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National HIV/AIDS Initiative

The United States continues to face a very serious HIV epidemic, with 1.1 million Americans living with HIV and roughly 50,000 people becoming newly infected each year.  Sustained efforts have been made over the past thirty plus years to fight HIV at home and around the world, and major progress has been made.  Now is a unique moment of opportunity for better supporting all people living with HIV in this country and improving their engagement in care and health outcomes.  In turn, by extending treatment and strengthening support for communities heavily impacted by HIV, we can reduce the number of people who become infected with HIV each year and reduce both the disparities in infection rates and health outcomes across populations.

The O’Neill Institute believes that, through legal and policy analysis and engagement with policymakers and stakeholders, we can help achieve the vision for the National HIV/AIDS Strategy.

See our Publications

The Institute publishes its work in a variety of formats: Quick Takes, Big Ideas, and Issue Briefs.

Featured Projects

HIV Prevention: Assessing Our Progress and Charting a Future Direction

The O’Neill Institute established this HIV Prevention Project to understand what is working in HIV prevention, identify issues and opportunities for progress, and describe future directions for HIV prevention. The project is supported by an educational grant from Gilead Sciences.

In March 2021, the O’Neill Institute released Big Ideas: Improving the Health of People Who Use Drugs and People in Recovery Is Essential for Ending the HIV Epidemic. HIV and drug use are inextricably intertwined. Today, one in ten new HIV diagnoses in the U.S. are attributed to people who inject drugs, with other forms of drug use contributing to additional transmissions. New HIV cases among people who use drugs increased 9% from 2014 to 2018. Success at achieving the goals of the Ending the HIV Epidemic (EHE) Initiative in the United States depends on improving the health of people who use drugs. The following policy actions are recommended: (1) Develop tailored plans with the meaningful participation of people who use drugs to respond to the unique challenges in each jurisdiction; (2) Deploy effective interventions at greater scale; and (3) Decriminalize substance use and re-orient drug use policy to enhance prevention, harm reduction, and treatment of addiction.

In May 2020, the O’Neill Institute released the document, Quick Take: HIV Lessons for COVID-19 Contact Tracing. The document describes what contract tracing is, who does it, and why it is important. Drawing lessons from the response to HIV and other STIs, the document also discusses recommendations for what to do and not to do in responding to the COVID-19 crisis, best practices for the use of technology in contact tracing, partnerships between health departments and community-based organizations, and problems with law enforcement and criminalization. By protecting rights, partnering with communities, and expanding a well-trained workforce, public health can implement effective contact tracing for COVID-19. 

In November 2019, the O’Neill Institute released Big Ideas: HIV Prevention and Care Systems Have Critical Roles in Addressing Sexually Transmitted Infections. Sexually transmitted infections (STIs) are on the rise in the United States. While great strides have been made in promoting the health of people living with HIV and preventing new HIV infections, more can be done to enhance STI prevention, screening, and treatment. This report discusses key actions for HIV programs to reduce the public health impact of STIs. The following key actions are recommended: (1) HIV prevention and care programs need to conduct more STI screenings, (2) HIV and STI programs can jointly adopt best practices for promoting sexual health, and (3) HIV surveillance and research initiatives need to strengthen the STI response.

In August 2019, the O’Neill Institute released three new documents to support the Ending the HIV Epidemic (EHE) Initiative in the United States. The first document, Quick Take: Using Cluster Detection to End the HIV Epidemic, provides a brief introduction to HIV cluster detection and highlights both its promise and risks. The second document, 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. The third document, 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.

In April 2019, the O’Neill Institute released the document Quick Take: The US STI Crisis. The number of STIs is rising: From 2013-2017, syphilis increased 80%, gonorrhea increased 67%, and chlamydia increased 22%. The document describes the disproportionate burden of STIs for different populations and by geography. It also discusses the importance of sexual health and the need for increased investment and innovation in STI prevention, care, and treatment.

In March 2019, the O’Neill Institute released the policy brief, Bolstering Latinx Gay and Bisexual Men to Promote Health and Reduce HIV Transmission. This policy brief explores the health and social factors that contribute to HIV risks among Latinx gay and bisexual men. One in five new HIV diagnoses in 2017 in the United States were among Latinx gay and bisexual men. While HIV rates are stable, or falling in other groups, they rose by 12% among these men from 2012-2016. Developed in partnership with Bienestar Human Services, this brief highlights strategic actions that policy makers and others can take to ensure that Latinx gay and bisexual men are benefitting from the exciting advances in HIV prevention and care.

