AIDS advocates are anticipating the imminent release of the first US National AIDS Strategy with strong opinions on what it should include.

"Our response to the global epidemic is squarely focused on outcomes, and we need to get to that point in our domestic responses," said Chris Collins, director of public policy at the American Foundation for AIDS Research (amfAR).

Gay men and blacks, disproportionately affected by the HIV epidemic, should be a major focus of the strategy, Collins said.

"In the United States, we have a concentrated epidemic among a few populations but we don't have a response that fits our epidemic," Collins said.

Federal spending for both domestic and international AIDS efforts in the 2011 fiscal year is projected at $27.2 billion, according to the Kaiser Family Foundation. KFF calculates that some 20 US programs or agencies are in line to receive money in the effort.

The federal-state AIDS Drug Assistance Program is one of the United States' most high-profile HIV assistance efforts. In June, however, a record 1,781 patients were on waiting lists to receive ADAP's help to pay for their HIV therapy. About 125,479 people received assistance through ADAP last year.

Gilead Sciences Inc., which derives about 22 percent of its US sales from the state-run funds, this year expanded its own assistance programs, said Citibank analyst Yaron Werber. The expansion will cover up to $2,400 per year in out-of-pocket patient expenses, Werber said, and it extends a pricing freeze.

One advocate noted that the strategy's release would be an important step toward fulfilling Obama's promise to align priorities among state and federal enterprises fighting the epidemic.

"It's kind of amazing that more than 25 years into it, we've been operating without an AIDS strategy," said Mitchell Warren, executive director of the New York-based AIDS Vaccine Advocacy Coalition.