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Ending HIV in America

Policy and Program Insights From Local Health Agencies and Providers

The Brief

The purpose of this Bipartisan Policy Center study is to understand the challenges and opportunities to end the HIV epidemic from the vantage point of frontline health care providers and local health agencies in eight diverse jurisdictions distributed geographically around the country: Seattle, Washington; Bronx, New York; Kansas City, Missouri; Jacksonville (Duval County), Florida; Clark County, Nevada; Scott County, Indiana; Richmond, Virginia; and, Montgomery, Alabama. BPC sought a balance among rural- and urban-focused epidemics; state Medicaid expansion status; and political party of the state legislature and governor. BPC compiled key epidemiologic data from each jurisdiction and conducted 16 qualitative interviews with local health officials and providers.

Since the 1980s, over 700,000 Americans have lost their lives due to the human immunodeficiency virus (HIV). Today, there are an estimated 1.1 million people living with HIV in the United States, with just under 40,000 new cases each year. Thanks to the marvels of modern medicine and public health achievements, HIV is now largely a chronic disease for many with the condition. Unfortunately, health disparities exist, and the epidemic has evolved to become highly heterogeneous across not only populations, but geographically. Federal spending for the domestic HIV epidemic totaled an estimated $28 billion in fiscal year 2019, and the President’s 2020 budget requests an additional $291 million for the U.S. Department of Health and Human Services (HHS) to eliminate new HIV infections in the United States.

The purpose of this Bipartisan Policy Center study is to understand the challenges and opportunities to end the HIV epidemic from the vantage point of frontline health care providers and local health agencies in eight diverse jurisdictions distributed geographically around the country: Seattle, Washington; Bronx, New York; Kansas City, Missouri; Jacksonville (Duval County), Florida; Clark County, Nevada; Scott County, Indiana; Richmond, Virginia; and, Montgomery, Alabama. BPC sought a balance among rural- and urban-focused epidemics; state Medicaid expansion status; and political party of the state legislature and governor. BPC compiled key epidemiologic data from each jurisdiction and conducted 16 qualitative interviews with local health officials and providers.

The findings can be categorized into three areas. First, with respect to access to HIV services, the Ryan White Program continues to provide crucial support for low-income people living with HIV and could also be a model for serving individuals at high risk for HIV. Medicaid expansion in 37 states and the District of Columbia has increased access to care for many with HIV, while non-expansion states closely overlap with the regions that are experiencing elevated rates of new HIV diagnoses. There are distinct barriers in rural settings, which are not dissimilar from the broader challenges of accessing health care services in rural America.

Second, with respect to the facilitators and barriers to the HIV response, surveillance efforts are critical to informing HIV programming, but there are often challenges in real-time communications and data exchange. Molecular HIV surveillance holds promise in identifying clusters of infection in local communities. Barriers addressing HIV include poverty and unmet social needs among people living with, or at risk of, HIV. Partnerships with community-based organizations to address social needs can assist in supporting the clinical care plan. Stigma also impedes the HIV response by contributing to HIV risk; stigma-reduction campaigns consistent with local cultural norms may be effective.

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Rates of New HIV Diagnoses in the United States, 2017 (Per 100,000 People)

  • <10.0
  • 10.0 - 19.9
  • 20.0 - 29.9
  • ≥30.0
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