Sec. 742. Findings

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The Congress finds the following: Over one million people are estimated to be living with HIV in the United States according to the Centers for Disease Control and Prevention, 16 percent of whom are unaware of their HIV-positive status. Annually there are over 50,000 new HIV infections and 20,000 deaths in people with an HIV diagnoses in 50 States and 6 dependent areas of the United States. The Centers for Disease Control and Prevention estimates that in 2010 there were approximately 47,500 people newly diagnosed with HIV.

Though this number seems to be staying relatively stable, the number of new infections is rapidly increasing among certain populations especially among young African-American men who have sex with men (MSM). CDC data show that since 2006, HIV incidence has increased among Black and Latino gay men/MSM, notably those aged 13 to 24 years. Even more concerning is that there are more new HIV infections among young African American gay men/MSM than any other subgroup of gay men/MSM.

HIV disproportionately affects certain populations in the United States. Though African-Americans represent approximately 14 percent of the population, African-Americans account for almost half (44 percent) of all people living with HIV in the United States. Men who have sex with men

(MSM)make up approximately 4 percent of the population, but account for 78 percent of all new HIV infections and are the only risk group in which HIV infections continue to increase. Disparities exist among Latinos/Hispanics; they make up 16 percent of the United States population and 21 percent of new infections (2010). Though American Indians/Alaska Natives represent less than 2 percent of the total number of HIV/AIDS cases, American Indians and Alaska Natives rank fifth in rates of HIV/AIDS diagnosis, still higher than their White counterparts. While Asian-Americans, Native Hawaiians, and Pacific Islanders HIV/AIDS cases account for approximately 1 percent of cases nationally, between 2010 and 2011, the rate of new HIV diagnoses increased for Asian-Americans by 22 percent. The latest data from the CDC

(2013)indicate that women account for 1 in 5 (20 percent) new HIV infections in the United States. Women of color, particularly Black women, have been especially hard hit and represent the majority of women living with the disease and women newly infected. In addition, Black women accounted for nearly two-thirds (64 percent) of all estimated new HIV infections among women, while only accounting for 13 percent of the female population; White women accounted for 18 percent and Latinas 15 percent of new infections among women. The history of HIV shows that culturally relevant and gender-responsive supportive services, including psychosocial support, treatment literacy, case management, and transportation are necessary strategies to reach and engage women and girls in medical care. The limited data available on transgender individuals point to a disproportionate burden of HIV infection. Stigma and discrimination contribute to these disparities. The Centers for Disease Control and Prevention has determined that increasing the proportion of people who know their HIV status is an essential component of comprehensive HIV/AIDS treatment and prevention efforts and that early diagnosis is critical in order for people with HIV/AIDS to receive life-extending therapy. Additionally, the Centers for Disease Control and Prevention recommend routine HIV screening in health care settings for all patients aged 13 to 64, regardless of risk. In 1998, Congress created the National Minority AIDS Initiative to provide technical assistance, build capacity, and strengthen outreach efforts among local institutions and community-based organizations that serve racial and ethnic minorities living with or vulnerable to HIV/AIDS. To combat the HIV epidemic in the United States, the National HIV/AIDS Strategy

(NHAS)from the White House Office of National AIDS Policy provides a framework of increasing access to care, reducing new infections, and eliminating HIV-related health disparities. The vision of NHAS is The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, gender identity, or socioeconomic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination. . In recent years, several thousand people across the country were waiting to receive AIDS treatment through the AIDS Drug Assistance Program authorized by the provisions popularly known as the Ryan White CARE Act. At present, 32 States and 2 United States territories have criminal statutes based on exposure to HIV. Most of these laws were adopted before the availability of effective antiretroviral treatment for HIV/AIDS. Although the cost of education, treatment and care, and research are not inconsequential, they are substantially less than the annual health care cost attributable to HIV in the United States. The lifetime cost of HIV care and treatment was estimated to be $326,500 to $435,000 dollars in a lifetime. Preventing 50,000 new infections in the United States each year could save $22 billion. According to the Centers for Disease Control and Prevention (CDC), latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV. Latex condoms also reduce the risk of other STIs. Despite the effectiveness of condoms in reducing the spread of STIs, the Bureau of Prisons does not recommend their use in correctional facilities. The distribution of condoms in correctional facilities is currently legal in certain parts of the United States and the world. The States of Vermont and Mississippi, the District of Columbia, and the cities of New York, San Francisco, Los Angeles, Washington, DC, and Philadelphia allow condom distribution in their correctional facilities. However, these States and cities operate fewer than 1 percent of all correctional facilities. Many correctional facilities in the United States do not provide comprehensive testing and treatment programs to reduce the spread of STIs. Fewer than half of correctional facilities provide counseling to HIV-positive incarcerated persons. Incarcerated individuals living with HIV/AIDS who are eligible for Medicaid would benefit from prompt and automatic enrollment upon their release in order to ensure their continued ability to access health services, including antiretroviral treatment. Research shows that stable housing leads to better health outcomes for those living with HIV. Inadequate or unstable housing is not only a barrier to effective treatment, but also increases the likelihood of engaging in risky behaviors leading to HIV infection. Insecure housing puts people with HIV/AIDS at risk of premature death from exposure to other diseases, poor nutrition, and lack of medical care. Due to advances in treatment, many people living with HIV/AIDS (PLWHA) today are living healthy lives and have the ability and desire to fully participate in all aspects of community life, including employment. Research associates being employed with tremendous economic, social, and health benefits for many people living with HIV/AIDS. The common benefits associated with employment include income, autonomy, productivity, and status within society, daily structure, making a contribution to one’s community, and increased skills and self-esteem. Research also indicates that many people with disabilities, including PLWHA, report perceiving themselves as being less disabled or not disabled at all, when working. Furthermore, some studies link working with better physical and mental health outcomes for PLWHA when compared to those who are not working. Preliminary data also suggest that transitioning to employment is associated with reduced HIV-related health risk behavior for many people. On July 16, 2012, the Food and Drug Administration approved the first drug to reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners.