[Federal Register Volume 78, Number 138 (Thursday, July 18, 2013)]
[Presidential Documents]
[Pages 43057-43059]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-17478]



[[Page 43055]]

Vol. 78

Thursday,

No. 138

July 18, 2013

Part III





The President





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Executive Order 13649--Accelerating Improvements in HIV Prevention and 
Care in the United States Through the HIV Care Continuum Initiative
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  Federal Register / Vol. 78, No. 138 / Thursday, July 18, 2013 / 
Presidential Documents  

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 Title 3--
 The President

[[Page 43057]]

                Executive Order 13649 of July 15, 2013

                
Accelerating Improvements in HIV Prevention and 
                Care in the United States Through the HIV Care 
                Continuum Initiative

                By the authority vested in me as President by the 
                Constitution and the laws of the United States of 
                America, and in order to further strengthen the 
                capacity of the Federal Government to effectively 
                respond to the ongoing domestic HIV epidemic, it is 
                hereby ordered as follows:

                Section 1. Policy. Addressing the domestic HIV epidemic 
                is a priority of my Administration. In 2010, the White 
                House released the first comprehensive National HIV/
                AIDS Strategy (Strategy), setting quantitative goals 
                for reducing new HIV infections, improving health 
                outcomes for people living with HIV, and reducing HIV-
                related health disparities. The Strategy will continue 
                to serve as the blueprint for our national response to 
                the domestic epidemic. It has increased coordination, 
                collaboration, and accountability across executive 
                departments and agencies (agencies) with regard to 
                addressing the epidemic. It has also focused our 
                Nation's collective efforts on increasing the use of 
                evidence-based approaches to prevention and care among 
                populations and in regions where HIV is most 
                concentrated.

                Since the release of the Strategy, additional 
                scientific discoveries have greatly enhanced our 
                understanding of how to prevent and treat HIV. 
                Accordingly, further Federal action is appropriate in 
                response to these new developments. For example, a 
                breakthrough research trial supported by the National 
                Institutes of Health showed that initiating HIV 
                treatment when the immune system was relatively healthy 
                reduced HIV transmission by 96 percent. In addition, 
                evidence suggests that early treatment may reduce HIV-
                related complications. These findings highlight the 
                importance of prompt HIV diagnosis, and because of 
                recent advances in HIV testing technology, HIV can be 
                detected sooner and more rapidly than ever before.

                Based on these and other data, recommendations for HIV 
                testing and treatment have changed. The U.S. Preventive 
                Services Task Force now recommends that clinicians 
                screen all individuals ages 15 to 65 years for HIV, and 
                the Department of Health and Human Services Guidelines 
                for Use of Antiretroviral Agents now recommends 
                offering treatment to all adolescents and adults 
                diagnosed with HIV.

                Furthermore, ongoing implementation of the Affordable 
                Care Act provides a historic opportunity for Americans 
                to access affordable, quality health care. The Act is 
                expanding access to recommended preventive services 
                with no out-of-pocket costs, including HIV testing, 
                and, beginning in 2014, insurance companies will not be 
                able to deny coverage based on pre-existing conditions, 
                including HIV. Starting October 1, 2013, Americans can 
                select the coverage that best suits them through the 
                new Health Insurance Marketplace, and coverage will 
                begin January 1, 2014.

                Despite progress in combating HIV, important work 
                remains. Since the publication of the Strategy, data 
                released by the Centers for Disease Control and 
                Prevention show that there are significant gaps along 
                the HIV care continuum--the sequential stages of care 
                from being diagnosed to receiving optimal treatment. 
                Nearly one-fifth of the estimated 1.1 million people 
                living with HIV in the United States are undiagnosed; 
                one-third are not linked to medical care; nearly two-
                thirds are not engaged in ongoing care; and only one-
                quarter have the virus effectively controlled, which is 
                necessary to maintain long-term health and reduce risk 
                of transmission to others.

[[Page 43058]]

                In light of these data, we must further clarify and 
                focus our national efforts to prevent and treat HIV 
                infection. It is the policy of my Administration that 
                agencies implementing the Strategy prioritize 
                addressing the continuum of HIV care, including by 
                accelerating efforts to increase HIV testing, services, 
                and treatment along the continuum. This acceleration 
                will enable us to meet the goals of the Strategy and 
                move closer to an AIDS-free generation.

