March PACHA Meeting: Agency Updates, Visits to Local Organizations, Community Listening, and More

The Presidential Advisory Council on HIV/AIDS (PACHA) convened its 76^th full council meeting in Washington, DC, and online on March 29 and 30, 2023. The meeting was held at the U.S. Department of Health and Human Services and included a “PACHA-to-the-People” community engagement listening session. Meeting video, slides, and a summary are available on HIV.gov. Brief highlights of some of the discussions are provided below.

Federal Partners’ Updates on HIV Activities

HHS partners shared updates on agency activities supporting the implementation of the Ending the HIV Epidemic in the U.S. (EHE) initiative. Among the highlights was an update from HRSA’s Bureau of Primary Health Care, noting that in 2021, 302 HRSA Health Centers receiving EHE funding conducted over 1.7 million HIV tests and provided PrEP services to 52,477 patients. CDC also reported that several EHE jurisdictions have met their 2025 targets for linking newly diagnosed persons to HIV care or prescribing PrEP. NIH shared information about the 201 HIV implementation research projects it has supported since Fiscal Year 2019 in 52 of the 57 EHE jurisdictions.

In addition, partners from several other federal agencies provided updates on HIV-related work:

• HHS Administration for Community Living (ACL): Deputy Assistant Secretary for Aging Edwin Walker discussed the work underway by ACL to implement the National HIV/AIDS Strategy (NHAS) with a focus on assessing and expanding the capacity of the network of local aging services supported through the Older Americans Act. He also highlighted ACL’s collaboration with OIDP on the HIV and Aging Challenges.
• Centers for Medicare and Medicaid Services (CMS): Chief Medical Officer Dr. Lee Fleisher observed that while many people often think of CMS only as a payer for health services, the agency also serves a major role in public health through regulation, quality improvement, clinical standards, and incentives. He briefed the Council on several activities underway across CMS, including a National Coverage Determination for oral and injectable PrEP that will be posted for public comment in July.
• HUD’s Office of HIV/AIDS Housing: Director Rita Harcrow discussed how, even though HUD is not an EHE-funded agency, it has worked to align some HOPWA activities with EHE activities where possible. She also discussed recent cross-agency collaborations on HIV, COVID-19, and mpox, as well as the President’s proposed $6 million increase in the HOPWA budget for FY24.
• FDA: Director of the Center for Biologics Evaluation and Research Peter Marks briefed the Council on the agency’s recent proposal to change from time-based deferrals to assessing blood donor eligibility using gender-inclusive, individual risk-based questions to reduce the risk of transfusion-transmitted HIV. PACHA had previously passed a resolution encouraging FDA to update the screening questions and ensure that they are based on sexual behavior risk, not gender or sexual orientation. Dr. Marks noted that the proposal was open for public comment and invited members to share any additional feedback. [In May, FDA finalized that recommendation.]

White House Updates

Harold Phillips, Director of the White House’s Office of National AIDS Policy (ONAP), thanked the Council for their recent resolution on cluster detection and response and molecular HIV surveillance and (CDR/MHS) and provided the federal response to it, noting that many of the recommendations are being pursued. He discussed the many ways the community has been engaged in CDR/MHS at the federal, state, and local levels. Director Phillips reiterated that MHS and CDR remain important parts of our national efforts to end the HIV epidemic, particularly to identify gaps in HIV prevention and care services, ensure that HIV resources and services are focused on communities that need them most, interrupt transmission networks, and advance health equity. He noted that CDC is strengthening data protections and supporting states in modernizing their HIV criminalization laws. He also acknowledged that further work is needed at the state and local levels to ensure that the data protections are followed and, as called for in the NHAS, state laws criminalizing HIV are repealed.

Director Phillips also provided an ONAP update. He discussed the President’s FY2024 Budget Proposal, which includes $850 million for the EHE initiative and other HIV funding. Without the needed investment in EHE, he noted that it will be difficult to meet the 2025 and 2030 EHE targets. He also discussed the national PrEP delivery program included in the President’s budget which would accelerate PrEP access and address disparities. He shared other updates on federal HIV activities and current concerns requiring both federal and community attention including Medicaid unwinding, stimulant and methamphetamine use, and mpox. 

