIV/AID programs at key federal agencies (CDC, Health Resources Services Administration, and the Substance Abuse and Mental Health Services Administration) while making the case for new investments based on demonstrated needs. We will continue to highlight the critical importance of mental and behavioral health in HIV prevention and care and treatment programs, and we will also emphasize the contribution of behavioral and social science research to national HIV policy goals.

Leo Rennie, MPA, is the senior legislative and federal affairs officer in the APA Public Interest Governmental Relation Office (PI-GRO). PI-GRO actively engages in shaping federal policy to promote psychology in the public interest. Rennie’s portfolio includes work on HIV/AIDs, racial/ethnic minority affairs, and health disparities. He came to APA in March 2010 after having worked in the HIV/AIDS and public policy arenas since mid-1990 in a variety of settings, including local AIDS service organizations, national technical assistance and policy organizations, and local government. Rennie believes that his position at APA affords him a unique opportunity to work at the intersection of HIV/AIDS and health disparities across diverse populations and communities. Now is an exciting yet challenging time to be doing so at an organization that has much to contribute to national HIV, health and mental health policy.