In March 2018, we released an issue brief, HIV Prevention in the United States: Federal Investments are Saving Lives and Strengthening Communities. At a time when many policy makers are asking fundamental questions about the impact of public investments on various programs, this issue brief examines the dynamic nature of the HIV epidemic in the United States to assess what our country has accomplished, where things stand, and where continued federal leadership and funding are needed to keep reducing the size and scope of the HIV epidemic.

Improving Laws and Policies for Sex Workers

In December 2016, the O’Neill Institute received a generous grant from the Elton John AIDS Foundation to explore the impact of laws and policies on sex workers’ access to clinical care and social services and recommend potential criminal law and policy reforms to better support sex workers in Washington DC. This collaboration between the O’Neill Institute, Whitman-Walker Health, and HIPS, with the Institute as the project lead, explores how sex workers in DC access health care; how they interact with law enforcement; and how laws, policies, and practices designed to disrupt commercial sexual activity and/or drug use impede access to HIV prevention and care services.

In December 2020, the O’Neill Institute, the Whitman-Walker Institute, and HIPS released a new report on the effect of the District of Columbia’s laws and policies on the safety and health of sex workers and the community at large. The report shows that DC laws criminalizing sex work stigmatize and victimize sex workers, degrading their health and trapping them in cycles of poverty and homelessness. Recommendations for change include reforming the criminal code of the District of Columbia to eliminate criminal penalties for consensual commercial sexual exchange between adults; increasing access to affordable housing; expanding resources for job training and employment programs; and strengthening efforts to address discrimination against lesbian, gay, bisexual, transgender, or queer (LGBTQ) people.

HIV Policy Project

The O’Neill Institute established the HIV Policy Project, formerly known as the Ryan White Policy Project, in 2014 to consider issues related to sustaining and adapting the Ryan White HIV/AIDS Program within a changing health care environment. Funded by the federal government at approximately $2.3 billion per year, the Ryan White HIV/AIDS Program is the third largest source of financing for HIV care after Medicaid and Medicare and is the cornerstone of the Nation’s response to the domestic HIV epidemic. In recent years, we have expanded the focus of the HIV Policy Project to encompass broader policy and legislative dialogues over the future of HIV care and prevention. This project is supported by funding from Gilead Sciences.

In October 2020, the O’Neill Institute released two briefs. The first brief, Big Ideas: Integrating Telehealth into HIV Services Systems Can Help to Sustain Improved Outcomes, discusses how the COVID-19 pandemic has spurred greater adoption of telehealth services and identifies key policy actions that are needed for HIV telehealth services delivery to evolve from a crisis response to an integrated component of sustainable, high-quality care delivery. The second brief, Big Ideas: Supporting HIV Programs Through COVID-19 and Beyond Is Critical to Improving Health Equity, discusses how the COVID-19 pandemic has exposed health inequities and caused a growing state and local budget crisis in the United States. The brief outlines policy recommendations for fighting COVID-19, improving equity, and sustaining momentum in responding to HIV.

In April 2020, the O’Neill Institute released Big Ideas: Better Meeting the Needs of People Living with HIV Is How to End the HIV Epidemic. The report highlights actions that can be taken by jurisdictions and advocates to improve the health of all people living with HIV. As community stakeholders and policymakers in the United States focus on achieving the goals of the Ending the HIV Epidemic (EHE) Initiative, many people with HIV have felt neglected and under-prioritized. To succeed at ending the HIV epidemic, differing strategies are needed to support three groups of people with HIV: (1) those who are unaware of their infection, (2) those who are in care but not virally suppressed, and (3) those who have been diagnosed but are not in care.

In March 2020, the O’Neill Institute released the document Quick Take: The USPSTF PrEP Recommendation. The document discusses the final recommendation for pre-exposure prophylaxis (PrEP) from the United States Preventive Services Task Force (USPSTF) and why the PrEP recommendation matters. The USPSTF PrEP recommendation has the potential to increase access to PrEP for HIV prevention and means that most private health plans and all Medicaid-expansion programs must cover PrEP without cost-sharing. To support effective implementation of this recommendation, the document outlines critical actions that are needed from federal agencies, health plans, health departments and insurance regulators, and providers and communities. Implementation of the recommendation must ensure access to comprehensive PrEP services and require coverage without cost-sharing of new PrEP regimens as they become available.

