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 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.

Ryan White Policy Project

The O’Neill Institute has established a Ryan White Policy Project to consider issues related to sustaining and adapting the Ryan White HIV/AIDS Program (Ryan White) within a changing health care environment. This project is supported by funding from Gilead Sciences.

Funded by the federal government at nearly $2.3 billion per year, the Ryan White 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. The purpose of this Ryan White Policy Project is to consider issues that arise as the context in which the program operates is altered both by technological advances and fundamental shifts in health care financing and service delivery with the implementation of the Affordable Care Act (ACA).

In June 2019, the O’Neill Institute released the issue brief, Eliminating Hepatitis C among People Living with HIV in the United State: 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.

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.

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.

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).