Dr. Ronald Valdiserri

As we continue to work within and outside of the Department of Health and Human Services (HHS) to pursue the goals of the National HIV/AIDS Strategy (NHAS), we are assessing HIV-focused programs and resource allocations to make sure that they are aligned with the priorities spelled-out in the NHAS . These efforts include a review of the Secretary’s Minority AIDS Initiative Fund (SMAIF).

The Minority AIDS Initiative (MAI) was established in 1999 in response to growing concern about the impact of HIV/AIDS on racial and ethnic minorities in the United States. The year before, the President had declared HIV/AIDS to be a severe and on-going health crisis in racial and ethnic minority communities. Subsequently, the Administration, HHS, the Congressional Black Caucus , and the Congressional Hispanic Caucus collaborated to develop the MAI. Beginning in FY1999, the MAI provided new funding with the principal goals of improving HIV-related health outcomes for racial and ethnic minority communities disproportionately affected by HIV/AIDS and reducing HIV related health disparities. These resources are intended to complement, rather than replace, other Federal HIV/AIDS funding and programs.

The bulk of the funds (approximately $367 million in FY2011) are Congressionally appropriated directly on a non-competitive basis to agencies within HHS including the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), Office of Minority Health (OMH), and Office on Women’s Health (OWH). Using these base funds, HHS agencies, in turn, provide resources to community-based organizations, faith communities, research institutions, minority-serving colleges and universities, health care organizations, state and local health departments, and correctional institutions to help them address the HIV/AIDS epidemic within the minority populations they serve.

The MAI also allocates resources to the HHS Office of the Secretary for the Secretary’s MAI Fund (SMAIF). Those resources (approximately $53 million in FY2011) are distributed on a competitive basis to HHS agencies and staff offices to support HIV prevention, care and treatment, outreach and education, capacity building, and technical assistance activities.  Activities funded through the SMAIF are positioned to complement other MAI-related activities being supported through MAI base funding and are often demonstrations of new approaches to addressing HIV/AIDS in minority communities.  In the past, HHS agencies and offices have submitted proposals for the SMAIF in response to general directions from an internal Steering Committee. The Office of HIV/AIDS Policy (OHAP) administers the Secretary’s Fund on behalf of the Office of the Assistant Secretary for Health (OASH), and the awards are approved and made by the Assistant Secretary for Health.

With the release of the NHAS in July 2010, the White House signaled the need for critical review and, where appropriate, restructuring within our Federal HIV programs.  The Strategy’s Federal Implementation Plan specifically asked OASH to “work with the relevant HHS agencies to consider ways to enhance the effectiveness of prevention and care services provided for high-risk communities, including services provided through the Minority AIDS Initiative.” But even before the release of the NHAS, a program evaluation conducted by John Snow, Inc. (JSI) , completed in spring 2010, suggested that SMAIF funding decisions should be more clearly tied to demonstrated outcomes.  According to Dr. Timothy Harrison, a senior program analyst in OHAP who has worked for several years coordinating SMAIF activities, “The evaluation conducted by JSI was very consistent with what we read in the NHAS. Namely, JSI recommended that we improve cross-agency collaborations, move toward more uniform reporting requirements across grantees, and tighten the scope and focus of the SMAIF to achieve better outcomes.”

We have already made some changes in FY2011 to the program management of SMAIF, in line with the findings of the program evaluation and the direction provided by the NHAS.  Key changes include:

• Placing a greater emphasis on projects that will be done in collaboration across agencies and offices.
• Specifically requiring that submitted proposals align with the priorities of the NHAS.
• Providing new guidance on HIV testing metrics so that all SMAIF recipients are using standard measures that are consistent with those used by CDC.
• Identifying standardized metrics for training activities.
• “Carving out” $15.5 million of the SMAIF funds to specifically support HIV prevention, treatment and care activities serving racial and ethnic minority populations in the 12 cities most heavily impacted by HIV/AIDS. Those activities will be coordinated by CDC, HRSA and SAMHSA.

We continue to dialogue with partners inside and outside of government about how best to utilize the SMAIF to reduce HIV infections among racial/ethnic minorities and to ensure that those who are infected with HIV are diagnosed in a timely manner and promptly referred into high quality, life-extending care.  In future posts, we will provide information on the activities supported by the FY2011 MAI Fund, as well as our strategic thinking on the future use of the MAI Fund in FY2012 and beyond.

In the meantime, what are your thoughts about these efforts to align the SMAIF with the NHAS? Share your feedback in the comments section below.