The White House
Office of the Press Secretary
For Immediate Release
July 15, 2013
Executive Order -- HIV Care Continuum Initiative
EXECUTIVE ORDER
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ACCELERATING IMPROVEMENTS IN HIV PREVENTION AND CARE IN THE UNITED STATES THROUGH THE HIV CARE CONTINUUM INITIATIVE
By the authority vested in me as President by the Constitution and
the laws of the United States of America, and in order to further
strengthen the capacity of the Federal Government to effectively respond
to the ongoing domestic HIV epidemic, it is hereby ordered as follows:
Section 1. Policy. Addressing the domestic HIV epidemic is a
priority of my Administration. In 2010, the White House released the
first comprehensive National HIV/AIDS Strategy (Strategy), setting
quantitative goals for reducing new HIV infections, improving health
outcomes for people living with HIV, and reducing HIV-related health
disparities. The Strategy will continue to serve as the blueprint for
our national response to the domestic epidemic. It has increased
coordination, collaboration, and accountability across executive
departments and agencies (agencies) with regard to addressing the
epidemic. It has also focused our Nation's collective efforts on
increasing the use of evidence-based approaches to prevention and care
among populations and in regions where HIV is most concentrated.
Since the release of the Strategy, additional scientific discoveries
have greatly enhanced our understanding of how to prevent and treat HIV.
Accordingly, further Federal action is appropriate in response to these
new developments. For example, a breakthrough research trial supported
by the National Institutes of Health showed that initiating HIV
treatment when the immune system was relatively healthy reduced HIV
transmission by 96 percent. In addition, evidence suggests that early
treatment may reduce HIV-related complications. These findings highlight
the importance of prompt HIV diagnosis, and because of recent advances
in HIV testing technology, HIV can be detected sooner and more rapidly
than ever before.
Based on these and other data, recommendations for HIV testing and
treatment have changed. The U.S. Preventive Services Task Force now
recommends that clinicians screen all individuals ages 15 to 65 years
for HIV, and the Department of Health and Human Services Guidelines for
Use of Antiretroviral Agents now recommends offering treatment to all
adolescents and adults diagnosed with HIV.
Furthermore, ongoing implementation of the Affordable Care Act
provides a historic opportunity for Americans to access affordable,
quality health care. The Act is expanding access to recommended
preventive services with no out-of-pocket costs, including HIV testing,
and, beginning in 2014, insurance
companies will not be able to deny coverage based on pre-existing
conditions, including HIV. Starting October 1, 2013, Americans can
select the coverage that best suits them through the new Health
Insurance Marketplace, and coverage will begin January 1, 2014.
Despite progress in combating HIV, important work remains. Since the
publication of the Strategy, data released by the Centers for Disease
Control and Prevention show that there are significant gaps along the
HIV care continuum -- the sequential stages of care from being diagnosed
to receiving optimal treatment. Nearly one-fifth of the estimated 1.1
million people living with HIV in the United States are undiagnosed;
one-third are not linked to medical care; nearly two-thirds are not
engaged in ongoing care; and only one-quarter have the virus effectively
controlled, which is necessary to maintain long-term health and reduce
risk of transmission to others.
In light of these data, we must further clarify and focus our
national efforts to prevent and treat HIV infection. It is the policy of
my Administration that agencies implementing the Strategy prioritize
addressing the continuum of HIV care, including by accelerating efforts
to increase HIV testing, services, and treatment along the continuum.
This acceleration will enable us to meet the goals of the Strategy and
move closer to an AIDS-free generation.
Sec. 2. Establishment of the HIV Care Continuum Initiative.
There is established the HIV Care Continuum Initiative (Initiative), to
be overseen by the Director of the Office of National AIDS Policy. The
Initiative will mobilize and coordinate Federal efforts in response to
recent advances regarding how to prevent and treat HIV infection. The
Initiative will support further integration of HIV prevention and care
efforts; promote expansion of successful HIV testing and service
delivery models; encourage innovative approaches to addressing barriers
to accessing testing and treatment; and ensure that Federal resources
are appropriately focused on implementing evidence-based interventions
that improve outcomes along the HIV care continuum.
Sec. 3. Establishment of the HIV Care Continuum Working Group.
There is established the HIV Care Continuum Working Group (Working
Group) to support the Initiative. The Working Group shall coordinate
Federal efforts to improve outcomes nationally across the HIV care
continuum.
(a)
Membership. The Working Group shall be co-chaired by the
Director of the Office of National AIDS Policy and the Secretary of
Health and Human Services or designee (Co-Chairs). In addition to the
Co-Chairs, the Working Group shall consist of representatives from:
(i) the Department of Justice;
(ii) the Department of Labor;
(iii) the Department of Health and Human Services;
(iv) the Department of Housing and Urban Development;
(v) the Department of Veterans Affairs;
(vi) the Office of Management and Budget; and
(vii) other agencies and offices, as designated by the Co-Chairs.
(b)
Consultation. The Working Group shall consult with the Presidential Advisory Council on HIV/AIDS, as appropriate.
(c)
Functions. As part of the Initiative, the Working Group shall:
(i) request and review information from agencies describing efforts
to improve testing, care, and treatment outcomes, and determine if there
is appropriate emphasis on addressing the HIV care continuum in
relation to other work concerning the domestic epidemic;
(ii) review research on improving outcomes along the HIV care continuum;
(iii) obtain input from Federal grantees, affected communities, and
other stakeholders to inform strategies to improve outcomes along the
HIV care continuum;
(iv) identify potential impediments to improving outcomes along the
HIV care continuum, including for populations at greatest risk for HIV
infection, based on the efforts undertaken pursuant to paragraphs (i),
(ii), and (iii) of this subsection;
(v) identify opportunities to address issues identified pursuant to
paragraph (iv) of this subsection, and thereby improve outcomes along
the HIV care continuum;
(vi) recommend ways to integrate efforts to improve outcomes along
the HIV care continuum with other evidence-based strategies to combat
HIV; and
(vii) specify how to better align and coordinate Federal efforts,
both within and across agencies, to improve outcomes along the HIV care
continuum.
(d)
Reporting.
(i) Within 180 days of the date of this order, the Working Group
shall provide recommendations to the President on actions that agencies
can take to improve outcomes along the HIV care continuum.
(ii) Thereafter, the Director of the Office of National AIDS Policy
shall include, as part of the annual report to the President pursuant to
section 1(b) of my memorandum of July 13, 2010 (Implementation of the
National HIV/AIDS Strategy), a report prepared by the Working Group on
Government-wide progress in implementing this order. This report
shall include a quantification of progress made in improving outcomes
along the HIV care continuum.
Sec. 4. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department, agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and
Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or
benefit, substantive or procedural, enforceable at law or in equity by
any party against the United States, its departments, agencies, or
entities, its officers, employees, or agents, or any other person.
BARACK OBAMA
Repairing the Breach
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