One of the major stakeholders in the process of devising any public policy is the government, and HIVAIDS is no exception. There is a reason behind it governments are concerned about well-being of their citizens, since they have been entrusted with the task to protect their basic rights and guarantee a decent standard of living. However, the government is a very broad concept a more detailed examination of which organs and agencies are dealing with the issue of HIVAIDS is necessary. Without any doubt, the U.S. Congress is responsible for creating laws which lay down the overarching framework for dealing with the problem, while the White House creates general conditions for the implementation of these laws.
One of the priorities of the President Obamas term in office is containing the spread of the virus and helping Americans living with it. To this end, the National HIVAIDS Strategy was created it is aimed at lowering HIV incidence and related health disparities, making healthcare more accessible for people living with HIVAIDS, and optimizing the use of healthcare resources. Within the federal government system, there are three bodies responsible for the implementation of the strategy. They are the White House Office of National AIDS Policy (ONAP), U.S. Department of Health and Human Services Office of HIVAIDS Policy (OHAP) and the Presidential Advisory Council on HIVAIDS (PACHA).
Although their functions and competencies sometimes overlap, all of them have different missions. For instance, the White House Office of National AIDS Policy (ONAP) will oversee the process of developing the strategy, and will be soliciting input through a series of community discussions and new media activities. ONAP works to coordinate an increasingly integrated approach to prevention, care, and treatment of HIVAIDS and emphasizes the integration of domestic and international efforts to combat HIVAIDS (AIDS.gov, 2009, para. 4). The Office of HIVAIDS Policy (OHAP) advises the Assistant Secretary for Health and senior HHS officials on the appropriate and timely implementation and development of HIVAIDS policy, the establishment of priorities, and the solid implementation of HIVAIDS programs, activities, and initiatives across other HHS health agencies (AIDS.gov, 2009, para. 6), while the Presidential Advisory Council on HIVAIDS (PACHA) provides information on past and upcoming events, reports, and policy recommendations (AIDS.gov, 2009, para. 7).
Another important player in all policy areas in the U.S. is state government. While policies or ways to implement federal policies at the local level may differ considerably, most states have some agency or at least a strategy for combating the dissemination of HIVAIDS and improving access to healthcare resources. It is usually state department of heath broadly responsible for addressing the issue. Some state governments establish special divisions or task forces to prevent the spreading of HIVAIDS. For example, Virginia Department of Health has a Division of Disease Prevention which provides leadership and support to local health departments, other medical providers and community-based organizations in the prevention, surveillance and treatment of HIVAIDS and other transmittable diseases (Virginia Department of Health, 2009, para. 1). Texas has a Department of Health Bureau of HIV and STD Prevention (Official Portal of Texas, 2008). California Department of Public Health has an Office of AIDS (State of California, 2007).
Partnerships between state government and community are very common for example, the California HIVAIDS Planning Group (CHPG) provides community perspectives, advice, and recommendations to the California Department of Public Health, Office of AIDS (CDPHOA) in the planning and development of programs and allocation of resources (Office of AIDS of the California Department of Public Health, 2008, p. 1). The New York City Prevention Planning Group (PPG) is charged with ensuring ongoing input from the diverse communities of New York State that are infected, affected and impacted by HIVAIDS (New York Department of Health, 2009, New York State HIV Prevention Planning Group, Program Description, para. 4). Such partnerships can be regarded as a distinct category of stakeholders influencing the formulation of the policy on the one hand, they are different from public authorities, on the other hand. they are not community organizations per se.
International organizations, such the United Nations and World Health Organization, also play a role in policy formulation in the Unites States. Despite the country is reluctant to accept the authority of international organizations over domestic political issues, the U.S. does not miss out on the opportunity to benefit from technical cooperation.
Think tanks can be identified as the fifth category of stakeholders which influence the formulation of the policy on HIVAIDS. For example, a paper titled Methodology for effective HIVAIDS policy formulation was presented at the International Conference on AIDS in 2004 by Mr. McCadney of the U.S. National Institutes of Health (2009). In general, the mission of a think tank is to provide objective, unbiased information on various policy issues in the U.S., there is a tradition of think tanks being funded by lobbies or political parties, which has a bearing on their objectivity.