In addition, the Council heard an update on the mpox outbreak from Dr. Demetre Daskalakis, Deputy Coordinator of the White House Mpox Response. He framed mpox as part of a syndemic along with HIV and the social determinants of health that drive both. Dr. Daskalakis discussed disparities in mpox vaccine uptake and the need to take actions as summer approaches to avert an mpox resurgence.

Site Visits to Three CBOs

The day prior to the meeting, PACHA members and federal partners visited three community-based organizations serving diverse populations, each of which is involved in ending the HIV epidemic in the DC-Baltimore metro area. Staff of the Institutes for Behavior Resources/REACHExit Disclaimer, Us Helping UsExit Disclaimer, and La Clinica del PuebloExit Disclaimer welcomed us and shared information about their organizations and how their HIV services had evolved and expanded over time to better meet the needs of their communities, as well as some of the current challenges they face and how federal programs and policies could help address them. ADM Rachel Levine, MD, HHS Assistant Secretary for Health, participated in the visit to Us Helping Us, which included a tour of one of their mobile health services units.

PACHA-to-the-People Community Listening Session

Complementing the site visits, the afternoon of the first day of the meeting was devoted to the Council’s “PACHA-to-the-People” community engagement session during which members of the HIV community from a meeting’s locale (and beyond) share ideas, concerns, and recommendations directly with PACHA members. Bringing these voices to the meeting informs the Council’s work.

Community members offered thoughts on a wide variety of topics, including FDA’s updated blood donor guidelines, questions about federal grant limitations on expenditures for harm reduction services, the important roles of Medicare and Medicaid and the need for more robust engagement from CMS in the HIV response as a growing number of people with HIV are aging, the need for more health care provider education on the updated infant feeding guidelines, and an inquiry about whether the Ryan White program would be developing a new performance measure for anal cancer screening in light of the ANCHOR study findings.

Community members also shared concerns about CDR/MHS, posed questions about status-neutral approaches to HIV service delivery, underscored the need for a national PrEP program and public input into planning for it, and asked about the Ready, Set, PrEP program. We are grateful to the community members who shared their ideas in person and online. Hearing from the lived experience of so many community members was very valuable to the PACHA members and federal staff participating.

USPHS Commissioned Corps and PEPFAR Updates, Addressing Stigma, and HIV and Substance Misuse

Also during the meeting:

• ADM Levine provided introductory remarks, praising the Council for continuing its community engagement efforts with site visits and PACHA-to-the-People sessions to gather a rich variety of important perspectives. She also highlighted the December 2022 announcement by the Commissioned Corps of the U.S. Public Health Service that it was changing its medical standards to accept future applicants living with chronic hepatitis B and Human Immunodeficiency Virus (HIV), the first of the uniformed services to do so.
• In an update about PEPFAR Mamadi Yilla, Deputy Coordinator, Office of the U.S. Global HIV/AIDS Coordinator, marked the 20^th anniversary of PEPFAR, reviewed PEPFAR’s new 5-year strategy, and discussed what the latest country data tells us about progress toward global goals, particularly among key populations.
• A panel on addressing HIV-related stigma advanced bi-directional learning with perspectives from both global and domestic experiences that highlighted various approaches to combat stigma, and the usefulness of targets, measures, and data to move the needle on stigma. This dialogue continues ongoing efforts across the federal government to facilitate and encourage more sharing of lessons, strategies, and tools across domestic and global HIV activities.
• A federal update on substance misuse and drug overdoses from colleagues from CDC and NIDA was followed by a conversation with community representatives about addressing HIV and substance misuse for different populations and in different settings.

Watch video of all these sessions and more, view the PowerPoint presentations, and read the full meeting summary on HIV.gov’s Prior PACHA Meetings page.

Next PACHA Meeting

PACHA’s next meeting will be held in Phoenix, AZ, on June 28 and 29, 2023. Watch for details here on the blog and on the About PACHA page on HIV.gov.