The Public Health Strategic Health Care Group (PHSHG) encourages all VHA health care providers and employees to remember that December 1 is World AIDS Day. This year's theme is "Working Together." This theme, embraced by providers and communities around the world, is especially relevant to providers in the VA health care system. In 2009, VA provided care to 23,000 Veterans living with HIV/AIDS. As such, we are leaders in the field when it comes to comprehensive care and treatment of persons with HIV/AIDS--especially older individuals.

VHA recognizes the importance of helping to make every Veteran aware of the benefits of early diagnosis of HIV and encouraging routine testing. For Veterans who are concerned that they may be at risk but worried about getting tested, encourage them that "It's better to know..." as early treatment can prevent damage to their immune system and can help them prevent transmission of HIV to others. The goal is to make sure that every Veteran who wants to get tested for HIV and know his or her status gets tested. Recent changes in federal law and VHA policy have removed requirements for written informed consent for HIV testing. These new policies will encourage many Veterans to learn their serostatus and, if infected, be able to take advantage of the state-of-the-art care offered by the VHA.

VHA health care providers can and do make a difference in HIV care for Veterans. VHA has been a leader in HIV care and research since the earliest days of the epidemic. VHA is the largest single provider of HIV care in the U.S., providing care for nearly 23,000 Veterans with HIV in 2009.

VHA is a full service health care organization, and Veterans with HIV can access care and treatment for HIV infection as well as any other conditions they may have. This is especially important as the availability of effective anti-HIV medications has increased survival. In addition, long term treatment with antiretroviral drugs can increase risk for some conditions including diabetes and high cholesterol. A recent analysis of over 18,000 Veterans receiving HIV care through VHA documented that by age 40, 96% had at least one chronic condition diagnosed along with HIV and that rates of such conditions tend to increase with age. The availability of a full range of primary and specialty care along with ancillary and supportive services required for diagnosis and treatment is an important part of care for Veterans with HIV.

VHA pharmacies provide access to all FDA-approved medications for HIV and also provide a mail-order system which allows many Veterans to have many of their prescriptions delivered right to their door. The VHA's electronic medical record, widely recognized as one of the best available anywhere, allows clinicians to quickly access information about an individual patient's history including results of laboratory testing and pharmacological treatment. VHA also operates the country's largest HIV specific registry, a system that confidentially collects important clinical data on patients with HIV and their care, allowing for tracking and monitoring of trends in HIV within VHA as well as rapid response to emerging scientific information. The Public Health Strategic Healthcare Group also provides electronic tools for local facilities and providers to track and improve care for Veterans with HIV.

It is now estimated that the number of new HIV infections in the U.S. is approximately 56,300. Moreover, it is estimated that over 225,000 Americans are infected with HIV and unaware of their status. Finally, many Veterans with HIV are only learning that they are positive late into the disease after they have suffered permanent immune system damage even though there may have been numerous opportunities for earlier testing that were missed.

To improve the rates of diagnosis, the CDC recommends that testing for HIV be performed as part of routine care in medical settings for all adult patients. In August 2009, VHA changed its policies to allow HIV testing to be performed with verbal informed consent, and to offer HIV testing to all Veterans, consistent with current public health recommendations. Please check this website for current VHA policies on HIV testing.

There is much that can be done to increase the rate of HIV testing among Veterans in care in VA so as to increase early detection as well. For example, providers in primary care, mental health, and substance use treatment clinics should routinely offer HIV testing to all of their patients--stressing the individual benefits of early diagnosis of HIV infection. The offer of HIV testing can be done independent of any discussions about risk for HIV, which helps to "destigmatize" HIV testing and make testing more accessible to patients who are unaware of or misperceive their risk. While in the past, HIV testing was targeted primarily for patient populations with known risk factors, it has now been shown that implementation of routine, voluntary testing in clinical settings where expected HIV prevalence is lower, such as primary care clinics, is likely to be cost-effective and is an important strategy to increase early detection of HIV nationally.

At the national level, VHA maintains a leadership role in promoting the dissemination of the latest scientific information about HIV. Along with nine other federal agencies, VHA participates on the Federal Scientific Collaborative Panel for the American Conference for the Treatment of HIV (ACT HIV)**, a biennial state-of-the-art conference for frontline providers in HIV care. The next meeting will be held in May 2011. VHA facilities throughout the country work in cooperation with local and regional community groups and agencies to coordinate and assure optimal care for persons with HIV. In some areas, VHA facilities provide services in conjunction with local Ryan White programs, and many VA staff members maintain active participation in local efforts to address HIV prevention and care. At the national level, VA operates this publicly accessible internet site providing extensive information for both the general public audience and health care providers on topics ranging from basic information about HIV to treatment decisions to living with HIV.

So, please join VHA and its Federal partners in the international observance of World AIDS Day. Continue to support our Veterans with HIV and their families and honor the year-round efforts of the many VHA health care providers who have made a commitment to prevention of HIV and to providing quality, comprehensive care to those who are living with the disease.