The following publications are produced by the National HIV/AIDS Initiative.
Ending the HIV Epidemic (EHE) Resources
In 2019, the Trump Administration launched its Ending the HIV Epidemic (EHE) Initiative that set a goal of reducing new infections by 90% over the next decade. Several resources of the National HIV/AIDS Initiative are supportive of key pillars of this plan.
This Quick Take 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.
The USPSTF PrEP Recommendation (March 2020)
This Quick Take 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.
Using Cluster Detection to End the HIV Epidemic (August 2019)
This Quick Take document provides a brief introduction to HIV cluster detection and highlights both its promise and risks. Cluster detection a public health tool that 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. This tool enables health departments to identify clusters where HIV transmission is occurring rapidly and tailor public health responses to these clusters. However, this tool also raises concerns about privacy and the potential use of cluster detection information to prosecute people living with HIV for exposing others to HIV.
The US STI Crisis (April 2019)
This Quick Take document provides an overview of the sexually transmitted infection (STI) crisis in the United States. 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.
HIV Prevention in the United States (January 2019)
Also released in January 2019, this Quick Take document provides an overview of the HIV epidemic in the United States and describes the range of tools and approaches used to prevent HIV infection, including HIV testing and linkage to care, treatment as prevention, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and syringe and harm reduction services. The document also discusses the need for continued support for and new investment in HIV prevention.
Released in January 2019, this Quick Take document discusses how the Ryan White HIV/AIDS Program is leading the way in getting people with HIV virally suppressed by ensuring stable access to HIV primary care and medication along with critical support services. The document describes the parts of the Ryan White Program and the importance of the program for meeting the health care needs of people with HIV and addressing new challenges.
The COVID-19 pandemic has exposed inequities in United States and weaknesses in the public health response at the federal, state, and local levels. While expanded utilization of telehealth services amid the COVID-19 crisis has created opportunities to overcome persistent barriers to engagement in HIV care, COVID-19 has also led to clinic closures, staffing redeployments, and funding cuts in health care and human services programs, which could undermine efforts to end the HIV epidemic. This report outlines policy recommendations for fighting COVID-19, improving equity, and sustaining momentum in responding to HIV.
The COVID-19 pandemic has spurred greater adoption of telehealth services. In order for HIV telehealth services delivery to evolve from a crisis response to an integrated component of sustainable, high-quality care delivery, policy action is needed. The following key actions are recommended: (1) Give clients more control over where, when, and how to access services, and give providers more flexibility in responding to patients in ways that lessen the demands of a full patient panel; (2) Focus on promoting equity and intervening to address the Digital Divide and other barriers for individuals and organizations; (3) Create new opportunities for shared learning so that HIV providers and clinics can learn best practices and avoid common pitfalls; and (4) Invest in research to develop and evaluate innovative approaches for using telehealth technology.
Better Meeting the Needs of People Living with HIV Is How to End the HIV Epidemic (April 2020)
This 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.
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.
This report 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. A principal recommendation is to enact a number of policy changes to ensure that HIV molecular data collected for cluster detection is not disclosed to law enforcement. Other recommendations include promoting meaningful partnerships between communities and health departments, ensuring data and security compliance, and educating stakeholders on public health practices.
Achieving Sufficient Scale of PrEP Use Is Critical to Ending the HIV Epidemic (August 2019)
Pre-exposure prophylaxis (PrEP) is a relatively new technology that holds the potential to greatly reduce HIV transmission. In this report, the authors explain how policy makers need to think differently about PrEP with a greater emphasis on achieving sufficient scale of PrEP use among high-need communities. To achieve population-level impact with PrEP, 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.
State and Local ‘End the Epidemic’ Plans Can Drive HIV Progress (December 2018)
The report identifies key elements of a plan to ‘End the Epidemic.’ One of the most significant elements of some emerging plans is to treat HIV earlier by offering same-day or rapid start of antiretroviral therapy (ART) when individuals receive an HIV diagnosis or are re-engaged in HIV care. Other significant elements include continued focus on monitoring engagement and actively intervening to address barriers to care and an emphasis on scaling up access to pre-exposure prophylaxis (PrEP) and ensuring appropriate access to post-exposure prophylaxis. The report also provides some leading examples of jurisdictions across the county that have developed plans. The jurisdictions highlighted in the report include New York State, New York City, Washington State, the District of Columbia, Houston, and Los Angeles.
In the report, the authors outline the elements of a rapid start program and discuss common barriers to scaling up rapid start, ranging from clinician acceptance and patient readiness to insurance and AIDS Drugs Assistance Program (ADAP) eligibility. The challenge in adopting rapid start of ART is developing workable models of care that can be implemented across our diverse national health care landscape. The authors also discuss how the Ryan White HIV/AIDS Program can help overcome barriers to widespread adoption of rapid start.
