In 2019, the federal government launched the Ending the HIV Epidemic in the U.S. (EHE) initiative. The plan outlines objectives and strategies to aid stakeholders—federal government agencies, state health departments, researchers, policy makers, health care providers, advocacy groups, and patients—in working together to end the HIV epidemic in the U.S.
Seven years in, the data show real progress against HIV — but not at the pace the 2030 target requires. We asked five leaders in HIV research, policy, state and federal government, and community engagement the following question:
What has worked so far, and what will it take to actually achieve these goals?
Geri Donenberg, PhD (with input from the NIH Office of AIDS Research Science Team)
Director of the Office of AIDS Research, Associate Director for AIDS Research, The NIH Office of AIDS Research (OAR), National Institutes of Health
What has worked so far
By investing in cross-sector partnerships and centering communities impacted by HIV, EHE expanded testing, rapid treatment, PrEP uptake, U=U messaging, and remarkable advances that deepened our understanding of HIV latency, brought promising new therapeutics closer to availability, and delivered an important long-acting prevention option. Additionally, implementation and other research stimulated by EHE is illuminating how best to deliver evidence-based multilevel interventions tailored to the unique needs, circumstances, and goals of the people and systems served to improve reach and access, uptake and adoption, sustainability, and scale-up.
What will it take to achieve the goals
Achieving the EHE goals will require sustained investment, de-medicalizing PrEP and PEP, and increasing affordability, access for all, and multisectoral partnerships that include communities, payers, providers, public health agencies, and policymakers to ensure that effective interventions address whole-person health and overall quality of life. NIH-funded research must continue to pursue a cure while simultaneously improving our understanding of—and response to—the complex reasons for suboptimal uptake (by individuals) and adoption (by conventional and non-conventional settings) of evidence-based HIV prevention, treatment, and care tools (e.g., stigma, non-inclusive health plans) to reduce HIV cases and improve treatment outcomes.
Marlene McNeese, MBA
Deputy Assistant Director, Bureau of HIV/STI and Viral Hepatitis Prevention, Houston Health Department
The Ending the HIV Epidemic initiative has shown us that progress is possible when we combine science, strong public health infrastructure, and trusted community partnerships. We have expanded access to testing, PrEP, treatment, and innovative approaches to reaching communities, but the benefits of these advances still aren’t reaching everyone equitably.
Achieving the 2030 goals will require us to confront the structural barriers that continue to drive disparities: stigma, racism, poverty, housing instability, and unequal access to care. It will also require sustained investment in the community organizations and the workforce closes to those most impacted. We cannot simply do more of what we have been doing; we must be willing to integrate services, share power with communities, use data more strategically, and respond differently where progress has stalled.
We have the tools to end HIV as an epidemic in the U.S. The question now is whether we have the collective commitment and courage to ensure those tools reach everyone who needs them.
Alicia Diggs, PhD, MPH
UNC Center for AIDS Research (CFAR) Office of Community Engagement Manager
I look at the Ending the HIV Epidemic initiative through two lenses: as a person living with HIV and as someone who works every day in community engagement, and while we have made progress, having the right tools means very little if they are not reaching the people who need them most. Ending the epidemic cannot simply be about reducing numbers on a surveillance report; it must also mean improving the lives of people living with HIV by addressing stigma, housing, poverty, access to healthcare, medical mistrust, HIV criminalization, aging, and the other realities that impact our ability to thrive.
We have to pay attention to who is still being left behind, particularly Black communities, women, rural communities, and others who continue to face significant barriers to prevention and care. People living with HIV and communities most impacted know where the gaps are, which is why authentic community engagement must mean shared power, shared decision-making, meaningful compensation, and including us from the beginning not after the decisions have already been made. I still believe we can end the HIV epidemic, but we will not science our way out of HIV alone; we must combine science with equity, trust, resources, policy change, and community leadership while making sure we do not leave behind the very people who have carried this movement for decades.
Harold Phillips
CEO, National Minority AIDS Council (NMAC), Former COO of the EHE U.S. Initiative, Former Director of the Office of National AIDS Policy
What has worked is clear: expanded testing, rapid linkage to care, effective treatment, U=U, PrEP—including long-acting options—and trusted community-led programs. But we have not brought these innovations to scale nationwide, leaving access dependent on geography, insurance, income, and race. We must also acknowledge that the Ending the HIV Epidemic initiative was based on funding models that assumed substantial, sustained federal investment—funding that was never fully provided. Achieving the 2030 goals will require the political will to fund the strategy at its intended scale, protect essential HIV programs, and ensure proven interventions reach every community that needs them.
Jeff Crowley, MPH
Program Director, Infection Disease Initiatives, O’Neill Institute for National and Global Health Law, Former Director of the Office of National AIDS Policy)
An important part of the HIV response is that the money must follow the epidemic. This means the people and places with the greatest need should get the greatest amount of support. The EHE initiative is an important effort because it recognizes that HIV transmission is concentrated in a relatively small number of jurisdictions, and these generally are both under-resourced and have inadequate public health systems to achieve optimal outcomes. EHE, built on top of our existing HIV prevention and care systems, is building critical local capacity AND improving the focusing of resources to achieve maximum impact. However, to achieve the EHE’s bold vision, requires that Congress sustain our nationwide HIV public health response and appropriate the level of new resources needed to enable EHE to build on its demonstrated success and achieve the adequate scale to truly move us toward ending HIV as an ongoing public health threat.
