Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, opened Day 2 of the National HIV Prevention Conference (NHPC) to a packed crowd. He shared a comprehensive look at High Impact Prevention (HIP) strategies, successes so far, and the potential that HIP 2.0 holds for further lessening the burden of HIV in the United States.

By embracing HIP, the nation has seen some encouraging results:

• The number of jurisdictions with integrated HIV prevention and care planning has doubled.
• Health departments have increased prevention activities for people living with HIV and men who have sex with men (MSM), especially black MSM.
• The proportion of those with HIV who know their status is the highest ever at 87%.
• Over the past decade, there were substantial decreases in HIV diagnoses among women, with particularly large reductions among African American women.
• Between 2010-2014, annual new HIV diagnoses decreased 9%, including a 2% decrease in young black MSM, following a 114% increase during the previous five years.
• Among those receiving care, viral suppression has increased from 72% in 2009 to 80% in 2013.

Mermin noted, however, that severe health disparities still exist, not only for certain race and ethnicities, gay and bisexual men, and transgender persons, but also, as a result of other factors, including population density, poverty, education, employment, homelessness, and region of residence. The Southern United States has particular challenges, with some of the worst indicators related to the proportion of persons with HIV who are aware of their status and mortality among persons with HIV. He emphasized that the nation needs to do better.

In the United States, 9 of 10 new infections are transmitted by people with HIV who are undiagnosed or who have been diagnosed but are not in care. “To truly improve the health of people living with HIV and AIDS and those at risk, we need to merge the clinical medicine, community, and public health efforts…and increase the scope of responsibility for all parties,” Mermin said. This will involve using surveillance data to identify people who are not engaged in care or not receiving optimal care and using those data for public health follow up. It will also require us to make HIV prevention services, including PrEP, a normative part of healthcare.

CDC has recently implemented additional activities related to HIP, Mermin said, for example:

• $216 million over 5 years to 137 community-based organizations to support HIV testing, help people living with HIV receive treatment and prevention services, and target prevention activities to specific groups, including persons of color, gay and bisexual men, and transgender persons;
• Funding to state and local health departments to support use of surveillance data to improve care for people living with HIV, especially MSM and transgender persons of color; and expanding the use of PrEP and other prevention tools; and
• A new, national bilingual Act Against AIDS HIV testing campaign, Doing It, released yesterday, that uses humor to spark conversation and encourage people to get tested, an essential component to ending the HIV epidemic (see below).

Mermin also spoke about the need for a new generation of risk messaging. “Protection is no longer only restricted to condoms,” he said. To educate and promote a wider range of risk reduction strategies and options, yesterday CDC released a beta version of its new HIV Risk Reduction Tool (see below for more information). Mermin also touched on the necessities of improving sexual health education, addressing the issue of substance abuse as an HIV risk factor for teens (especially sexual minorities), and integrating and coordinating services, including STD and viral hepatitis screenings and partner services.

Panel

After Mermin’s remarks, Murray Penner, Executive Director of the National Alliance of State and Territorial AIDS Directors (NASTAD), moderated a panel on High Impact Prevention initiatives at the state and local level. The panelists were: Randy Mayer, Iowa Department of Public Health; David Ernesto Munar, Howard Brown Health Center; Chi-Chi Udeagu, NYC Department of Health and Hygiene; Terrell Parker, of The Damien Center; and Diana Jordan, Virginia Department of Health.

The panelists shared their experiences with adapting HIV prevention programs to incorporate HIP approaches, and with setting priorities and leveraging resources to improve outcomes. They also discussed stigma-reduction efforts, strategies to retain clients in care, and the need to focus on maximizing health equity for people living with HIV.

At the end of the session, Parker told the audience, “The easiest part is getting someone to the doctor…the difficult part is keeping a person engaged and in care” because of challenges related to housing, mental health, stigma, and drug use. He said “For us, these are just policies,” but for those living with HIV, they can be key challenges to health.

New Resources Released

Mermin touched on two new resources that were formally released on Day 2 of the conference: CDC’s new HIV testing campaign called Doing It and the HIV Risk Reduction Tool, which lets people get customized information on behaviors that place them at risk for HIV and provides strategies to reduce their risk.

The Doing It campaign features everyday people, community leaders, and celebrities emphasizing that HIV testing is a smart choice to stay healthy and protect yourself and your partners. The campaign highlights people from a spectrum of communities, including gay, bisexual, heterosexual, African American, Latino, white, men, women, and transgender people. Visit www.cdc.gov/doingit for more information.

The interactive online HIV Risk Reduction Tool allows users to compare the risks of different sexual activities and to see how one or a combination of prevention methods—such as condoms, pre-exposure prophylaxis (PrEP), or HIV treatment for those living with HIV—could change their level of protection. The tool has been issued as a beta release, and CDC anticipates continued revision and improvement of it over time, as the agency pilots the tool with users and incorporates feedback and new findings. Visit wwwn.cdc.gov/hivrisk for more information.