The U.S. National HIV/AIDS Strategy: What's Useful, What's Promising, What's Missing

At the XVIII International AIDS Conference in Vienna, I caught up with Naina Khanna, director of policy and community organizing for WORLD (Women Organized to Respond to Life-threatening Disease) in Oakland, Calif. Khanna coordinates the U.S. Positive Women's Network, a national membership body of HIV-positive women working for a response to the U.S. epidemic that meets women's needs. She also sits on the Obama administration's Presidential Advisory Council on HIV/AIDS (PACHA), so she's quite familiar with the newly released U.S. national HIV/AIDS strategy. I asked her what she thought of the strategy, and what people can do in their own communities to contribute to its implementation.

What should individuals in the HIV/AIDS community -- particularly those less inclined to follow policy developments -- be keeping their eyes on in their own lives to gauge whether the national HIV/AIDS strategy is being implemented effectively?

First of all, it's definitely worth reading the strategy, even if you're not a policy person. It's not very long. A lot of it is indexes and references. It's not as long as it looks and it's a pretty good read. And the vision statement is really nice. It talks about the United States being a place where HIV infections are rare and where once people are diagnosed, they have unfettered access to all these things and to a life free of stigma and discrimination. And so that's a really beautiful vision statement. So I definitely encourage folks to read it because I think it helps to give some context to what we're talking about.

As far as what people should be looking for: Now we're moving into implementation, so we're looking at how this strategy is actually going to translate into action on the ground. We don't really know yet exactly what that's going to look like, but there are a few things I can say.

One is, if you look at the strategy and the implementation plan, it's really clear who the priority populations are, for example, and how resources should be allocated. If you're on a planning council and you're helping to make decisions about priority populations and resource allocation, the strategy actually gives you some really good language for being to make a case -- to say, "Hey, are we really doing enough for, say, black women in our community? The national HIV/AIDS strategy says that we must, because this is a priority. They're a population that's being very impacted." So, asking your local planners and policymakers what they're doing to address that population. That's one example I can think of.

In terms of people's individual access to services: The markers in the strategy are all for 2015, so when some of them are being met is also when we'll be looking at health care reform rolling out. There's a lot of overlap between these two different things.

The bottom line is that the strategy's not going to necessarily help you get more services or better health care. But what it can help with is, if you are a person involved in your community and who understands what the needs of your community are, then what it can do is help you advocate to better meet the needs, if that makes sense.

For example, the strategy might say we're going to have 80 percent of all HIV-positive people who know their status also accessing regular health care every year. So what does it take to actually meet that number? You might not be the doctor or the clinician to provide the services, but you might be able to say, "Well, actually it's really hard for people to go to the doctor because they don't have transportation vouchers, because they don't know how to get there, because it's not located in a convenient place, because of the hours it's open, because it doesn't provide child care" -- whatever those other factors are that make it hard for people to actually get to the doctor. So there's a role for everybody, I think, in terms of helping to meet the strategy's goals.

Is there any particular aspect of it that you're fired up about or interested in or worried about?

There are a couple of things. I'm working with a coalition of women's rights and gender justice groups that are going to be putting out a gender monitoring assessment of the national HIV/AIDS strategy. While we're happy with a lot of what's in the strategy, there were some things that were very much overlooked. One of the priorities of the women's community, because it's directly linked to women's prevention and women's care, was to better integrate sexual and reproductive health services with HIV services. The strategy language is not very strong in that, not as strong as we would have liked.

When you talk about human rights violations or discrimination against people living with HIV, for women one of the places it happens a lot is in reproductive health care settings. A lot of HIV-positive women are encouraged to abort, coerced to abort, encouraged to get tubal ligation. We just hear case after case after case of this and we have a lot of surveys and documentation to show that. So it's a little disappointing that there wasn't an explicit commitment in the strategy to addressing reproductive justice for women living with HIV -- and really for men living with HIV too, because more and more men are wanting to parent or have kids. Whether they're single, in a same-sex relationship or whatever kind of relationship they're in, a lot of men who have sex with men who are HIV positive are also contacting us wanting to know about options for having kids. This is becoming a really big issue and it's not really covered anywhere in the strategy.

You also asked what I was excited about in this strategy. I'm excited about the linkage that's being made between employment, economic justice and HIV. The presidential memo specifically calls for a review. It calls for the Equal Employment Opportunities Commission to provide a report within 150 days of opportunities to increase employment and reduce discrimination in employment settings for people with HIV. That is very much a step in the right direction. HIV is a sentence to a life of poverty for a lot of people simply because they end up being shut out of the workforce. So that's not really necessary. There are a lot of cruel disability statutes that perpetuate that cycle that need to be addressed. But this is hopefully a step in the right direction.

Olivia Ford is TheBody.com's community manager.