We have made incredible progress in HIV treatment and prevention, but too many Americans from all walks of life still get HIV, and too people with HIV are dying needlessly. Since the early years of the epidemic, the impact of HIV has been concentrated in racial and ethnic minority communities. While we now have a host of effective HIV prevention, testing, and treatment options at our disposal, some communities continue to bear a disproportionate burden of HIV or have poorer HIV-related health outcomes. We are committed as a nation to ending the HIV epidemic for everyone. Achieving this goal requires even greater focus, innovation, and concerted effort to accelerate progress among racial and ethnic minorities.
Some populations and communities have been more heavily affected by HIV than others. Among these are racial and ethnic minorities: Blacks/African Americans, Hispanics/Latinos, American Indians, Alaska Natives, Native Hawaiians, and Asians and Pacific Islanders. Even in racial and ethnic minority populations that have not been hit as hard, we need to ensure that individuals in these communities who are at-risk for HIV infection or are living with the virus have access to services that will protect their health and prevent the further spread of HIV. Recognizing this, Congress established and continues to support the Minority AIDS Initiative to improve HIV-related health outcomes for racial and ethnic minority communities and to reduce HIV-related health disparities.
The Initiative includes an annual allocation of resources to the Secretary’s Minority AIDS Initiative Fund (SMAIF), which our office, OHAIDP, manages on behalf of the Office of the Assistant Secretary of Health.
I am pleased to report that in FY16 the SMAIF awarded a total of $50.7 million to support 33 programs and activities led by nine HHS Operating Divisions and Staff Offices, who in turn make awards to state and local health departments, community-based organizations and other grantees across America.
These SMAIF-supported initiatives promote innovation and collaboration across HHS agencies to strengthen HIV prevention and care among racial and ethnic minorities and bolster the critical focus areas identified in the National HIV/AIDS Strategy: widespread testing and linkage to care; support for people living with HIV to remain engaged in comprehensive care; universal viral suppression; and full access to PrEP services for those for whom it is appropriate and desired.
SMAIF-Supported Demonstration Initiatives
Approximately half of the FY16 SMAIF resources were allocated to the continuation of two cross-agency, multi-year demonstration initiatives. The Partnerships for Care (or P4C) demonstration ($2.6M to CDC and $7M to HRSA) is building sustainable partnerships among CDC-funded state health departments and HRSA-funded health centers to support expanded HIV service delivery in communities highly affected by HIV, especially among racial and ethnic minorities. Under P4C, health departments and health centers are working together to increase the identification of undiagnosed HIV infection, integrate HIV services into primary care, enhance the use of surveillance and electronic health record data to improve linkage to and retention in care, and improve HIV outcomes along the HIV continuum of care. Health departments and health centers in four states are participating in this demonstration project: Florida, Maryland, Massachusetts, and New York.
The THRIVE demonstration project (formerly Developing Comprehensive Models of HIV Prevention and Care Services for Men Who Have Sex with Men (MSM) of Color) ($16.5M to CDC) supports state and local health departments in collaborating with community-based organizations; health care clinics and providers; behavioral health providers; and social services providers to develop comprehensive models of prevention, care, behavioral health, and social services models for MSM of color at risk for or living with HIV. Health departments in seven jurisdictions are involved in this effort: Alabama, Baltimore, District of Columbia, Louisiana, New York City, Philadelphia, and Virginia, as well as HealthHIV, a national nonprofit providing culturally competent technical assistance, training, and capacity building services to the health departments and their partners.
“These projects show the continued role of the SMAIF as a catalyst for change to achieve the goals of the Strategy through cross-agency collaboration and prioritizing the populations in which HIV is most heavily concentrated in terms of race/ethnicity, geography, and transmission risk,” observed Tim Harrison, Ph.D., Senior Policy Advisor at OHAIDP, who manages the SMAIF.
Other Awards: Pioneering Efforts to Support National HIV Goals
Another $24.5 million from the FY16 SMAIF was allocated to 30 activities demonstrating a pioneering and outcome-driven response to the HIV epidemic. These awards, ranging from $125,000 to $3.8 million, focus on capacity development in support of our nation’s HIV prevention and care goals by: improving health outcomes for racial and ethnic minority populations living with HIV/AIDS; supporting efforts to reduce health disparities among racial and ethnic minorities; and promoting innovation in prevention, linkage to care, retention in care, and viral suppression services in racial and ethnic minority populations. The core focus of the SMAIF is innovation in what we do and how we do it. If we just keep on doing everything the same way as it has always been done, we will miss key opportunities to improve further the efficiency, effectiveness, and impact of HIV prevention, care, and treatment. If this happens, we run the risk of seeing a resurgence of new infections. A few of the newly funded projects include:
- A CDC project to evaluate program models that integrate HIV prevention and care activities into the STD prevention work of Disease Intervention Specialists to improve HIV outcomes among racial and ethnic minority people living with HIV;
- A HRSA project to implement a jurisdictional public health approach to expanding HCV testing and treatment for racial and ethnic minority individuals who are coinfected with HIV and HCV;
- A HRSA project to support leadership training for people living with HIV, including African American women, racial and ethnic minority youth, and transgender women of color;
- A HRSA project to support the integration of housing and healthcare data systems to improve health outcomes for homeless and unstably housed people of color living with HIV;
- A SAMHSA project to improve health outcomes for people of color at risk of HIV infection through drug treatment, HIV and viral hepatitis testing, and access to PrEP services in conjunction with syringe services programs; and
- A number of IHS projects to improve HIV outcomes for American Indians and Alaska Natives through enhanced prevention, screening, linkage to care, and re-engagement efforts.
Together, these initiatives reflect our focused efforts to align the SMAIF with the best available evidence and our national HIV goals, objectives, and priorities in order to improve HIV prevention and care in racial and ethnic minority communities.
Over the coming year, we will share highlights from these investments on this blog.