August 22, 2019

CONTACT: Johan Marulanda /

August 22, 2019 WASHINGTON DC | President Trump announced his Administration’s Ending the HIV Epidemic (EHE) Initiative in this year’s State of the Union address. The O’Neill Institute for National and Global Health Law is releasing three new documents to support this effort. “The EHE Initiative is a smart approach to regaining the momentum to keep improving HIV health outcomes and reducing new HIV transmissions. We want to contribute to the initiative’s success,” said Jeffrey S. Crowley, O’Neill Institute Distinguished Scholar and former Director of the White House Office of National AIDS Policy who led the development of the first US National HIV/AIDS Strategy. New briefs highlight critical actions to support two pillars of the EHE Initiative: scaling up pre-exposure prophylaxis (PrEP) use and using HIV cluster detection tools to respond to outbreaks more effectively.

Big Ideas: Achieving Sufficient Scale of PrEP Use Is Critical to Ending the HIV Epidemic explains how policy makers need to think differently about PrEP with a greater emphasis on achieving sufficient scale of PrEP use among high-need communities. Citing a modeling study, Crowley and his co-author, Sean E. Bland, O’Neill Institute Senior Associate, report that if 40% of men who have sex with men (MSM) were on PrEP and 62% were highly adherent, it would avert 1 in 3 HIV transmissions over the next decade. The authors state that PrEP programs need to be able to effectively serve a larger volume of clients and need service models that make it easier for users and providers to maintain PrEP engagement.

The EHE Initiative calls for using the right data and tools to end the epidemic, and cluster detection can give insight into how to respond to the epidemic. Cluster detection uses molecular data about the HIV virus reported to health departments by laboratories that conduct drug resistance testing as a part of routine clinical care. Cluster analysis allows public health authorities to spot outbreaks more effectively and to find more people who are part of a cluster, which enables public health authorities to better respond with tailored prevention and care services. Because, in many states, people with HIV can be prosecuted for exposing others to HIV, the use of cluster data raises concerns.

Quick Take: Using Cluster Detection to End the HIV Epidemic is a brief primer that introduces cluster detection and highlights both its promise and risks.

Big Ideas: Policy Action Can Increase Community Support for HIV Cluster Detection is a companion brief that highlights four critical actions where community stakeholders and public health officials can work together to minimize risks associated with cluster detection and broaden support for its use.

Federal and state officials have stated that HIV molecular data collected for public health functions should not be disclosed to law enforcement. A principal recommendation is for community stakeholders and public health officials to work together to enact a number of policy changes to ensure that such data are not disclosed to law enforcement.

These documents are supported by a grant from Gilead Sciences, Inc. Gilead Sciences, Inc. has had no input into the development of these documents.  These materials were informed by stakeholder consultations held in 2018 and 2019.

The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Celebrating its 10th year in 2017, its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure. The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.