As you may already know, President Obama has committed to developing a National HIV/AIDS Strategy (NHAS) that has three major goals: reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities. The White House Office of National AIDS Policy (ONAP), the office responsible for developing the NHAS, has been hosting community discussions for public input on the development of the strategy. There are many barriers and challenges in preventing HIV and hepatitis as well as complex care issues for  people living with HIV and hepatitis; some of which overlap. However, given that this strategy focuses on HIV, the most appropriate way for viral hepatitis to be included in the strategy is by focusing on the people who are living with and at-risk for both HIV and viral hepatitis.

Help ensure that the NHAS fully addresses people living with and at-risk for both HIV and viral hepatitis by voicing your concerns at the community discussions. The community discussions present one way that we can engage and inform our policymakers about viral hepatitis through the context of co-morbidities with HIV.

ONAP has launched a website where you can see the remaining community discussions for the NHAS. You can also submit testimony and/or supporting documents through the website.  The following community discussions are coming up:

October 26, 2009       Columbia, SC
November 1, 2009    Oakland, CA
November 6, 2009    Puerto Rico
November 9, 2009    Virgin Islands
November 16, 2009  Jackson, MS
November 20, 2009  Ft. Lauderdale, FL
December 4, 2009     New York, NY

You will need to be one of the first people in line in order to be heard and will only have 60 seconds to express your thoughts. This is why it is so important that you prepare and practice your comments ahead of time. The HIV Prevention Justice Alliance has developed a very effective worksheet to help you prepare: Tips to Form Effective Community Testimony to Shape a Results-Oriented National HIV/AIDS Strategy. We strongly encourage you to fill out this worksheet but with viral hepatitis co-morbidity talking points rather than HIV-specific talking points.

We also encourage you to submit comments online. The following talking points can help you in framing your comments, and we encourage you to talk about the barriers and challenges in your area to accessing prevention and care services, particularly as they relate to HIV co-infection, or prevention for persons at risk for both HIV and viral hepatitis.

We have provided you some talking points below for you to use as well as to give you some ideas. Ryan Clary of Project Inform in San Francisco, CA, and Colin Schwartz of the National Alliance of State and Territorial AIDS Directors (NASTAD) in Washington, DC, are happy to help you develop your comments if you have any questions or concerns.

Background
Before you discuss these co-morbidities, keep in mind that the audience may not know what viral hepatitis is; a clear and concise definition of viral hepatitis at the beginning of your comments can help ONAP as well as other community discussion participants understand your concerns. Please use any of the following in your definition:

• Viral hepatitis attacks the liver and can lead to chronic liver disease, cirrhosis, liver cancer and liver failure. It is the most common cause of liver disease, which is one of the most lethal, expensive and fastest rising cancers in America.
• Viral hepatitis is a leading cause of death among Americans co-infected with HIV and viral hepatitis.
• Nearly 30% of HIV-positive persons are co-infected with hepatitis C and nearly 10% of HIV-positive persons are co-infected with hepatitis B.
• Many Americans who are at risk of contracting HIV are also at risk of contracting viral hepatitis; for instance injection drug users are far more likely to contract hepatitis C than HIV and hepatitis B can be transmitted more easily through sexual activity than HIV.
• It is recommended that all persons living with HIV be tested for hepatitis C and vaccinated against hepatitis A and B, yet there is no federal program to test and vaccinate Americans at risk.

Challenges
There are various challenges you can bring to ONAP’s attention in terms of the barriers that people living with viral hepatitis experience:

• State and city budget cuts to HIV programs hurt other programs such as viral hepatitis.
• Since there is little dedicated funding to viral hepatitis prevention and no comparable Ryan White program for Americans mono-infected with viral hepatitis, these services more often than not rely on HIV programs and their capacity and infrastructure to operate.
• The federal funding ban on syringe exchange programs hurts people at risk for HIV and hepatitis C. These are cost-effective and scientifically-proven programs that reduce incidence of these infectious diseases among injecting drug users.

Recommendations

• An NHAS that seeks to reduce HIV morbidity benefits in reducing incidence of co-infection of viral hepatitis among HIV-positive Americans by ensuring those at risk for both diseases receive comprehensive prevention messages as well as routine screening, hepatitis A and B vaccination and access to care. 
• The NHAS is an opportunity for collaboration across government agencies, HHS, and the Administration to focus on not only HIV but the syndemics that occur with HIV. Issues such as co-infection with viral hepatitis must be included in the process. Simple recognition of viral hepatitis co-morbidity with HIV and its associated health disparities is crucial to the development of a comprehensive NHAS.

[INTRODUCTION:] I’m a gay African American man from Los Angeles who has been living with HIV and hepatitis C for 10 years.

[ISSUE RELATES TO:] I’m concerned about the NHAS not including viral hepatitis in the strategy. Hepatitis B and C can cause liver cancer and are a leading cause of death in people living with HIV in our country.

[MY CONCERN:] If we are to improve health outcomes and reduce HIV-related health disparities, I believe that we need to ensure that HIV-positive people at risk for viral hepatitis get proper counseling and testing and receive the hepatitis A and B vaccination to prevent infection and prevent them from unknowingly transmitting the virus to others, as well as ensuring that those who are infected with both HIV and viral hepatitis are properly medically managed.

[SOLUTIONS:] I propose that the NHAS include strong language around developing and supporting viral hepatitis counseling, testing, referral, and hepatitis A and B vaccination programs for people living with HIV.

[RESPONSIBILITY:] The federal government must develop more models, fund them, and coordinate with state and local public health and other entities to make sure that viral hepatitis is prioritized.

[CLOSING:] My greatest wish is that the NHAS not only accomplishes the prevention of new infections of HIV and viral hepatitis but also prevents both sickness and death from hepatitis-related liver disease among HIV-positive Americans.