HRSA Gears Up for HIV Fight

Dr. Laura Cheever, head of HRSA's HIV/AIDS Bureau, briefed some of the agency's most influential partners on Sept. 17, heading towards the launch of a new campaign to effectively end the HIV epidemic within 10 years. One in seven people living with the virus don't know they have it, fueling a cycle of new infections, especially in the American South. ​
Dr. Laura Cheever, head of HRSA's HIV/AIDS Bureau, briefed some of the agency's most influential partners on Sept. 17, heading towards the launch of a new campaign to effectively end the HIV epidemic within 10 years. One in seven people living with the virus don't know they have it, fueling a cycle of new infections, especially in the American South.

 

​More than half of the 1.1 million people diagnosed with HIV in America get medication and care through HRSA's Ryan White program -- and more than 8 out of 10 of those in care are able to lead normal lives as a result. But some 400,000 people with the virus are outside the HRSA system, and 1 in 7 are unaware they are infected. Making HIV testing an essential part of routine primary health care offered by Community Health Centers could be key to getting the remainder into treatment, the agency's senior leaders say.

Widely recognized for having helped transform the once deadly illness into a manageable disease, the Ryan White HIV/AIDS and Health Center programs will be integral to making it preventable, agreed HRSA Acting Administrator Tom Engels and Associate Administrators Laura Cheever (HAB) and Jim Macrae (BPHC).

The trio addressed the annual gathering of HAB's National Partners on Sept. 17.

"The agency," Engels pledged, "will play a leading role in helping to diagnose, treat, prevent and respond to end the HIV epidemic in the United States."

 

Jim Macrae and Tom Engels
Jim Macrae and Tom Engels

 

There is reason for optimism: According to 2017 health center data, for example, over 165,000 patients living with HIV got their medical services at health centers, including many sites co-funded by the Ryan White HIV/AIDS Program. Health centers also provided more than 1.8 million HIV tests that year, which confirmed a positive diagnosis to more than 8,000 patients. Among them, approximately 85 percent were seen for follow-up treatment within 90 days.

With the Administration having rolled out a bold initiative to end HIV/AIDS, both programs are critical stops for people who have the virus and have dropped out of care, those infected who don't know it, and for anyone at risk for the disease. See Ending the HIV Epidemic: a Plan for America.

As part of the initiative, HRSA will target resources to the 48 'highest burden' counties, Washington, D.C., San Juan, Puerto Rico, and seven states with a substantial rural HIV burden.

"By focusing on the hardest hit areas first, we can achieve maximal impact," Cheever said, "with the goal of achieving a 75 percent decrease in new infections by the end of year 5 and at least a 90 percent overall decrease in new infections" in 10 years. This, at a time when federal experts have warned that there is a real risk of an HIV resurgence due to several factors, including injection drug use and complacency among health care providers in certain regions of the country.

 

Attending the briefing were Sabrina Matoff-Stepp, Dir., HRSA Office of Women's Health; Jonathan Reveil of AIDS United;  Carl Schmid, Dpty. Executive  Dir., The AIDS Institute, and Co-Chair of the Presidential Advisory Comm. on HIV/AIDS; and Steve Young, Dir., HAB Div. of Metropolitan HIV/AIDS Programs.
Attending the briefing were Sabrina Matoff-Stepp, Director of HRSA's Office of Women's Health; Jonathan Reveil of AIDS United; Carl Schmid, Deputy Executive Director of The AIDS Institute, and Co-Chair of the Presidential Advisory Committee on HIV/AIDS; and Steve Young, Director of HRSA HAB's Division of Metropolitan HIV/AIDS Programs.

 

Long recognized as pre-eminent in combatting HIV, Ryan White provides HIV care, medication and support services to more than half a million people each year. In 2017, 86 percent of people receiving care through the program were virally suppressed -- meaning they have virtually no chance of transmitting the virus to others.

HIV testing should be standard primary care medicine, Macrae said. Patients should be informed that an HIV test will be conducted as part of routine health screening unless they explicitly decline. The protocol was first recommended by the CDC and U.S. Preventive Services Task Force in 2013: Patients between the ages of 13 and 64 should get tested for HIV at least once, and those with risk factors should get tested at least annually.

 

From left, Emily McCloskey, National Alliance of State and Territorial AIDS Directors;  Jenny Collier, Ryan White Medical Providers Coalition; and Taryn Couture, National Coalition of STD Directors.
From left, Emily McCloskey, National Alliance of State and Territorial AIDS Directors; Jenny Collier, Ryan White Medical Providers Coalition; and Taryn Couture, National Coalition of STD Directors.

 

Collectively, HRSA-supported health centers conduct about 2.4 million HIV tests annually.

Moreover, some 900 health centers administer PrEP, or pre-exposure prophylaxis, Macrae reported. PrEP is an HIV prevention medication available as a single pill, which people who don't have HIV take daily to reduce their risk of getting HIV if they are exposed to the virus.

Health centers will build on that number as part of a broader effort to emphasize the availability of HIV prevention and treatment services in 'welcoming' settings, he said.

 

Gretchen Weiss, National Association of County and City Health Officials; and Elizabeth Ruebush of the Association of State and Territorial Health Officials.
Gretchen Weiss, National Association of County and City Health Officials; and Elizabeth Ruebush of the Association of State and Territorial Health Officials.

 

"We need to, in the Health Center program, make HIV prevention part of what we do, Macrae said. "It's not something separate … it's something we should be doing" as a matter of routine.

Macrae added that including HIV care - testing, prevention and treatment services – as part of a standard health center package should also reduce stigma, which has been identified as a major reason that many patients don't get tested, particularly in small towns and rural communities ... for fear of being identified as a member of a stigmatized group.

Date Last Reviewed:  October 2019