Finally, the last but definitely not least actor is a community based organizations (CBO). Such organizations exist in a variety of shapes and sizes and can represent either people living with HIVAIDS or members of a local community concerned about the spread of HIVAIDS. They can be working to spread HIVAIDS awareness among youth, communities of color, or sexual minorities they are often faith-based. The emphasis has been made on CBOs rather than NGOs, given that American NGOs active in the field of HIVAIDS are usually development-oriented and help other counties, mostly in Africa, to combat the AIDS epidemics.
While it might appear that it is important to include healthcare providers and organizations in the list, such organizations are mostly responsible for policy implementation rather than formulation CBOs, public agencies and partnerships between government and community often seek their input into their policy proposals.
As for the factors which influence policy making in different contexts such as prevention, access to care, treatment, and payment options they need to be examined separately for each category. In terms of HIV prevention, the two main categories of prevention message recipients are young people and at-risk groups, mostly intravenous drug users. For young people, the main factor is sex education regardless of whether it teaches abstinence or contraception, it should be designed to inform young people about the ways of contracting HIV, identifying the virus, and seeking help. For drug users, both information campaigns and needle exchange programs are necessary.
In terms of access to care, the issue of testing and the problem of social stigmatization should be discussed. Testing is the first step towards getting in contact with the healthcare system, and this is of high importance if the results are positive. Testing should be free, anonymous, and accessible to all mobile laboratories within at-risk communities are a good example. Pretest and posttest counseling should be available, and users should be given information on where to seek further advice and treatment. Another factor is social stigma some people living with HIV are unaware of it due to fear of getting tested because of ensuing discrimination. The most vulnerable group here comprises females, mostly teenage, especially rape victims. This problem can be overcome by discussing the issue of HIVAIDS in public, removing stigma associated with it, and eradicating discrimination against people living with the virus.
As for treatment, two factors are at play first of all, choosing the right therapy program, and secondly, making necessary lifestyle changes. Most Americans living with HIVAIDS nowadays have access to triple combination therapy (Avert, 2009), while they still should make changes to their nutrition and way of life to avoid opportunistic infections.
As for payment options, there are two ways Americans can receive funding for antiretroviral drugs either through an insurance plan, or though other sources, such as Medicaid, Medicare, and funding provided by the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act (Avert, 2009), although it is necessary to note with regret that funding allocated trough these sources is often not enough to cover the full costs of treatment.
Two factors here are that employers should be prohibited from inquiring about HIV status of a potential employee and basing their hiring decision on it, which is always associated with insurance costs, and that underinsured citizens should be given more opportunities to afford expensive medications, for instance through taking part in trials of new antiretroviral drugs (Avert, 2009). Eradicating racial and income disparities in access to AIDS treatment is the priority of the current administration.
The conclusion that can be made is that a variety of stakeholders influence policymaking with regard to HIVAIDS in the U.S. First of all, various federal agencies work to implement the National HIVAIDS Strategy they are the White House Office of National AIDS Policy (ONAP), U.S. Department of Health and Human Services Office of HIVAIDS Policy (OHAP) and the Presidential Advisory Council on HIVAIDS (PACHA). At the level of state government, each states department of health has set up its own agency or task force to address the issue. International organizations and think tanks supply expertise, policy recommendations, and policy analysis. Partnerships between public authorities and communities ensure that users needs and preferences are taken into account when designing polices. Finally, community based organizations play an active role in informing citizens about the virus, helping those living with it, and mobilizing resources to fight the disease.
The major challenges the policy on HIVAIDS should address is making testing and treatment available to all, informing schoolchildren through sex education, providing needle exchange programs for drug users, alleviating social stigma associated with the disease, and prohibiting all forms of HIVAIDS-related discrimination, especially in the workplace.
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