10 Ways to Maximize High-Impact HIV Prevention

December 15, 2015

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Earlier this month, I had the privilege of moderating a panel on High-Impact Prevention (HIP) initiatives at the state and local level at the 2015 CDC National HIV Prevention Conference (NHPC) in Atlanta.

The panelists were: Randy Mayer, Iowa Department of Public Health; David Ernesto Munar, Howard Brown Health Center; Chi-Chi Udeagu, NYC Department of Health and Hygiene; Terrell Parker, of The Damien Center; and Diana Jordan, Virginia Department of Health.

The panelists shared their experiences with adapting HIV prevention programs to incorporate HIP approaches, and with setting priorities and leveraging resources to improve outcomes. They also discussed stigma-reduction efforts, strategies to retain clients in care, and the need to focus on maximizing health equity for people living with HIV. I took the opportunity to share 10 ways to maximize high impact prevention that really emphasize the theme of the conference to Accelerate Progress, Prevent Infections, Strengthen Care and Reduce Disparities.

Envision a World Free of HIV

1. First, we must Envision a world free of HIV. Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases (NIAID), shared that there is no scientific reason that this can't be done. We HAVE the tools. And Dr. Eugene McCray, Director of the CDC Division of HIV/AIDS Prevention emphasized that we are seeing movement in this direction. But there is MUCH to be done. We must think and work differently and be creative and diligent, more than ever, in order to get different results. I applaud states and cities such as New York, Washington State, Colorado and Denver, San Francisco and others who have done the hard work and committed resources to create bold, transformative plans to end new HIV infections.

Address Structural Inequalites

2. Second, we must address structural inequalities. We have the tools we need but that does not mean that we have everything in place to put those plans into action. Not all people have access to health care services in their communities that are responsive to their experiences. Not all Black and Brown people in this country live a life free of racism and fear. Not all governors have done the right thing and expanded Medicaid to allow access to comprehensive services for millions of low-income people. In order to end new infections, we must end structural inequalities that exist in all sectors of our society. Public health programs can't exist in a bubble, just as HIV does not exist in a bubble.

Prioritize Key Populations

3. Third, we must prioritize key populations. We know that we haven't gotten it right in providing services to specific populations most impacted by HIV. We must do far more to ensure that the transgender community and gay men, particularly young gay and bisexual men of color, are receiving services that are impactful. This does not mean that we will ignore other populations. We must focus on leveraging digital tools and technologies such as social media and mobile apps to reach people where they are. The role of public health's Disease Intervention Specialists (DIS) also need to be reimagined to more effectively serve these populations.

We must also address the needs of people who inject drugs and in particular, the epidemic of opioid abuse; public health, law enforcement and substance use programs must collaborate in new ways. And WE MUST END the Congressional ban on the use of federal funds for syringe access programs.

Use Data to Care to Improve Outcomes

4. Next, we must use data to improve health outcomes. We all know that we collect a lot of data in our programs. But in order for that data to work for us and inform the most effective interventions we must break down data siloes and improve collection, timeliness and accuracy in order to make decisions that improve outcomes and keep people engaged in the health system. Our surveillance system, for example, must "talk" to our programmatic databases and inform such steps along the continuum of care including linkages to and especially retention in care. We need to move our data collection systems forward so that they can be more responsive to the changing landscape and the opportunities in front of us.

Scale Up Pre-Exposure Prophylaxis and Treatment as Prevention

5. Fifth, we must rapidly scale up PrEP, treatment as prevention and access to STD treatment and prevention. The thrilling advances of PrEP and treatment as prevention have ushered in a new prevention paradigm -- one that requires collaboration across HIV care and prevention and one that depends on culturally appropriate clinical providers. Despite their promise, we will not be successful in capitalizing on these interventions if we can't expand access to medications to the individuals and populations who need them the most. Everyone who is living with HIV should have access to and be taking antiretroviral treatments to achieve viral suppression. I know it's saved my life. Our federal and state governments must change policies and allow PrEP services AND medication to be purchased with public funds. Only 1 in 3 providers even know about PrEP. We must increase our work with providers to be more comfortable talking with their patients about sex -- we ALL have it and we need to be talking about it.

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This article was provided by National Alliance of State and Territorial AIDS Directors. Visit NASTAD's website to find out more about their activities and publications.

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