Last month, the U.S. Department of Health and Human Services (HHS) released an 87-page draft of its HIV National Strategic Plan for 2021 through 2025, setting in motion more ambitious targets than the previous strategic plan released in 2015. The draft has been posted on HIV.gov for public comment; the deadline for feedback is Dec. 14.
The updated strategy is closely aligned with the federal Ending the HIV Epidemic initiative (https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview) (EHE), which was announced in 2019. In fact, the strategic plan takes the EHE initiative, which began in the jurisdictions hardest hit by the epidemic, and broadens it nationally, crossing federal departments and agencies. The plan also takes into account several key components that are vital to collective efforts to end HIV, including addressing stigma, discrimination, and social determinants of health.
The strategic plan’s high-level goals, which according to the draft will be monitored and reported on annually, include:
- Increase knowledge of HIV status to 95%, from a 2017 baseline of 85.5%.
- Increase PrEP coverage to 50%, from a 2017 baseline of 12.6%. (PrEP was not addressed in the 2015 plan, but did [get a mention](https://files.hiv.gov/s3fs-public/nhas-update.pdf in the 2020 update.)
- Reduce new HIV infections 75% by 2025 and 90% by 2030.
The draft of the new plan “is what we’ve wanted,” said Carl Schmid, the executive director of the HIV and Hepatitis Policy Institute and a co-chair of the Presidential Advisory Council on HIV/AIDS. He acknowledged, however, that the plan could stand a few tweaks, particularly “more specificity about systems of care, such as Medicare and Medicaid.”
Addressing HIV-Related Disparities and the Impact of COVID-19
The updated strategic plan prioritizes four key areas of focus: preventing new HIV transmissions; improving health outcomes of people with HIV; reducing HIV-related disparities and health inequities; and better integrating and coordinating efforts that address the HIV epidemic among all partners and stakeholders. Unlike the 2015 plan, it slightly veers away from priority based on geography (there was a strong emphasis on HIV infection rates in the South) in favor of focusing on demographic groups disproportionately impacted by HIV, including Black, Latinx, and transgender Americans.
The plan also sets goals for reducing two other key influencers of HIV transmission and health disparities: stigma and homelessness. The plan aims to decrease stigma, a frequent barrier to health care, among people diagnosed with HIV by 50% (as measured by a 10-item questionnaire, which in 2018 yielded a stigma score of 31.2). It also sets a goal of reducing homelessness among people living with HIV by half (from a 2017 baseline of 9.1%). The plan will use viral suppression as an indicator of progress toward reducing other HIV-related disparities.
The new strategic plan acknowledges that the COVID-19 health crisis has curtailed many public health activities, including a disruption HIV prevention and care services provided by community-based organizations. It also highlights treatment approaches that have evolved in response to the coronavirus crisis—including widespread adoption of telehealth, as well as the distribution of self-testing and home specimen collection kits—and their potential impact on efforts to end HIV.
Ramping Up HIV Spending in 2021
The 2021-2023 strategic plan, like previous plans, is a roadmap. But oftentimes roadmaps, by design, lack specifics on how to reach the destination, including funding and how it will be distributed.
The U.S. Congress holds those purse strings. In 2020, a bipartisan coalition of lawmakers added $300 million to combat HIV/AIDS; that could potentially be increased by $200 million or more for 2021. President-Elect Biden will get a chance to request even more funding when he releases his budget upon taking office in January.
As for how the money will be spent, federal agencies including the Centers for Disease Control and Prevention, the National Institutes of Health, and Health Resources and Services Administration will have their say through five-year funding documents. Schmid expressed hope that a large chunk will go toward helping more people get on HIV pre-exposure prophylaxis (PrEP). “Much of this money, coming through [the Ryan White CARE Act], would go to community health centers to help them ramp up services,” he said.
Finalizing the Plan
HHS will roll out a finalized version of the HIV National Strategic Plan in early 2021. After that, a federal implementation plan will be developed, providing more specifics on how resources will be allocated.
Before that can happen, the HHS is seeking input on the draft plan’s goals, objectives, and strategies, in an effort to identify any critical gaps. All comments may be submitted to HIVPlanComments@hhs.gov and are due Dec. 14. For more information on submitting comments, see the Federal Register notice.