Dr. Patrick Sullivan, PhD, is a Professor of Epidemiology at Emory University and the Principal Scientist at AIDSVu
Q: What do you hope a renewed national focus on ending the HIV epidemic will achieve?
Focusing on the HIV epidemic is critical, and it is equally important that renewed attention to the epidemic be driven by data about where the epidemic is most intense. The goal is to end the HIV epidemic in the U.S. once and for all, and the new national attention will help us get there. There are many jurisdictions across the country that are already working on their own local Ending the Epidemic plans, and people in these areas have been doing wonderful work towards improving the health of their communities. That kind of local focus has been essential because local health officials and other local stakeholders know their communities better than anyone. They know what their communities need and how to reach the most vulnerable members. However, a national focus and a national plan is key to making the kind of broad progress I would like to see towards ending the HIV epidemic in the U.S. Many people perceive HIV as having been largely brought under control – for some people, it’s not perceived as the threat that it used to be. But there are many people who are still at risk for HIV and we are still seeing about 39,000 new HIV diagnoses each year. We need to do more and to work in focused ways to end new HIV infections across the United States.
Q: What are the goals of Ending the HIV Epidemic: A Plan for America, and how does it propose to accomplish those goals?
The overarching goal of the plan is to reduce new HIV diagnoses by 75% by 2025 and by at least 90% by 2030. It proposes to accomplish these goals through four main avenues:
- Diagnose all people with HIV as early as possible.
- Treat people with HIV rapidly and effectively to reach sustained viral suppression.
- Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs).
- Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.
The first phase of the national plan will focus efforts and resources in 48 counties, plus San Juan, Puerto Rico and Washington, DC, where more than half of all new HIV diagnoses occurred in 2016 and 2017, along with and seven states (Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina) with a substantial rural HIV burden. The initiative involves several government agencies, including Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and the Indian Health Service (IHS).
Q: How does an increased use of prevention methods, such as PrEP, in populations that need it most, including and especially communities of color, help to accomplish the initiative’s goals?
Preventing new HIV transmissions through expanding the use of PrEP is a central pillar of the national plan. PrEP is often underutilized in communities and among certain populations who need it the most. AIDSVu data show that most of the 48 priority counties fall in states with a high unmet need for PrEP. This initiative has made it one of its goals to increase PrEP use in communities that need it most. Targeting funding and resources towards these specific geographic locations is key in reaching that goal, and we hope that the PrEP data provided through AIDSVu will be helpful to health departments in developing local targets for PrEP coverage and in evaluating progress towards those goals.
Q: Of the 48 highest-burden counties targeted by the initiative, 48% are in the South. What is necessary for the South to make progress towards national goals at the same rate as the rest of the country?
Despite significant advances in diagnosis, care, and prevention, HIV continues to be a public health crisis in the Southern U.S., which experiences the greatest burden of new HIV infection, illness, and deaths of any U.S. region. The South currently accounts for approximately 44% of all people living with an HIV diagnosis in the U.S. and 52% of all new HIV diagnoses in 2017. This is despite the region only making up one-third (38%) of the U.S. population. Some communities in the South, such as Black and Latino gay and bisexual men, are disproportionately impacted by HIV and are seeing increased rates of new infection – a chilling reminder that the HIV epidemic is far from a thing of the past.
For the South to make progress at the same rate as other regions, we have to engage community leaders, public health officials, and other stakeholders. They know their communities and know what those communities need. Many of these communities are experiencing other overlapping public health crises and are impacted by social determinants of health that make it difficult to access affordable healthcare, let alone HIV prevention, treatment, and care. If you do not have access to affordable health insurance coverage or you are experiencing poverty, insecure housing, or are food insecure, it can be difficult to take care of your health and protect yourself against something like HIV. Southern states are less likely than other states to have adopted Medicaid expansion policies that would increase healthcare coverage. And the problems related to lack of healthcare coverage can be compounded by other factors. We know, for instance, that in all seven target states, the percent of people living in poverty is higher than the national average. We have to look at the whole picture when trying to address barriers to HIV prevention and treatment in the South.
Q: AIDSVu is releasing new and updated resources around the Ending the HIV Epidemic initiative, including a Deeper Look page, new infographics, and profiles for each of the 48 target counties. How do those resources help stakeholders engage with the initiative’s goals?
Visualizing HIV data geographically can be invaluable when stakeholders are targeting resources and developing local strategies. That is why AIDSVu is releasing new resources in relation to Ending the HIV Epidemic: A Plan for America:
- A Deeper Look: Ending the Epidemic page, which provides an overview of the national plan, its goals and focus, as well as insights on areas targeted by the plan.
- County-level profiles for the 48 counties with the highest burden of new HIV diagnoses that are being targeted by the initiative.(note to Alicia: I moved this up)
- City-level profiles, including the cities targeted by the plan: Washington, DC, and San Juan, PR.
- State-level profiles, including the seven states with a substantial rural HIV burden being targeted by the initiative.
- Regional-level profiles for the four U.S. regions as defined by the U.S. Census Bureau, including the South which is home to 48% of the counties targeted by the initiative.
- A national profile outlining the HIV burden across the nation.
- Additional infographics on the national plan’s key strategies and other state and local jurisdictional plans to end the HIV epidemic.
These resources help contextualize the national plan and give stakeholders a way to visualize and understand what the HIV epidemic looks like in each of the target jurisdictions. Hopefully, that can help us all work towards achieving these goals together.