In June 2019, the O’Neill Institute released the issue brief, Eliminating Hepatitis C among People Living with HIV in the United States: Leveraging the Ryan White HIV/AIDS Programs to Move Us Forward. One in four people living with HIV will become infected with Hepatitis C (HCV) during their lifetime. This brief identifies target populations and various barriers as well as providing strategies to address those issues. These strategic actions include comprehensive efforts to overcome barriers to treatment, better metrics for taking progress toward elimination, increased emphasis on re-screening, and stronger planning and commitment to HCV elimination in states, communities, and clinics.

In December 2018 in conjunction with World AIDS Day, the O’Neill Institute released two Big Ideas reports on emerging HIV issues in the United States: Big Ideas: State and Local ‘End the Epidemic” Plans Can Drive HIV Progress and Big Ideas: Leveraging the Ryan White Program to Make Rapid Start of HIV Therapy Standard Practice.

To find all the publications from this project, see the National HIV/AIDS publication webpage and the Ryan White Policy Project webpage.

Big Ideas for HIV Prevention and Treatment

In advance of World AIDS Day on December 1st, the O’Neill Institute for National and Global Health Law has released two new reports on emerging HIV issues in the United States, including policy ideas for states and local communities and for the Ryan White HIV/AIDS Program. The reports were written by two leading HIV/AIDS policy experts, Jeffrey S. Crowley, Distinguished Scholar and Director of Infectious Disease Initiatives at the O’Neill Institute, and Sean Bland, a Senior Associate at the O’Neill Institute.

HIV and Public Health Surveillance: Legal, Policy, Ethics, and Human Rights Considerations

In November 2018, the O’Neill Institute’s Sean Bland and Jeffrey Crowley will join Auntré Hamp and Jay Smart from Office of the Senior Vice President for Research at Georgetown University, to begin work on assesses the relevant legal, policy, ethics, and human rights considerations when using new technologies in public health surveillance and programming as part of the United States and global responses to HIV. This project will launch with the generous support of Georgetown University’s Global Health Initiative.

Addressing Policy Barriers to Pre-Exposure Prophylaxis (PrEP) Uptake and Planning for Long-Acting Agents for Treatment and PrEP Treatment and PrEP

In October 2016, the O’Neill Institute received a generous grant from the amfAR Foundation for AIDS Research to examine critical policy issues that impact access, availability and acceptability of pre-exposure prophylaxis (PrEP) and long-acting agents, which are innovative forms of PrEP and HIV treatment that are under development and do not require daily pill taking. The project will explore how to support uptake of effective HIV prevention and treatment modalities for adolescents and young adults, with a focus on young Black gay, bisexual, and other men who have sex with men.

On July 16, 2018, amfAR, The Foundation for AIDS Research, released four reports, Long-Acting HIV Treatment and Prevention Are Coming: Preparing for Potential Game Changers, prepared by O’Neill Institute scholars Jeffrey S. Crowley and Sean E. Bland. The reports highlight the education and policy dialogues needed to prepare for innovative long-acting products under development to treat and prevent HIV infection. 

On March 13, 2019, amfAR released the issue brief, Expanding Access to Pre-Exposure Prophylaxis (PrEP) for Adolescents and Young Adults: Models for Addressing Consent, Confidentiality, and Payment Barriers. This issue brief, written by Sean Bland of the O’Neill Institute, offers an examination of how three jurisdictions consider and address consent, confidentiality, and payment barriers that adolescents and young adults may face in accessing PrEP.

Blueprint for HIV Biomedical Prevention

The O’Neill Institute is working in partnership with NMAC to examine the status of biomedical HIV prevention research and implementation in the United States. The focus of the project is to explore how to bring the promise of biomedical HIV prevention to all communities highly impacted by HIV. Biomedical HIV prevention offers a range of tools that can effectively prevent HIV infection. These tools include treatment as prevention (TasP), pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP).

The O’Neill Institute produced a two-part report, Blueprint for HIV Biomedical Prevention. The first of two reports, “Blueprint for HIV Biomedical Prevention: State of the State,” was released on December 3, 2016 at the National HIV PrEP Summit in San Francisco. The State of the State report provides an overview of policies and programs that are critical to effective biomedical HIV prevention in communities of color. The report highlights current health department and community efforts to implement the new science. It also includes descriptions of the roles played by selected federal agencies in supporting biomedical HIV prevention and identifies some of their key recent initiatives.

The second of two reports, “Expanding Access to Biomedical HIV Prevention: Tailoring Approaches for Effectively Serving Communities of Color,” was released on April 10, 2018 and shares policy recommendations on ways to expand access to PrEP and TasP/treatment as prevention. This report highlights the unique challenges people of color face in HIV prevention, care, and treatment and gives ways to improve outreach to gay men of color, women of color, and the transgender community.