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Ending the HIV Epidemic by 2030

Speaking before a panel of key advocates on Feb. 27, HRSA Administrator Dr. George Sigounas broadly outlined a plan to have BPHC and HAB jointly work in high-risk jurisdictions to stop the HIV epidemic in the U.S. within a decade.
Speaking before a panel of key advocates on Feb. 27, HRSA Administrator Dr. George Sigounas broadly outlined a plan to have BPHC and HAB jointly work in high-risk jurisdictions to stop the HIV epidemic in the U.S. within a decade. He was among senior HHS leaders to speak in a department-wide address last month.

 

In 2020, HRSA would devote Health Center Program resources to expand PrEP services to selected health centers in the focus jurisdictions where over half of all new HIV infections occur ... Through this initiative, HRSA’s Ryan White HIV/AIDS Program would increase the capacity to provide HIV care and treatment to those newly diagnosed with HIV. It would also improve outreach to individuals living with HIV, but who are not currently engaged in HIV care.

- Dr. George Sigounas

In a webcast to all HHS staff, Dr. George Sigounas and other senior department leaders outlined an Administration proposal to mount an all-out fight against HIV in 48 U.S. counties, seven rural states, the District of Columbia and San Juan, Puerto Rico -- which are so burdened by the virus that they now account for more than half of the nation's 40,300 new infections annually.

If funded, the plan would rely on HRSA to "play a leading role" through its flagship HIV/AIDS, Primary Care and 340B drug discounting programs, Dr. Sigounas said, in addition to the CDC, NIH, IHS and SAMHSA.

"The people engaged in this effort are as serious as they can be," said  ADM Brett P. Giroir, M.D., Assistant Secretary for Health. “This is an absolutely doable public health effort … this is real.”

The initiative -- Ending the HIV Epidemic: A Plan for America  -- was first unveiled in the President's State of the Union address. It would include enlisting the aid of 19 major universities identified as Centers For AIDS Research by the NIH to develop new approaches tailored to specific communities; the formation of a specialized CDC corps to work on the ground with local providers; and funding for faith-based organizations to help garner support for public health campaigns aimed at eliminating the virus.

HRSA's Dr. Laura Cheever -- a leading national authority on HIV/AIDS -- said that it would entail an "all hands on deck" effort by agency staff and stakeholders to pursue the virus into some of the most underserved counties and rural communities, particularly in the South.   

From left, Susan Monares, Dir., HRSA Office of Planning, Analysis and Evaluation; Suma Nair (BPHC) and Dr. Laura Cheever, Associate Administrator of the HIV/AIDS Bureau; with Steve Young,  Dir., HAB Division of Metropolitan HIV/AIDS Programs, were on hand for a conference at 5600 Wednesday with longtime HAB partners.
On deck: From left, Susan Monares, Dir., HRSA Office of Planning, Analysis and Evaluation; Suma Nair (BPHC) and Dr. Laura Cheever, Associate Administrator of the HIV/AIDS Bureau; with Steve Young,  Dir., HAB Division of Metropolitan HIV/AIDS Programs, were on hand for a conference at 5600 Wednesday with longtime HAB partners.

 

Cheever pointed out that about half of all Ryan White HIV/AIDS program grant recipients are Community Health Centers, and the overwhelming majority of designated "hot spot" counties are within range of HRSA-funded sites.

Nair, who is the director of BPHC's Office of Quality Improvement, added that health centers performed more than two million HIV screenings last year -- a 22 percent increase -- and the bureau is providing technical assistance training to increase screening, treatment and the dispensing of PrEP (Pre-Exposure Prophylaxis) on-site to patients at highest risk.

A daily pill, PrEP has been lauded as a breakthrough drug that reduces the risk of transmission to near-zero for people at risk of exposure to HIV through IV drug use or unsafe sex practices. Tens of thousands of Americans -- particularly those in areas lacking ready access to routine screening or health insurance -- are infected without knowing it and at risk of spreading the virus to unprotected partners.

HHS estimates that up to half of people who have HIV are unaware of it for three years before they're diagnosed, and one out of five don't find out until the virus has progressed to AIDS. A staggering 87 percent of new cases are contracted through these individuals or those who have dropped out of treatment, observed CDC Director Dr. Robert Redfield on Thursday.

Hence, Dr. Sigounas told the gathered advocates that increasing PrEP dispensing from health centers will be a linchpin of the plan.

Among those in attendance at 5600 on Wednesday were Jenny Collier, the Ryan White Medical Providers Coalition; Emily McCloskey, the National Alliance of State and Territorial AIDS Directors; Andrea Weddle, the HIV Medicine Association; and Carl Schmid of the AIDS Institute, who has been tapped as the new chairman of the Presidential Advisory Council on HIV/AIDS, it was announced on Thursday.
HRSA Partners: Among those in attendance at 5600 on Wednesday were Jenny Collier, the Ryan White Medical Providers Coalition; Emily McCloskey, the National Alliance of State and Territorial AIDS Directors; Andrea Weddle, the HIV Medicine Association; and Carl Schmid of the AIDS Institute, who has been tapped as the new chairman of the Presidential Advisory Council on HIV/AIDS, it was announced on Thursday.

 

Adherence to PrEP, especially in major urban centers, is a contributing factor to HAB's remarkable 10-year success in stopping the spread of the disease and reducing new infections in targeted areas like New York City, Chicago and Atlanta -- while stepped up screening and treatment has led to 86 percent of all Ryan White program participants being "virally suppressed" and able to live normal lives, Cheever said.

By contrast, Dr. Sigounas noted that among all patients living with the virus, the suppression rate stands at only about 60 percent, testament to the effectiveness of the HAB treatment model, which covers about half of all people living with the virus in the U.S. as the "program of last resort" for the poor and uninsured.

"If we knew how to get the people who are out of care into care," Cheever said, "they'd be in care."

Map of the U.S. showing 48 counties and 7 states with substantial rural hiv burden
Map of the U.S. showing 48 counties and 7 states with substantial rural hiv burden. Read a list of the 48 HIV Burden Counties, as well as states that have a substantial rural HIV burden (PDF 44 KB).

 

And therein lies perhaps the biggest challenge, advocates said: The stigma associated with drug use and sexual behavior underlie engrained resistance within certain communities to such programs, on grounds that "it's immoral," said Andrea Weddle of the HIV Medicine Association.

"We are well aware of the importance of educating providers," Nair replied, listing BPHC training programs to address misconceptions among clinicians, adding that "it sometimes  just comes down to a lack of information" about the public health imperatives involved. Among other possible avenues, telehealth may provide the means to have direct contact with affected patients at a distance.

"At the level of the discussions we've had within the Department," Cheever noted, "stigma comes up all the time. And when we talk about the people who are out of care, we don't know all the reasons ... but certainly stigma plays a role for some of them. And we know that mental health and substance abuse issues are part of it. But certainly stigma is a major issue," particularly in geographically isolated regions of the country and areas with high rates of IV opioid misuse.

Said Carl Schmid of the AIDS Institute: Getting PrEP widely distributed has "been a missing link for the uninsured" in remote communities, applauding the proposed rapid ramp-up of health center dispensing.

Learn more about the initiative.

Date Last Reviewed:  March 2019