Background
During the 2019 State of the Union address, the Trump administration announced the new “Ending the HIV Epidemic: A Plan for America.” This will be a ten year initiative beginning in FY 2020 to achieve the important goal of reducing new HIV infections to less than 3,000 per year by 2030. Reducing new infections to this level would essentially mean that HIV transmissions would be rare and meet the definition of ending the epidemic. The initiative will focus efforts in 48 counties, Washington, DC, San Juan (PR), and seven states with substantial rural HIV burden.
Geographic locations: The 48 counties, plus Washington, DC, and San Juan, PR, where >50% of HIV diagnoses occurred in 2016 and 2017, and an additional seven states with a substantial number of HIV diagnoses in rural areas.Key Strategies in the Plan
The efforts will focus on four key strategies that together can end the HIV epidemic in the U.S.
- Diagnose all people living with HIV as early as possible after transmission.
- Treat HIV rapidly and effectively to achieve sustained viral suppression.
- Prevent HIV transmission among people at highest risk with Pre-Exposure Prophylaxis (PrEP) and prevention education.
- Respond rapidly to detect and respond to HIV clusters and prevent new HIV infections.
HRSA's Role in the Plan
Through the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program and the HRSA-funded Health Center Program, the agency will play a leading role in helping diagnose, treat, prevent, and respond to end the HIV epidemic.
Diagnose
HRSA-funded health centers are a key entry point for people with HIV who are undiagnosed. Nearly two million patients annually receive an HIV test at a health center. HRSA’s Health Center Program will increase HIV testing in high impacted areas by conducting expanded outreach within their communities and increasing routine and risk-based HIV testing of health center patients.
HIV Care and Treatment
People living with HIV who take HIV medication daily as prescribed, and get and keep an undetectable viral load, effectively have no risk of sexually transmitting the virus (PDF - 390 KB) to their HIV-negative partner. This finding highlights the importance of getting people living with HIV linked to HIV care and treatment and helping them stay in care and on their medication.
If HRSA’s Ryan White HIV/AIDS Program receives funding and flexibility to direct the funding to the identified jurisdictions for the Ending the HIV Epidemic initiative, HRSA will focus on linking people living with HIV who are either newly diagnosed, or are diagnosed but currently not in care, to the essential HIV care and treatment and support services needed to help them achieve an undetectable viral load.
Prevent
Many health centers provide HIV prevention services, including pre-exposure prophylaxis (or PrEP) for people at high risk of acquiring HIV. Studies show daily PrEP reduces the risk of getting HIV from sex by more than 90 percent. An estimated 1.2 million Americans are at high risk for HIV infection, but fewer than 10 percent use PrEP.
HRSA plans to focus on key geographic areas and expand access to PrEP for health center patients who are at highest risk of acquiring HIV infection. This will include receiving referrals from community-based programs and providing PrEP for those who are at high risk.
Respond
New laboratory methods and disease control techniques allow health departments to see where HIV may be spreading most rapidly. Called "cluster detection," this technique will allow community partners to quickly develop and implement strategies to stop ongoing transmission. HRSA’s Ryan White HIV/AIDS Program and Health Center Program will support these transmission-ending strategies by providing HIV care and treatment (RWHAP) and PrEP (CHC) to those identified through cluster detection activities.