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.
One in four people living with HIV will become infected with Hepatitis C (HCV) during their lifetime. This policy brief shows how the Ryan White HIV/AIDS Program has a major role to play in helping eliminate HCV among people living with HIV. 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.
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.
Ensuring that adolescents and young adults at risk for HIV can access pre-exposure prophylaxis (PrEP) is a key step toward reducing the number of HIV diagnoses in the United States. This amfAR 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.
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.
In partnership with amfAR, the O’Neill Institute published a series of issue briefs. The briefs provide examination of critical policy issues that impact access, availability and acceptability of PrEP and long-acting agents, which are innovative forms of PrEP and HIV treatments that are under development and do not require daily pill taking. The series of briefs highlight the education and policy dialogues needed to prepare for innovative long-acting products transmission and reduce health care spending.
Expanding Access to Biomedical HIV Prevention: Tailoring Approaches for Effectively Serving Communities of Color (April 2018)
Along with NMAC, the Institute shared 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.
The Ryan White program has led the way in the development of integrated models of care that other parts of the United States health system are seeking to replicate. It has also enabled states, territories, and local jurisdictions to mount flexible responses to their unique epidemics, while also raising the standard of care and expectations for population-level outcomes for everyone. This issue brief examines the changing role of the Ryan White program and how it supports Medicaid, Medicare, and private insurance to prevent HIV
Blueprint for HIV Biomedical Prevention: State of the State (December 2016)
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.
This amfAR report identifies changes in policy and practice in clinics, communities, and health care programs to reduce unnecessary health spending, increase the effectiveness of services, and increase the integration of services. Done right, the same steps that lead to appropriate management of care by health plans and purchasers also will help to achieve national public health goals.
Bolstering State Efforts to Implement the National HIV/AIDS Strategy: Key indicators and recommendations for policy and community stakeholders (July 2015)
This report builds upon the Centers for Disease Control and Prevention’s (CDC) 2014 “State Prevention Progress Report,” which provided state-level data on indicators related to national HIV prevention goals. The release of the report coincides with the release by the White House Office of National AIDS Policy of the National HIV/AIDS Strategy Update, which sets priorities to guide the nation’s HIV response through 2020.
Originally built as a standalone system, the Ryan White program has evolved to a complement to the insurance system. Nonetheless, as the health system seeks to better integrate services and design more effective and efficient care delivery models, this report offers strategies for better aligning the Ryan White program with insurance to ensure that people with HIV do not get left behind.
The Ryan White program has always looked and acted differently than other parts of the health system. This report provides recommendations for ways to streamline existing planning and monitoring activities to retain critical aspects of community engagement. It also forcefully calls for increased Ryan White program investments to build health department data management systems and capacity to better partner with Medicaid, Medicare, health plans, and HIV prevention programs to monitor engagement in care and intervene when care is interrupted.
Generations of dedicated HIV care providers and community partners have built today’s HIV care system. While more must be done to better reach underserved populations and communities, the need is great to bolster and sustain the existing HIV care workforce. This report offers recommendations for building upon recent changes to the AIDS Education and Training Center (AETC) program and other efforts to support clinical and non-clinical providers
Building on the Affordable Care Act to Make the Health System Work for Young Gay Men (March 2014)
The MAC AIDS Fund and Trust for America’s Health worked with experts in HIV care, prevention and policy to produce this guide, Building on the Affordable Care Act to Make the Health System Work for Young Gay Men. Advocates working to improve the health of the LGBT community can use this guide as they work with Medicaid programs and plans offered in the insurance marketplace to assure meaningful coverage. The Affordable Care Act has the potential to be a powerful lever in the fight to end the AIDS epidemic by providing meaningful coverage, access to quality care and investments in HIV prevention.
This brief identifies key issues and questions facing the program and explores a range of potential changes for policymakers and others to consider. These fall into four broad, intersecting areas: Supporting people with HIV at each stage of the treatment cascade, from diagnosis to viral suppression; Building HIV care networks in underserved communities; Integrating HIV care expertise into the mainstream health care system effectively and fairly allocating Ryan White resources.
This brief explores key provisions of the Affordable Care Act (ACA) for people with HIV, and the opportunities and challenges for using the law to improve HIV care, particularly in light of the Supreme Court’s 2012 ruling on the law. Medicaid is the largest payer of HIV care in the United States, but the Court’s ruling limits the ability to enforce the ACA’s planned Medicaid expansion and has generated uncertainty over whether all states will decide to expand their programs.