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O’Neill Institute report examines federal investment in HIV prevention

Friday, April 13, 2018

The SBS Core would like to share the following report and summary from the O’Neill Institute for National & Global Health Law:

As HIV/AIDS advocacy groups prepare to gather in Washington, DC on March 26 and 27 for AIDSWatch, the nation’s largest annual constituent-based national HIV/AIDS advocacy event, our policy experts have issued a new report outlining the impact that federal investments have on preventing new cases of HIV infection.

With data from the Centers for Disease Control and Prevention (CDC) documenting an 18 percent decline in new HIV infections in the United States from 2008 to 2014, our new report, “Federal Investments are Saving Lives and Strengthening Communities,” details the history of HIV prevention in the U.S. from the earliest years to today and identifies priority areas where more innovation is needed for forward progress in reducing HIV as a public health threat.

“This issue brief examines the dynamic nature of the HIV epidemic in the United States to assess what our country has accomplished, where things stand, and where continued federal leadership and funding are needed to keep reducing the size and scope of the HIV epidemic,” write the authors, Jeffrey S. Crowley, Program Director of Infectious Disease Initiatives at the O’Neill Institute, and his colleague there, Sean E. Bland, a senior associate.

Nearly two million people in the U.S. have become infected with HIV and more than 700,000 have died of HIV/AIDS since the beginning of the epidemic. While more than 130,000 people were infected each year in the mid 1980s, new infections have declined to roughly 40,000 per year in recent years. Today, 1.1 million people in the U.S. are believed to be living with HIV.

The new report tracks the history of the prevention response and describes the scientific evidence underpinning the nation’s current approach to preventing new infections, called “High Impact Prevention.” By assessing current opportunities and challenges, the report states that federal investments must support continuing innovation to: 

•    Integrate surveillance and clinical care data systems;
•    Interrupt HIV transmission within sexual and drug-using networks;
•    Improve the tailoring and integration of services to the highest need communities;
•    Develop long-acting prevention and therapeutic options; and
•    Promote jurisdictional plans to end HIV as a public health threat.

The report was developed following an expert consultation held in Washington, DC in July 2017 with diverse stakeholders, including people living with HIV, medical and non-medical providers, epidemiologists, and federal, state, and local HIV policy and program staff. 

“Because HIV is no longer new, and rarely front-page news, we risk losing sight of how far we have come, or worse, how far there is to go,” Crowley says, adding, “Expanded HIV screening and more focus on supporting all people with HIV to start antiretroviral therapy (ART) and achieve viral suppression, along with pre-exposure prophylaxis (PrEP) for high risk HIV negative individuals, are a powerful combination. We need to keep scaling up access to these and other critical prevention services.”

Bland says, “HIV continues to disproportionately impact people of color, most especially young gay and bisexual men of color and transgender women of color. To truly reduce the scope of HIV nationally, we need to heighten the resources directed to these communities.” 

Crowley and Bland conclude that the U.S. must continue investing in prevention services, but the field is also poised for exciting innovations that will allow the Nation to produce even better results. By investing in research and program innovation, it is possible to keep driving down the number of new infections in all jurisdictions and within all communities.

This project is supported by grant funding from Gilead Sciences, Inc. Gilead Sciences has had no input into the development or content of these materials. Crowley and Bland received honoraria from Gilead for speaking engagements unrelated to this report.

The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy.  Celebrating its 10th year in 2017, its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure.  The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.