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TAGline Fall 2013


Fall 2013

The Domestic Issue:

Rising to the Domestic Challenge
By Mark Harrington
The past decade has brought astonishing developments in HIV disease management...Yet the U.S. epidemic continues unabated. Roughly 50,000 U.S. residents are newly infected every year (with a recent 22 percent increase among young gay and bisexual men). Of all U.S. residents living with HIV, one in five is unaware of having been infected; only one in four has an undetectable viral load; and less than half are in continuous care.

We are at a stalemate. This issue of TAGline underscores TAG’s commitment to ending AIDS in the United States and realizing the goals of the National HIV/AIDS Strategy.

U.S. TB Control: From Confidence to Crisis
Funding cuts and shifting budgetary priorities threaten tuberculosis gains - By Coco Jervis
The United States is losing ground in its fight against the tuberculosis (TB) epidemic within its own borders. Sequestration and shifting priorities of Congress and the Obama administration have led to a waning of political support and resources for domestic and global TB programs...Perceived low prevalence, coupled with a lack of political vigilance and declining federal and state resources for TB control and elimination, has set the stage for a dangerous and costly resurgence of domestic TB.

An Obligatory Overhaul to Address Domestic TB Drug Shortages
Bold strategies are required to remedy frequent stock-outs and supply interruptions
- By Lindsay McKenna
Drug shortages, especially of tuberculosis (TB) drugs, have become increasingly common in the United States. Over the past year alone, the U.S. Centers for Disease Control and Prevention (CDC) has reported shortages (also referred to as stock-outs or supply interruptions) of various TB products including second-line injectables (capreomycin and amikacin), required to fight drug-resistant TB (DR-TB)­, and tubersol and aplisol, important products for TB diagnosis.

A Commitment to the HIV Continuum of Care
President Obama orders multiagency cooperation to achieve National HIV/AIDS Strategy goals, but without required funding commitment
- By Scott Morgan
If the United States is to effectively move toward the 2015 goals outlined in the National HIV/AIDS Strategy (NHAS) through the scale-up of evidence-based strategies and practices intended to maximize engagement in care and treatment outcomes, tighter collaboration between various federal agencies will be required. A critical step to accomplish this was made on July 15, when President Obama issued an executive order establishing the HIV Care Continuum Initiative, which mandates the creation of a working group that crosses federal agencies to work toward these goals.

Engagement in Care: A Final Frontier of HIV Medicine
Getting more HIV-positive people linked to and retained in care requires innovation and research
- By Tim Horn
Viral-load suppression remains the holy grail of HIV care. Its associations with AIDS-free survival and a profound reduction in transmission risk are well established. To maximize the odds of getting viral load undetectable and keeping it there, numerous safe, effective, and miraculously simplified HIV drugs and fixed-dose combinations have been developed and approved. But there’s a problem: far too many people living with HIV in the United States—and elsewhere around the world—aren’t accessing the care they need to benefit from the personal and public health benefits of antiretroviral therapy.

Toward a Plan to End AIDS in New York State
A coalition of community groups push to end AIDS at the epicenter of the U.S. epidemic
Beginning in January 2013, a coalition of New York HIV/AIDS leaders came together to begin a series of discussions to reenvision the state’s HIV/AIDS response. The goal was to encourage the state government to develop a New York State plan to end AIDS, applying the latest science, and building on implementation of the Affordable Care Act (ACA).

HIV Prevention Is the Surest Way to Fight AIDS
ACT UP/NY demands Department of Health accountability at the epicenter of the U.S. epidemic and commits to reinvigorate the national prevention agenda - By Jim Eigo and James Krellenstein, ACT UP/NY
Before Hillary Clinton stepped down as secretary of state, she presided over the official November 29, 2012, release of PEPFAR Blueprint: Creating an AIDS-Free Generation... Twenty days later, however, another arm of the U.S. government released another document. Some news it contained struck a discordant note with Secretary Clinton’s battle cry. After reading it, many wondered if we hadn’t somehow traveled back to the dark early years of the epidemic.

TAG’s Commitment to HIV Prevention - By Tim Horn
Though the number of new HIV infections in the United States is down from its peak in the 1980s, incidence has refused to budge below its decade-long average: roughly 50,000 American residents are infected with the virus every year. While advocacy is making significant progress in terms of scaling up HIV testing, engagement-in-care and treatment for people living with the virus—all stages of the HIV care continuum that can help prevent ongoing transmission of HIV—little has been done to see key prevention goals of the National HIV/AIDS Strategy implemented and achieved.

Emerging Regulatory Issues in HIV Cure Research
The science of discovery comes with ethical challenges in human clinical trials
- By Richard Jefferys
Over the past several years, there has been a welcome invigoration of the research effort to cure HIV infection. The mainstream media has picked up on this development, and stories about putative or possible cures are appearing more frequently than in the past. Contrary to the impression conveyed by some of these stories, a cure is not likely to announce itself by leaping from a scientist’s test tube waving a flag of victory. To prove their worth, potential curative strategies—whether based on a single approach or a combination—will need to be evaluated in human trials.