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Plan to end HIV Epidemic: AFC, Community Solutions staff join roundtable discussion in Cincinnati

August 19, 2019
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Dr. Amy Acton and Dr. Bruce Redfield

The Ohio Department of Health (ODH) hosted a roundtable in Cincinnati on August 1 featuring the director of the Centers for Disease Control and Prevention (CDC), Dr. Robert Redfield. Dr. Redfield is traveling around the country to states and counties that are eligible for new federal funding as part of the president’s recently announced plan to end the domestic HIV epidemic. In Ohio, the counties that are eligible are Cuyahoga (Cleveland), Franklin (Columbus) and Hamilton (Cincinnati), they are three of the 48 highest HIV-burdened counties in the country. ODH director Dr. Amy Acton provided opening remarks, then Dr. Redfield recounted his decades of work to address HIV/AIDS internationally through the President’s Emergency Plan for AIDS Relief (PEPFAR) program. He then told the group of public health agency representatives, treatment providers, consumers and other stakeholders that Ohio’s three eligible counties need to be innovative and develop a plan to end HIV that will work for them.[bctt tweet=".@CommunitySols joined the OH Dept. of Health and @CDCgov for a roundtable discussion on the #HIV epidemic. Find out what we learned here" username="CommunitySols"]

 Dr. Redfield is traveling around the country to states and counties that are eligible for new federal funding as part of the president’s recently announced plan to end the domestic HIV epidemic.

Redfield discussed how the federal government worked to determine the eligible counties and states across the country and expressed his disappointment that the progress addressing the domestic HIV epidemic had stalled. Providers have not yet widely adopted a 2006 CDC recommendation to universally test all 13 to 64-year-olds for HIV which would have significantly increased the percentage of people living with HIV/AIDS (PLWHA) who know their status. He stressed that jurisdictions need to develop and promote novel ways for Ohioans at risk of exposure to be tested and diagnosed, driving home the need to create plans designed by and for the populations in need. Dr. Redfield’s view is that “the people who have avoided testing are the ones who should be telling us why.”

 Dr. Redfield’s view is that “the people who have avoided testing are the ones who should be telling us why.”

Community Solutions' Director of Policy Tara Britton with AIDS Funding Collaborative's Julie Patterson

Dr. Redfield talked about viral suppression and how treatment has transformed since he started working in the field. He said helping people achieve viral suppression is a key part of the strategy to end the epidemic because it will improve the health of PLWHA while eliminating the risk of transmission. When a person’s viral load is undetectable (virally suppressed), they cannot transmit HIV. This concept is also known as U=U or Undetectable Equals Untransmittable. Another critical part of the strategy is increasing access to pre-exposure prophylaxis (PrEP) for people most at-risk of acquiring HIV. If taken regularly, PrEP reduces the risk of acquiring HIV up to 99 percent.

 When a person’s viral load is undetectable (virally suppressed), they cannot transmit HIV.

Redfield stated that he supports syringe service programs as an evidence-based component of the strategy to end the epidemic. These programs are also helpful in connecting people with a substance use disorder to treatment, which can result in long-term recovery. He recognized that syringe programs have to be done in a “jurisdictional” to best meet local need.  

The conversation then turned to consumers, providers and public health representatives at the local, state and national levels and other stakeholders doing work at the community level. A wide swath of issues were covered by the group, including these highlights.

 Culturally competent service providers are crucial to recruiting and retaining people living with HIV/AIDS into primary care, particularly when they are members of historically disenfranchised communities and populations such as people of color, gay men, women and substance users.”
  • A key to getting people tested and into treatment is engaging with providers who care about and are reflective of the population that they’re serving. Recruiting a diverse pool of providers, from community health worker to physicians, is important to truly connect with the populations who should be targeted for testing and are in need of treatment. “Cultural competency in HIV care is imperative. This is reflected in a statement from the Health Resources and Services Administration, which administers the Ryan White HIV/AIDS Program. Culturally competent service providers are crucial to recruiting and retaining people living with HIV/AIDS into primary care, particularly when they are members of historically disenfranchised communities and populations such as people of color, gay men, women and substance users.”
  • No plan should be developed without thorough involvement and integration of PLWHA across race, sexual orientation, identity and those dealing with substance use disorders and in recovery.
  • Social determinants of health can’t be ignored as they relate to HIV prevention and treatment. A roundtable participant said “social determinants are why people get infected.” Any strategy to end the epidemic needs to be broad enough to engage transportation, housing and food access, among other things.
  • Stigma around HIV continues to be a major barrier in many communities. Beginning conversations with at-risk populations early on could help address this, but it is challenging to engage young people around this issue.
  • Given that young men who have sex with men of color are disproportionately impacted by HIV, this population really needs to be part of conversations about what works for communities.
  • Communities need to explore how to engage PLWHA who are not receiving care and learn why that is.
  • Providers and stakeholders who work with PLWHA need to be accepting of the LGBTQ community; this is unfortunately still not widely practiced.
  • Syringe services programs are an important part of the strategy to reduce the spread of HIV infection and should be supported in a way that’s aligned with evidence.
  • The transgender population must be part of the development of this plan, including prioritizing data collection of current gender identity and sex at birth in order to accurately assess the impact of HIV among the transgender community and how best to address it. Dr. Redfield concluded the roundtable with three main points:  

AIDS Funding Collaborative's Julie Patterson and Dr. Amy Acton

  1. This is your plan to develop,” said Dr. Redfield. It should meet the needs of the communities.
  2. Be open to rethinking what it means to be a provider of HIV prevention and treatment services.
  3. There are a lot of ways to structure how HIV testing and diagnosis is done and this should be informed by people who are at-risk but aren’t currently being reached with traditional methods.  
 Some dollars have gone out the door already to select jurisdictions (none in Ohio) that are in the preliminary stages of their plans to end the epidemic.  Redfield will continue to visit eligible counties and states across the country. Some dollars have gone out the door already to select jurisdictions (none in Ohio) that are in the preliminary stages of their plans to end the epidemic. Later this year, Ohio should expect to see an announcement about funds available for jurisdictional planning. Ohio applied and is eligible to receive up to $375,000. The president’s budget proposal included $291 million to be allocated to this effort, but final details about how much HHS funding will be allocated are not yet available.
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