Over the past month, the White House Office of National AIDS Policy (ONAP) hosted a series of listening sessions in four cities across the country—Los Angeles, Nashville, Detroit, and Boston—to gather community perspectives that will inform its update of the National HIV/AIDS Strategy (NHAS). At each session, Mr. Douglas M. Brooks, MSW, Director of ONAP, discussed the process underway to review and update the NHAS, which will continue to guide the U.S. government and partners’ response to HIV/AIDS domestically for the next 5 years. He then listened to community input, beginning with ideas shared by a panel of local HIV community leaders assembled for each session. This post shares highlights from each of those sessions.
Los Angeles Session Highlights Reducing New HIV Infections
The first goal of the Strategy is to reduce new HIV infections in the U.S. by intensifying prevention efforts in our most heavily-impacted communities; expanding comprehensive, evidence-based prevention approaches; and educating all Americans about HIV. Los Angeles County has seen a substantial decrease in HIV diagnoses—nearly 40% between 2010 and 2013—so it was a natural place to hold the first forum on April 22, focusing on reducing new HIV infections.
Dr. Eugene McCray, the director of CDC’s Division of HIV/AIDS Prevention, participated in this forum, discussing CDC’s High-Impact Prevention approach to reducing new HIV infections, guidelines for routine HIV testing and clinical guidelines for the provision of pre-exposure prophylaxis (PrEP).
Among the recommendations delivered by community participants at this forum were:
- Enhance comprehensive sexual health education for adolescents to reduce HIV-risk behavior and build lifelong skills to prevent HIV and other sexual transmitted infections.
- Improve access to PrEP for high-risk clients, including the services needed to “wrap around” the provision of PrEP so as to ensure that individuals maintain adherence.
- Increase access to sterile injection equipment for people who inject drugs (PWID) as a component of a comprehensive package of HIV prevention services.
- Better integrate HIV prevention and care, including mental health, substance use and other behavioral health services, into “one stop shops” to facilitate sustained HIV prevention.
- Make HIV testing more accessible and less stigmatized by improving service provider competency, especially for LGBT clients, and by fully implementing routine testing guidelines in clinical settings.
Nashville Session Spotlights Increasing Access to HIV Care
Increasing access to care and improving health outcomes for people living with HIV, the Strategy’s second goal, was the focus of the April 24 listening session in Nashville, Tennessee. Approximately 60 people participated in the session, including providers from community-based organizations and healthcare organizations, people living with HIV, and advocates.
I was honored to be part of the Nashville meeting and provided an overview of the HIV care continuum in the U.S. and in Tennessee.
Participants expressed strong support for the continuation of the Ryan White HIV/AIDS Program to provide vital services to uninsured and under-insured individuals, even in the era of expanded health coverage made possible through the Affordable Care Act. Other recommendations from the community participants in Nashville included:
- Continue to address the social determinants of health and other contextual issues that present obstacles—or facilitate—people living with HIV/AIDS entering, remaining in, or re-engaging in HIV care.
- Recognize and address the different needs of people living with HIV across the lifespan including the special needs of youth with HIV and the multiple health concerns—including other chronic conditions—faced by people with HIV who are aging.
- Identify alternate models of HIV care delivery in areas of the country where the population density is lower so that access to high quality care is available.
Detroit Session on Reducing HIV-Related Health Disparities
The Thursday, May 7, listening session in Detroit focused on the third NHAS goal, reducing HIV-related health disparities. Joining Director Brooks for this session was Dr. Gina Brown of NIH’s Office of AIDS Research who provided an overview of national HIV epidemiology as well as data on the epidemic in Michigan, underscoring that African Americans are disproportionately impacted in both. She also discussed how NIH research informs the NHAS goals. Nearly 75 participants attended and shared their observations and recommendations.
Notably, several of the suggestions dealt with the need to better confront and combat HIV-related stigma and discrimination, reported by participants to be stronger in some communities than in others. Participants called for continued efforts to reduce stigma against people living with HIV, sexual minorities, including sexual minority youth, and others.
Among the other community suggestions shared in Detroit were:
- Improve HIV/AIDS data collection among transgender women, who are currently counted in HIV surveillance data in the same category as gay, bisexual and other men who have sex with men.
- Ensure that HIV testing and care are available in suburban and rural areas, not just in major metropolitan areas.
- Enhance efforts to address co-infection with hepatitis C virus among people living with HIV.
- Recognize that HIV occurs in a broader context and that our efforts must also address social determinants of health that can impede access to or retention in HIV care and appropriate support services should be provided.
- Work to ensure that healthcare providers are culturally competent and able to deliver services in a non-stigmatizing manner to a diverse array of clients, especially youth of color and sexual minorities.
- Identify ways that that the nation’s schools can more effectively and uniformly educate youth with medically accurate information about HIV and HIV prevention.
- Ensure that HIV prevention, care and treatment programs are accessible to and address the needs women of color in areas where they are among the disproportionately impacted populations.
Boston Session Focused on Achieving a More Coordinated National Response
The series of listening sessions concluded on Friday, May 8, in Boston with a forum discussing ideas about how to achieve greater coordination at the federal, state and community levels through integration and innovation to improve outcomes along the HIV care continuum. Dr. Andrew Forsyth, Senior Science Advisor in the HHS Office of HIV/AIDS and Infectious Disease Policy, joined Mr. Brooks for this session. He provided an epidemiological overview of the HIV epidemic in the U.S. and in Massachusetts, observing that if we are to achieve the goals of the NHAS, we must align resources to match the burden of the epidemic.
Nearly 100 participants shared their recommendations about how the nation could reach the goal of improved coordination, including:
- Improve collection and sharing of data on disproportionately impacted populations, including transgender persons living with HIV.
- Identify new metrics to measure expanded access to HIV services.
- Be more directive about how best to integrate services at the local level.
- Continue to ensure accountability of programs receiving federal HIV funds.
Participants also shared recommendations related to other NHAS goals, including:
- Create an HIV prevention continuum, grounded in implementation science, to keep people free of HIV infection and complement the focus on the HIV care continuum; task a federal interagency workgroup to develop and monitor it.
- Support programs and policies that increase the number of minority providers of mental health and addiction services.
- Engage community-based organizations as well as peers to reach populations at risk of HIV or living with HIV but not engaged in care.
- Increase funding and enhance services to address homelessness among people with HIV, and shelter people with HIV and those at high risk.
- Ensure that food and nutrition services as well as oral health are addressed as key services.
- Enhance HIV training for primary care providers to increase capacity of workforce.
- Ensure that localities that have more successfully responded to the epidemic are not punished for their success through decreased funding.
- Monitor health plans to ensure that fundamental HIV services and drugs are available in a non-discriminatory manner (e.g., unfair utilization criteria or burdensome cost-sharing requirements) and ensure reasonable access to hepatitis C treatments.
Insight for All
While the listening sessions were convened for the purpose of informing the development of the updated NHAS, Director Brooks reminded participants at all the forums that the Strategy is a national plan, not merely a federal one, and it requires action by all sectors of society if we are to achieve its goals. Thus, the recommendations offered at the listening sessions provide all HIV community stakeholders with an opportunity to reflect on whether and how they may be able to address them to improve HIV prevention, care and treatment services in their own communities.
Share Your Ideas for Updating the NHAS
If you have recommendations about updating the NHAS, you can share them online –or vote for or comment on suggestions made by others – until May 22, 2015 using this feedback forum hosted by AIDS.gov for the White House Office of National AIDS Policy. Read more about this opportunity.