Ending the HIV Epidemic Initiative

Ending the HIV Epidemic: A Plan for America (EHE) is an operational plan to end the HIV epidemic and reduce the number of new HIV transmissions in the U.S. by 75% by 2025 and by 90% by 2030. Developed by agencies across the U.S. Department of Health and Human Services (HHS), the EHE initiative focuses on advancements in HIV prevention, diagnosis, treatment, and outbreak response by coordinating the highly successful programs, resources, and infrastructure of many HHS agencies and offices.

Ending the HIV Epidemic

HIV continues to be a significant public health issue impacting communities across America. The following are U.S. statistics

• More than 1.1 million Americans are currently living with HIV and many more are at risk of HIV transmission.
• While new HIV diagnoses have declined significantly, almost 40,000 Americans are newly diagnosed each year.
• About 1 in 7 people with HIV are unaware of their diagnosis.
• Black and Hispanics make up 69% of all new HIV diagnosis.
• There’s a disproportionately lower percentage of Black and Hispanic men that either are not aware of Pre-Exposure Prophylaxis (PrEP) or have not discussed PrEP with a health care provider, or have not used PrEP within the past year.
• Less than 7% of women who could benefit from PrEP are using it.
• Stigma, fear, discrimination, and homophobia place many people at higher risk for HIV.
• Socioeconomic issues associated with poverty—including limited access to high-quality health care, housing, and HIV prevention education—directly and indirectly increase the risk for HIV and affect the health of people with HIV and at risk for HIV.

Priority Jurisdictions & Phases

In Phase I, the EHE initiative focuses on 57 priority areas, including 48 counties, Washington, DC, and San Juan, Puerto Rico, where more than 50% of new HIV diagnoses occurred in 2016 and 2017 and also seven states with a disproportionate occurrence of HIV in rural areas. In Phase II, efforts will be even more widely disseminated across the nation to reduce new transmissions by 90% by 2030. In Phase III, intensive case management will be implemented to maintain the number of new transmissions at fewer than 3,000 per year.

Key Strategies

The EHE initiative implements four key strategies: Diagnose, Treat, Prevent, and Respond.

Diagnose all individuals with HIV as early as possible after infection.

More than 160,000 Americans are unaware they are living with HIV. Early detection coupled with rapid linkage to care is critical and can lead to improved individual and community health outcomes. Federal agencies work in collaboration with communities to expand the availability of HIV testing, immediately connecting people with HIV to care services, and connecting those who test negative to appropriate prevention services are important activities supporting this strategy.

Treat people with HIV rapidly and effectively to reach sustained viral suppression.

After diagnosis, it is critical for anyone with HIV to begin treatment as soon as possible. People with HIV who take HIV medication as prescribed and stay virally suppressed can live long, healthy lives and have effectively no risk of sexually transmitting HIV to a partner. Increasing viral suppression amongst people with HIV is a key strategy to prevent new transmissions. HHS agencies are working with health providers, clinics and partners to expand capacity, strengthen systems, establish new programs and services, and forge new partnerships to tailor and implement these approaches as appropriate in their communities.

Prevent new HIV transmissions by using proven interventions, including PrEP, post-exposure prophylaxis (PEP) and syringe services programs (SSPs)

The HIV epidemic can affect communities differently, and plans developed locally with community member input guides prevention interventions and strategies tailored for local needs. This will increase the access to and availability of PrEP and SSPs, in the communities where these services are needed most.

PrEP is a pill that reduces the risk of getting HIV when taken as prescribed. However, of the estimated 1 million Americans who could benefit from PrEP, fewer than 1 in 4 actually use it. HHS agencies will support states and local communities to implement strategies to increase access to and use of PrEP—especially among African American and Latino gay and bisexual men, African American women, and other populations disproportionately affected by HIV. In addition, health centers will expand PrEP services. In December 2019, HHS launched Ready, Set, PrEP, a nationwide program that provides PrEP medications for free to individuals who qualify. As of August 2020, HHS contracted TrialCard as a distribution partner to verify Ready, Set, PrEP participant eligibility, enrollments, maintain the network of participating pharmacies, distribute the donated medications to uninsured participants, and process medication requests.

PEP is a short course of HIV medicines taken to prevent the virus from taking hold in your body. PEP must be taken within 72 hours after exposure to HIV to be effective and should be used only in emergency situations. Once prescribed, PEP must be taken every day for 28 days before HIV testing.

SSPs are another effective component of a comprehensive, integrated approach to HIV prevention for people who inject drugs. SSPs play an important role in reducing the transmission of viral hepatitis, HIV, and other infections. Comprehensive SSPs dramatically reduce HIV risk and can provide an entry point for a range of services to help stop drug use, overdose deaths, and infectious diseases.

Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.

Real-time response systems are key to ending the HIV epidemic in the U.S. To implement, major areas of action include:

• Increasing investments in geographic hotspots through existing programs such as the Ryan White HIV/AIDS Program as well as establishing new programs through community health centers to provide outreach, HIV testing, pre-exposure prophylaxis (PrEP), and care coordination.
• Using data to identify where HIV is spreading most rapidly and guide decision-making to address prevention, care, and treatment needs at the local level.
• Supporting the jurisdictions to establish local teams committed to the success of the Initiative who will work with the community to design locally developed and tailored plans to expand HIV prevention and treatment services.

HHS Agencies Involved

The EHE initiative is implemented through collaboration among agencies and offices across HHS, leveraging scientific advances in HIV prevention, diagnosis, treatment, and care along with the programs and expertise of each agency and office.

Office of the Assistant Secretary for Health

The Office of the Assistant Secretary for Health (OASH) leads this cross-agency initiative through the Office of Infectious Disease and HIV/AIDS Policy (OIDP), providing overall project coordination and management and by monitoring progress and delivering information through HIV.gov. OASH’s Minority HIV/AIDS Fund further supports EHE activities that are designing and testing innovative solutions to address critical and emerging needs for HIV prevention, care, and treatment among communities of color.

