Ann Lefert, MPP and Natalie Cramer, MS of NASTAD spoke about Ending the Epidemic plans across the U.S.
Q: NASTAD recently released a directory of local and state jurisdictional plans to “End the HIV Epidemic,” which are also referred to as Getting to Zero plans or Campaigns to End AIDS. What is an Ending the Epidemic plan, and why is it so important for a city, county, or state to have its own plan?
Ending the Epidemic plans are a little different than other HIV plans that we have seen previously. Ending the Epidemic plans are broader, solicit far more community input, and are more intersectional. They are also different in the sense that we wouldn’t necessarily expect them to be led by the health department. Ending the Epidemic plans are usually efforts led by the community with health department support. The health department may put structures in place, but the plan is led by a large coalition that works to achieve the outcomes of the plan. Because of this, the plan can really focus on the local HIV epidemic – where’s it’s going, where it’s been, and what broad structural and programmatic interventions need to be put in place. This will often have immense effects on what the plan might include, like looking into ending criminalization in the state, or Medicaid expansion. Overall, it looks into things that are broader than just HIV prevention and Ryan White funded services.
We consider these Ending the Epidemic plans to be really instructive for the community to build because it can be a galvanizing process for the whole community. It allows the community, health department, funded partners, clinicians, and a lot of other people who are working on this issue to have some difficult conversations about what is needed in order to move forward in a different, more productive way. Once those conversations take place, everyone is in a place where they feel good about the recommendations and where the plan is heading. Then, concrete actions can take place.
When Ending the Epidemic plans started to be discussed around the country, it was possible to be bold because of the incredible advancements in treatment and prevention, and evolution of policy and health care coverage. Simultaneously, we could see that there was a complacency around HIV because it wasn’t in the media as much as it used to be. We saw an opportunity to highlight how close we were are to ending the epidemic because we have these new tools, but we are not finished yet. We hope that Ending the Epidemic plans reinvigorate the HIV community and other partners to address the continuing needs of people living with or at risk for HIV.
Q: Every jurisdiction’s plan is tailored to local needs, priorities, and resources but there are also many similarities across plans. What are some of the core elements of successful plans?
The biggest goal is community engagement. We really need the commitment from the community to be involved and, in many cases, lead the efforts in partnership with the local health department. Another core element is having government involved in more than just the public health context. Having support from the mayor or the governor or other elected officials is vital. Having them put their stamp of approval, and ideally involving themselves directly in the development of the plan, makes a huge difference. It is also really important to hit the right balance between making sure the plan is bold and also making sure everything is grounded in the reality of a local jurisdiction’s data. The Ending the Epidemic plan becomes an opportunity to share what the local epidemic looks like more broadly and to identify the milestones each community needs to reach.
Q: Some cities and states have had Ending the Epidemic plans in place now for several years. What are some examples of successful outcomes that have been achieved as a result of these plans?
There are some general milestones and some specific ones that we have achieved. New York is the plan that gets highlighted the most often where both the state and the city of New York are willing to contribute significant resources to ending HIV. A specific outcome to highlight from the New York plan is that for persons living with HIV, the city allocated a significant amount of resources to support their housing needs to improve health outcomes. In other states that are beginning to think about putting plans into place, we see organizers beginning to double-down on efforts that will affect HIV rates tangentially, such as criminalization laws and regulations for syringe service programs. And in jurisdictions who have not yet been able to devote the incredible amount of time and resources that it takes to create an Ending the Epidemic plan, we see them beginning to get into the holistic mindset.
Q: There are a growing number of Ending the Epidemic plans across the country. How has NASTAD been involved in supporting this effort?
NASTAD has been focused around the idea of ending the epidemic in a number of different ways for the last three years. We have been calling upon all of the state- and CDC-funded health departments to begin developing their own Ending the Epidemic plans. We’ve been available to provide tailored technical assistance to all of those health departments.
We’ve also developed a resource tool called the core competencies index—an assessment across the care continuum with an emphasis on some of the things that make ending the epidemic difficult—for our health department members to use to measure progress. It is an opportunity for health departments to score themselves on the building blocks of what is needed programmatically and policy-wise in order to end the epidemic. In addition to this national core competencies report, we did individual core competencies reports for each jurisdiction and then walked them through their individual technical assistance plans, recommending steps they could take to develop their Ending the Epidemic plan.
Additionally, we have a series of success stories we keep on our website to inspire others. It’s great to have quantitative data, but sometimes the stories and other illustrative examples of how jurisdictions are doing this innovative work can be more powerful. They are all framed to both highlight innovative work and provide a springboard for other jurisdictions that are interested in doing similar work. They have become a way to provide some peer-based technical assistance.
Finally, NASTAD has been working closely with the ACT NOW: End AIDS Coalition, which is led by Housing Works. Housing Works is a group of interested community members and jurisdictions, which have developed plans or are in the beginning stages of developing a plan to provide some galvanizing force and technical assistance. We were also involved in the Ending the Epidemic University event this August in Birmingham along with Treatment Action Group and Housing Works, to support Southern jurisdictions in the process developing their plans. NASTAD wants to be broad in the way we support the variety of efforts and the many different iterations of Ending the Epidemic plans.
Q: What advice would you give to a local jurisdiction that is thinking about developing their own Ending the Epidemic plan?
For a health department, it is about figuring out how you are going to identify community leaders to take the lead in this process and identify what the appropriate role for the health department is. Jurisdictions who are beginning their plan need to be honest about the time and the resources it takes to put one of these plans together. It is not a process that only requires three meetings and two phone calls to formulate a plan. It is countless hours of phone calls, support groups, listening sessions, traveling around, and conducting webinars. It is time- and capacity-intensive. We also know that in the states that have been successful, they have been able to identify health department resources that they can use in the community to support organizations and staff to lead the process. In some instances, it is a full-time job or a significant portion of someone’s job. For example, in Louisiana, the state has identified resources to give to a community-based organization that is going to fund two staff positions to work on their Ending the Epidemic plan. Having those conversations about the time commitment, capacity, and resources, is key. There needs to be a lot of transparency, communication, and time.
Although each jurisdiction is unique, most of the plans have some real similarities. Successful plans have used similar processes so jurisdictions should be talking to each other – and NASTAD and ACT NOW: End AIDS Coalition can help with that! A first step should be having conversations with others who have done this and asking them what worked well and what didn’t.