I had the great privilege of presenting CDC’s findings from a thematic review of the Ending the HIV Epidemic in the United States (EHE) jurisdictional plans at the last meeting of the Presidential Advisory Council on HIV/AIDS (PACHA). In September 2019, CDC awarded $12 million from the HHS Minority HIV/AIDS Fund to 32 state and local health departments to develop comprehensive EHE plans that are tailored by and for each of the 57 prioritized jurisdictions. Due to the COVID-19 pandemic, CDC extended the deadline for jurisdictions to submit their revised and updated EHE plans to December 31, 2020. Each EHE plan was developed in collaboration with community partners and outlined the strategies and activities the jurisdictions intend to implement to end the HIV epidemic in their communities.
It was promising to see the breadth of new partners engaged for the first time in their community’s HIV planning process, including Historically Black Colleges and Universities (HBCUs), formerly incarcerated persons, and persons experiencing homelessness. While all jurisdictions reported that COVID-19 affected their ability to conduct community engagement activities, jurisdictions were still able to hear the voices of their respective communities through more than 20 town halls, 140 listening sessions, 280 in-depth interviews, 150 focus groups, and surveys of more than 10,000 community members, including persons with HIV. During the PACHA presentation, CDC reported that 25 out of the 32 plans specifically reference engaging Persons with HIV (PWH). CDC examined additional supporting documents from the jurisdictions and concluded that 31 out of the 32 state and local health departments engaged PWH. Additionally, communities identified critical systemic challenges that must be addressed to end the HIV epidemic; specifically, over 75% of the jurisdictions identified economic insecurity, education, housing, access to healthcare, and stigma as significant structural barriers.
All jurisdictions included evidenced-based strategies that align with CDC priorities and the EHE pillars. For example, over 80% of EHE jurisdictions plan to increase access to and use of HIV self-tests and to conduct targeted testing in non-healthcare settings (e.g., mobile testing in communities). Over 60% of EHE jurisdictions plan to expand telemedicine services, especially in rural areas, and rapidly link persons to care and start treatment ≤ seven days after diagnosis of HIV. Over 70% of EHE jurisdictions plan to begin or expand PrEP linkage programs and establish or expand Syringe Services Programs (SSPs) (where legally allowed) using innovative delivery options (e.g., mobile SSPs). Fifty percent or more of EHE jurisdiction also plan to establish a dedicated response workforce and improve the use of real-time information to direct resources to the communities most in need. Promisingly, 27 jurisdictions also addressed the syndemic of HIV/STIs/Viral Hepatitis, 25 addressed the opioid crisis, and 22 included strategies to improve HIV prevention education in K-12 schools.
EHE plans are “living documents,” and each jurisdiction is expected to modify, update, and post its plans to meet the HIV prevention needs of their communities. Federal agencies will also continue to provide guidance, best practices, and technical assistance to EHE jurisdictions and share creative community-based solutions to help them address new and evolving challenges. There is great potential in these plans to alter the HIV prevention and care landscape radically. The plans addressed issues ranging from discrimination and systemic racism to advancing status-neutral service delivery programs. Jurisdictions heard the voices of many of the people disproportionately affected by HIV and developed holistic strategies to address their needs. I look forward to working alongside jurisdictions, federal partners, and communities as these plans turn into action.