World AIDS Day 2021: Ending the HIV Epidemic

November 30, 2021 | ASTHO Staff

On World Aids Day, commemorated each year on Dec. 1, organizations like ASTHO are raising awareness of HIV, combating stigma, and endeavoring to end the HIV epidemic. This year's World Aids Day theme is Equitable Access, Everyone’s Voice. Joining our conversation from the Health Resources and Services Administration (HRSA) are Laura Cheever, MD, ScM, Associate Administrator for HIV/AIDS Bureau, and Heather Hauck, MSW, LICSW, Deputy Associate Director. We spoke with them about the federal Ending the HIV Epidemic (EHE) initiative, recent efforts to elevate community voices, and to ensure equitable access to prevention and HIV care.

Listen to the interview or read the highlights below, condensed for clarity.

The HIV epidemic initiative. What is so innovative about it?

CHEEVER: The federal EHE initiative began in 2020 to achieve the goal of reducing new HIV infections in the United States to less than 3,000 per year by 2030. And that 3,000 number comes from the World Health Organization in terms of ending the epidemic. The initiative currently focuses on 48 counties, Washington, D.C., and San Juan, Puerto Rico where 50% of new infections have occurred and seven states with substantial rural burdens with the additional expertise, technology, and resources needed to end the epidemic in the United States.

Through HRSA’s Ryan White HIV/AIDS program and the HRSA-funded health center program, the agency is playing a leading role in helping to diagnose, treat, prevent, and respond to end the epidemic. What's really innovative about the program is that within the initiative, we are leveraging scientific advances in HIV prevention, diagnosis, and treatment and care and providing expertise across HHS, HRSA, CDC, Indian Health Services, NIH, and SAMHSA.

What progress has been made so far in implementing the initiative?

HAUCK: We're very excited that in the first year of the initiative, which was fiscal year 2020, HRSA awarded $63 million to our 60 current Ryan White HIV/AIDS program recipients. And the health center program was able to award $54 million to 195 health centers with service delivery sites in those geographic locations that Dr. Cheever just mentioned. The funding for the HRSA-funded health centers is to expand HIV prevention and treatment, including pre-exposure prophylaxis related services, outreach, and care coordination.

We're excited that, despite the challenges posed by the COVID-19 pandemic, our funding recipients have made significant progress towards implementing their EHE activities. So, for example, for our HIV/AIDS Bureau recipients these activities have included developing administrative and service-delivery infrastructure, engaging community members and new partners and delivering comprehensive services to clients and really focusing on linkage to care and re-engagement activities.

We're focusing on people who are newly diagnosed or who have fallen out of care and need to be reengaged. Our recipients have focused on establishing rapid re-engagement protocols after missed appointments or establishing low-barrier clinics with high-intensity support, incentives, and care coordinator. We also have focused on rapid anti-retroviral therapy programs. Those were implemented by many EHE recipients for clients who needed to be neutral into care or reengaged. And, in addition, many of our recipients have been engaging peer navigators and community health workers—people with lived experience—to help clients navigate their HIV care and general health system.

What role do ASTHO members and their agencies play in ensuring the initiative's success?

CHEEVER: This is a public health endeavor to end the HIV epidemic, so it's core that we have those people responsible for public health critically involved. Since states have access to data on who is most affected by HIV, ASTHO members and their agencies play a large role in making sure we are reaching the people and communities who need HIV care and treatment the most.

Another important piece is community engagement. This is really a central component to state EHE implementation plans. EHE jurisdictions that have substantial rural or urban populations are both engaged in this initiative. So ASTHO members and their agencies can really help support engage and nurture partnerships at the state local and community level.

ASTHO members in your agencies also provide counsel and expertise on designing health systems that promote health equity and can show how health systems that address health disparities can strengthen health systems overall. Lastly, ASTHO members and agencies can continue to serve as intermediaries for communicating important information about HIV prevention, care and treatment to their colleagues and their communities.

How is HRSA engaging communities to drive progress in this space?

HAUCK: The Ryan White HIV/AIDS program has a long history of community engagement since the requirement to engage people with lived experience in planning and program development is embedded in the statute. So HRSA has carried or brought that tenant of community engagement into the EHE initiative. And that's because we truly believe that our collective success depends on how well communities are engaged in the planning, development and implementation of HIV care and treatment strategies that meet the needs of their own communities.

To foster that level of community engagement in 2021 we hosted 16 regional virtual listening sessions in partnership with our health center program colleagues, regional office colleagues, CDC colleagues, state and local health departments and community providers.

What innovations during the COVID-19 pandemic can be applied towards ending the HIV epidemic?

CHEEVER: The COVID-19 pandemic was extremely disruptive to HIV care and treatment. But it also forced us to find new ways to do our work and really drove a tremendous amount of innovation.

Many recipients embrace technology to implement EHE. This includes telehealth and telemedicine services, which have been shown in some instances to better engage some people that were not fully engaged in care. We moved very quickly to remote work for staff, which has provided some increased flexibility and a better work-life balance.

Many of our jurisdictions purchased internet-ready devices for their clients to better engage in telemedicine and provided virtual training for staff, providers, peer navigators, and community health workers. Another big innovation that existed prior to the COVID-19 pandemic but wasn't well-implemented was self-testing.

What are your top priorities and what excites you the most?

CHEEVER: Our top priority continues to link people with HIV to essential support, treatment, and care services so that they reach viral suppression. That'll help people live a near-normal lifespan with this disease and not sexually transmit HIV to their HIV negative partners. We need to continue and develop innovative evidence-informed interventions that connect and retain people to HIV care and build organizational capacity to address stigma and employ people with HIV.

HAUCK: We launched our best practices compilation, which is a central location for Ryan White programs to share their innovative strategies to bring people into care, keep them engaged in care, and improve their health. It is an effort to promote knowledge sharing between Ryan White HIV/AIDS program recipient and sub recipients and provides access to new and innovative strategies that improve outcomes for our clients. We're also excited about our Ryan White HIV/AIDS compass dashboard. It's a user-friendly interactive data tool, which allows people to visualize the region impact of the program as well as the outcomes among the clients served.

The development of this blog post is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under grant number 2 UD3OA22890-10-00. Information, content, and conclusions will be those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.