The CHAC Strategic Plan Workgroup provided recommendations for revising the domestic goals in the original 2001 Plan, and suggested several major considerations.

Recommendations Regarding Goals and Objectives

CDC identified a short-term goal through 2010 and chose to call the four original domestic goals short-term milestones in this Extended Plan. CDC modified short-term milestones 1-3 and extended all four milestones to 2010. The Workgroup recommended deleting the original Goal 4, "By 2005, strengthen the capacity nationwide to monitor the epidemic, develop and implement effective HIV prevention interventions and evaluate prevention programs.” CDC, however, retained that goal (as short-term milestone 4) because the ability to measure progress toward the overall short-term goal and other milestones articulated in the Extended Plan rely on the ongoing capacity to perform surveillance and evaluation activities. To revise the milestones, CDC reviewed and analyzed information from several resources including: trends in HIV diagnoses, behavioral surveillance data; data on risk behavior among people living with HIV; proportion of people at risk for HIV; reach of HIV prevention interventions; and implementation of the “Revised HIV Testing Recommendations for Adults, Adolescents, and Pregnant Women in Health-Care Settings.”

Of the 34 new objectives recommended by the Workgroup, CDC incorporated more than half (12 new objectives and 13 modified objectives). CDC did not incorporate the others as they were duplicative or were not within the mission of CDC. Specifically, CDC added new objectives and modified existing objectives as follows:

•  Made more explicit the focus on African-American and MSM communities.
• Added new objectives that
  • address advances in understanding about the importance of acute HIV infection, the role of incarceration in the HIV epidemic, and technical advances in HIV rapid testing.
  • underscore the priority to increase HIV screening in medical care settings.
  • reflect recent data about disparities in knowledge of one’s HIV infection, especially among MSM.

Recommendations Regarding Implementation

The Workgroup also cited lack of support for the 2001 Plan from some partner groups, and made an overarching recommendation that there be increased partnering with the medical community and the private sector. Partnerships have always played a key role in progress toward HIV prevention in the United States, and both traditional and expanded partnerships will be essential to efforts to accelerate progress. CDC began building public/private partnerships with multiple sectors in the late 1980s, including efforts to engage leaders from the business and faith community, civic and social organizations, media and entertainment, philanthropy, and labor in the collective fight against HIV. These programs have evolved and been built to address emerging challenges over time, with a particular emphasis on ensuring reach and impact among minority populations disproportionately impacted by HIV. In recent years, CDC has had a particular focus on expanding partnerships necessary to implement recommendations for routine HIV testing in health-care settings and to accelerate progress in reducing new infections among African Americans. The success of these efforts requires deepening and expanding relationships with the traditional medical community and with African-American leaders from all sectors of society. Since the release of the Revised HIV Testing Recommendations in 2006, CDC has engaged in an intensive effort to assist stakeholders in preparing to implement HIV screening in health-care settings. CDC has engaged community partners, grantees, other federal agencies, the private sector, and state and local health departments in this process. Several examples include working with the Health Resources and Services Administration (HRSA), the National Association of Community Health Centers, the American Hospital Association, and a wide range of professional medical associations to increase the number of clinical sites that offer HIV testing as part of routine medical care and to develop referral and linkage procedures for HIV-infected and high-risk uninfected persons to additional prevention and treatment services. CDC also is collaborating with the Substance Abuse and Mental Health Services Administration

(SAMHSA) on implementation plans for HIV screening in substance abuse treatment programs. To accelerate prevention progress in reducing infections among African Americans, CDC is working to both build upon existing partnerships and programs and make new connections with African-American leaders who have the power and influence to expand the reach of HIV prevention to more at-risk African Americans. Additionally, CDC and state and local health departments are expanding efforts to partner with African-American small businesses in multiple cities to reach their communities with HIV prevention information and links to testing services. To further engage new partners in the fight against HIV and AIDS, CDC held a meeting in March 2007 to bring together a range of African-American leaders from all walks of life to discuss additional actions that entertainers, civic leaders, business leaders, and the faith community can take to intensify HIV prevention efforts for African Americans. Building upon these efforts will continue to be a key CDC priority to implement this Expanded Plan.

Recommendations Regarding Stigma and Discrimination

The Workgroup also recommended adding a goal focused on stigma and discrimination. CDC recognizes that interventions to reduce stigma and discrimination are important and need to be addressed. While CDC did not include a specific goal on these issues, the Extended Plan addresses stigma and discrimination in several objectives. Given the difficulty of measuring the impact of stigma and discrimination on HIV transmission, CDC will also continue to investigate effective models for discerning behavior change associated with reducing stigma and discrimination.

CDC is also addressing stigma and discrimination through the Revised Recommendations for HIV Testing, which call for HIV screening in health-care settings for all persons aged 13-64. By making HIV testing a routine part of medical care for everyone – rather than targeting certain individuals based on perceived risk behavior – these recommendations help to further reduce stigma and discrimination. Research shows that more patients accept HIV testing when it is offered routinely to everyone.

Additionally, the accelerated community mobilization begun in March 2007 as part of the Heightened National Response to the HIV/AIDS Crisis among African Americans will work to reduce stigma by encouraging an open dialogue about HIV/AIDS in places where African Americans live, work, play, and worship. Connecting HIV/AIDS prevention to broader efforts to reduce stigma, discrimination, racism, homophobia, joblessness, sexual violence, homelessness, and substance abuse can play a key role in reducing the impact of HIV/AIDS among African Americans. Together with its partners, CDC hopes to change the community perceptions that inhibit those at risk from seeking early HIV diagnosis and treatment and adopting healthy behaviors that prevent the spread of HIV.