                Sec. 2. Establishment of the HIV Care Continuum 
                Initiative. There is established the HIV Care Continuum 
                Initiative (Initiative), to be overseen by the Director 
                of the Office of National AIDS Policy. The Initiative 
                will mobilize and coordinate Federal efforts in 
                response to recent advances regarding how to prevent 
                and treat HIV infection. The Initiative will support 
                further integration of HIV prevention and care efforts; 
                promote expansion of successful HIV testing and service 
                delivery models; encourage innovative approaches to 
                addressing barriers to accessing testing and treatment; 
                and ensure that Federal resources are appropriately 
                focused on implementing evidence-based interventions 
                that improve outcomes along the HIV care continuum.

                Sec. 3. Establishment of the HIV Care Continuum Working 
                Group. There is established the HIV Care Continuum 
                Working Group (Working Group) to support the 
                Initiative. The Working Group shall coordinate Federal 
                efforts to improve outcomes nationally across the HIV 
                care continuum.

                    (a) Membership. The Working Group shall be co-
                chaired by the Director of the Office of National AIDS 
                Policy and the Secretary of Health and Human Services 
                or designee (Co-Chairs). In addition to the Co-Chairs, 
                the Working Group shall consist of representatives 
                from:

(i) the Department of Justice;

(ii) the Department of Labor;

(iii) the Department of Health and Human Services;

(iv) the Department of Housing and Urban Development;

(v) the Department of Veterans Affairs;

(vi) the Office of Management and Budget; and

(vii) other agencies and offices, as designated by the Co-Chairs.

                    (b) Consultation. The Working Group shall consult 
                with the Presidential Advisory Council on HIV/AIDS, as 
                appropriate.
                    (c) Functions. As part of the Initiative, the 
                Working Group shall:

(i) request and review information from agencies describing efforts to 
improve testing, care, and treatment outcomes, and determine if there is 
appropriate emphasis on addressing the HIV care continuum in relation to 
other work concerning the domestic epidemic;

(ii) review research on improving outcomes along the HIV care continuum;

(iii) obtain input from Federal grantees, affected communities, and other 
stakeholders to inform strategies to improve outcomes along the HIV care 
continuum;

(iv) identify potential impediments to improving outcomes along the HIV 
care continuum, including for populations at greatest risk for HIV 
infection, based on the efforts undertaken pursuant to paragraphs (i), 
(ii), and (iii) of this subsection;

(v) identify opportunities to address issues identified pursuant to 
paragraph (iv) of this subsection, and thereby improve outcomes along the 
HIV care continuum;

(vi) recommend ways to integrate efforts to improve outcomes along the HIV 
care continuum with other evidence-based strategies to combat HIV; and

(vii) specify how to better align and coordinate Federal efforts, both 
within and across agencies, to improve outcomes along the HIV care 
continuum.

                    (d) Reporting.

[[Page 43059]]

(i) Within 180 days of the date of this order, the Working Group shall 
provide recommendations to the President on actions that agencies can take 
to improve outcomes along the HIV care continuum.

(ii) Thereafter, the Director of the Office of National AIDS Policy shall 
include, as part of the annual report to the President pursuant to section 
1(b) of my memorandum of July 13, 2010 (Implementation of the National HIV/
AIDS Strategy), a report prepared by the Working Group on Government-wide 
progress in implementing this order. This report shall include a 
quantification of progress made in improving outcomes along the HIV care 
continuum.

                Sec. 4. General Provisions. (a) Nothing in this order 
                shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department, agency, or the 
head thereof; or

(ii) the functions of the Director of the Office of Management and Budget 
relating to budgetary, administrative, or legislative proposals.

                    (b) This order shall be implemented consistent with 
                applicable law and subject to the availability of 
                appropriations.
                    (c) This order is not intended to, and does not, 
                create any right or benefit, substantive or procedural, 
                enforceable at law or in equity by any party against 
                the United States, its departments, agencies, or 
                entities, its officers, employees, or agents, or any 
                other person.
                
                
                    (Presidential Sig.)

                THE WHITE HOUSE,

                    July 15, 2013.

[FR Doc. 2013-17478
Filed 7-17-13; 11:15 am]
Billing code 3295-F3