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) works closely with state and local governments, communities, and people with and at risk for HIV, as well as federal partners to expand the use of the highest-impact HIV prevention strategies: Diagnose; Treat; Prevent; and Respond. With resources from the HHS Minority HIV/AIDS Fund, CDC is working with state and local health departments to build the foundation for effective Ending the HIV Epidemic implementation efforts through jumpstart activities in three communities and EHE planning in all 57 Phase I jurisdictions. Using these tailored, community-driven plans, CDC is providing additional resources, technology, and expertise to help scale-up the use of the four strategies. These efforts focus on innovation and outreach to increase HIV testing in clinical and non-traditional settings; developing robust networks to rapidly link persons with HIV to clinical care and support services and relink people who have fallen out of care; increasing awareness, delivery, and uptake of PrEP and comprehensive Syringe Service Programs; and building capacity to detect and respond quickly to potential HIV outbreaks.

Health Resources and Services Administration

Through its Ryan White HIV/AIDS Program and its Health Center Program, the Health Resources and Services Administration (HRSA) plays a critical role in diagnosing, treating, preventing and responding to the HIV epidemic. The Health Center Program is increasing HIV testing in the initiative’s 57 Phase I priority jurisdictions by conducting expanded outreach within their communities and increasing routine and risk-based HIV testing of health center patients. These health centers expands access to PrEP for patients who are at risk of infection. HRSA’s Ryan White HIV/AIDS Program is focusing on linking people living with HIV who are either newly diagnosed, or are diagnosed but currently not in care, to the essential HIV care, treatment, and support services needed to help them achieve and maintain an undetectable viral load.

Indian Health Service

The Indian Health Service (IHS) provides health services to approximately 2.6 million American Indians and Alaska Natives from 573 federally recognized tribes in 37 states, through a network of over 605 hospitals, clinics, and health stations. As part of a comprehensive public health approach, the IHS focuses its EHE efforts on coordinating and promoting HIV prevention and treatment activities in the communities most affected. In partnership with Native communities, the IHS promotes HIV, HCV, and STI testing, prevention, and treatment using innovative tools such as tele-health, electronic health record clinical reminders, and PrEP guidelines.

National Institutes of Health

The National Institutes of Health (NIH), through its 19 Centers for AIDS Research and six AIDS Research Centers at academic and research institutions nationwide, collaborates with community partners on research to determine optimal implementation of proven HIV treatment and prevention tools. NIH informs HHS partners on best practices, based on state-of-the-art biomedical research findings, and by collecting and disseminating data on the effectiveness of approaches.

Substance Abuse and Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA) utilizes its expertise to address the intersection of HIV and substance use disorders and help ensure that appropriate and effective behavioral health interventions are implemented as part of the national plan to end the HIV epidemic in the United States. SAMHSA’s ongoing efforts to increase providers of medication-assisted treatment (MAT) for individuals with substance use disorder help control the spread of HIV and provide access for people who use drugs to HIV prevention, diagnosis, and treatment. SAMHSA also works to increase access to syringe services programs (SSPs), reducing the spread of infectious diseases, including HIV and hepatitis C (HCV), via injection drug use. SAMHSA-supported activities serve as a bridge to MAT for opioid use disorder as well as other health services, including HIV and HCV diagnosis and treatment, and pre-exposure prophylaxis (PrEP).

Whole-of-Society Initiative

Achieving EHE’s goals requires a whole-of-society effort with inclusion of partners at all sectors of society. This includes federal agencies; people with HIV or at risk for HIV; city, county, tribal, and state health departments and other agencies; local clinics and healthcare facilities; healthcare providers; providers of medication-assisted treatment for opioid use disorder; professional associations; advocates; community- and faith-based organizations; and academic and research institutions, among others.

AHEAD Dashboard

America’s HIV Epidemic Analysis Dashboard (AHEAD) visualizes data for six HIV indicators to inform local, state, and national decision-making around ending the HIV epidemic in the United States. This tool provides the most up to date information available to monitor and track EHE progress.

Launched in August 2020, AHEAD provides national and local data on the six EHE indicators:

• HIV Incidence: The estimated number of new HIV infections in a year
• Knowledge of HIV Status: The estimated percentage of people with HIV who have received a HIV diagnosis

• HIV Diagnoses: The number of people with HIV diagnosed in a given year, as confirmed by laboratory or clinical evidence
• Linkage to HIV Medical Care: The percentage of people with HIV diagnosed in a given year who have received medical care for their HIV infection within 1 month of diagnosis
• Viral Suppression: The percentage of people living with diagnosed HIV infection in a given year who have an amount of HIV that is less than 200 copies per milliliter of blood
• PrEP Coverage: The estimated percentage of individuals with indications for AHEAD is an evolving resource, with new information, resources, data, and functionality added to the site throughout the initiative.

Funding Overview

Funding is determined by budget considerations submitted to congress. Once passed in Congress and signed into law by the President, the funding is included in the Federal Budget proposal for the fiscal year. The budget appropriates funds towards the EHE initiative supporting HIV prevention, care, treatment, and research programs to eliminate HIV in America.

See Also

U.S. Department of Health and Health Services HIV/AIDS in the United States Centers for Disease Control and Prevention (CDC) Health Resources and Services Administration (HRSA) Indian Health Service (IHS) National Institutes of Health (NIH) Substance Abuse and Mental Health Services Administration( SAMHSA) Pre-Exposure Prophylaxis (PrEP) Ready, Set, PrEP

References

 This article incorporates public domain material from websites or documents of the United States Department of Health and Human Services.

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