When the United States helps other countries address their HIV/AIDS epidemics, we require that the country's government develops a national strategy that provides a roadmap for effective delivery of services and steadily improved results.   Despite this requirement, however, the U.S.  has never had a comprehensive national AIDS strategy of its own, even though our government committed to having one when it signed the United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS in 2001.  
   
This is in spite of the fact that our HIV epidemic is far from over. HIV/AIDS remains one of the most significant public health issues in the US, a disease that exploits inequities in our society and reveals many of the complex challenges facing our health care system. Over a million people in the US are now living with HIV/AIDS, and over half a million have died since the beginning of the epidemic.  Moreover, it is estimated that half of the people living with HIV/AIDS in the richest country in the world are not receiving lifesaving care.  Many people are diagnosed with HIV late in the course of disease, losing the benefit of early treatment.  Nearly four out of 10 people who tested HIV-positive in 2004 received a diagnosis of AIDS fewer than 12 months later.  And troublingly, the US epidemic is characterized by severe racial disparities.  African Americans represent 13% of the US population but nearly half of all new HIV infections. 
   
This data points to the fact that the United States epidemic demands a more effective, strategic approach to reducing the number of new infections and extending the lives of people living with HIV/AIDS.  Many federal HIV/AIDS programs have proven highly effective.  Nonetheless, the US response to HIV/AIDS is a patchwork of uncoordinated programs. Numerous government and private studies have pointed to the need for better planning of HIV/AIDS policy and programming.  In 2004, the Institute of Medicine determined that fragmentation of insurance coverage, and differing eligibility requirements and services across states is prohibitive to ensuring comprehensive and sustained access to quality HIV care in the US. And in 2007, a federal government rating system determined that the US Centers for Disease Control and Prevention domestic HIV prevention efforts are not performing and results are not demonstrated. 
   
Recognizing this, a group of more than one hundred organizations from across the United States, including the San Francisco AIDS_Foundation, have come together to form the National AIDS Strategy campaign, calling for the next President to commit to ending the AIDS epidemic in America. We have requested that every Presidential candidate commit to developing a results-oriented national AIDS strategy designed to significantly reduce HIV infection rates, ensure access to care and treatment for those who are infected, and eliminate racial disparities. 
   
So far the campaign has had some great successes with all of the leading Democratic Presidential candidates, as well as Republican candidate, Mike Huckabee, releasing their own HIV/AIDS plans (which can be found at www.nationalaidsstrategy.org/). The effort will continue beyond the presidential election, so stay tuned and get involved.