Ending the HIV Epidemic in the U.S. Initiative: An Overview

“Ending the HIV Epidemic in the U.S.” is a government prerogative to do just that: end the HIV epidemic within the United States. A reduction to non-epidemic levels does not mean a complete eradication of the disease within the nation. Rather, it is reducing transmission levels to where there is no uncontrolled spread. There are two major goals in this initiative to meet this reality:

  • Reducing the number of infections by 75% within a five year time span (2025)
  • A 90% reduction of new infections within ten years (2030)

This initiative is funded by various means: Mainly through HHS, the CDC, HRSA (which administers the Ryan White Program), the Indian Health Service and the National Institutes of Health. Grants are awarded to organizations within declared jurisdictions.  

This initiative was launched in 2019 by the Trump administration, building on a patchwork of federal HIV programs, but especially that of the Obama administration’s National HIV/AIDS Strategy launched in 2010. President Biden has promised a commitment to the goal and an expansion: The administration requested $850 million from Congress in 2022 to “aggressively reduce new HIV cases by increasing access to HIV prevention and care programs and ensuring equitable access to support services.” In addition, the administration proposed nearly $10 million for a national PrEP program that would ensure access to PrEP for all who need it. These ambitious goals would support Ending the HIV Epidemic (EHE), though there are questions on whether the proposed amount is sufficient.  

Rather than a top-down approach, the EHE initiative is purposefully designed for communities to fight the disease based on their specific needs. 

The initiative is broken into three phases. In Phase I, the focus is on 48 counties, Washington, D.C. and San Juan, Puerto Rico. In addition, seven states with large outbreaks in rural areas—Mississippi, Alabama, South Carolina, Kentucky, Missouri, Arkansas and Oklahoma—are a major focus. Within these regions, over 50% of all new diagnoses occurred from 2016-2017 and continue to be “hot spots” for HIV. 

There are four main foundations for this work. It includes: 

  • Diagnosing people who have been exposed as early as possible. 
  • Treating rapidly to reach and sustain viral suppression. 
  • Preventing new transmissions using tools such as PrEP and syringe service programs. 
  • Responding quickly to new outbreaks. 

The CDC’s own numbers show a major effort in reaching these milestones. There were 1.7 million HIV tests in 2021, health centers under the initiative linked 86% of new diagnoses to early treatment and worked to increase PrEP coverage. 227 clusters of infections were reported to the CDC and addressed by 41 various health departments. 

Should the effort continue with the same determination, an estimated 250,000 new HIV diagnoses could be averted, and the majority of people currently living with HIV today would become undetectable in their viral levels. Undetectable means untransmissible (referred to as “U=U”). 

There is no date for Phase II  begin which will bring broader resources outside of these centers of outbreak. Phase III will work to keep new infections below 3,000 cases per year. 

This initiative has made significant progress, but it is clear a bolstering of new funding is needed to reach the goals outlined by 2025 and 2030. It is also worth noting the COVID-19 pandemic slowed the efforts on the ground due to various shutdown and safety measures. Actual results of the program throughout that time period may be skewed. 

According to the EHE’s indicator data, the estimated number of HIV cases continues to decrease. Knowledge of status is growing at a slower pace, while there was a small increase of new diagnoses from 2021-2022. National linkage to medical care and viral suppression have flatlined. One major success is in the number of people being prescribed PrEP: Each year has seen growth between four percent and six percent, well on track to reach the 50% mark by 2025. 

Each community has various factors resulting in outbreaks, namely social determinants of health. National numbers may not reflect local results. One community may find huge successes, another may need further funding. A rural community may not have access to the number of clinics within an urban setting. Another unfortunate reality is that Black and Latinx communities are infected at a much higher rate than their White counterparts. 

The success of the initiative is also highly dependent on increased Congressional funding, visibility of the program’s successes and flexibility for improvement. CDC data shows we are well aware of where disparities persist and where the new growth for cases accumulates. The question is whether the funding will match words and promises.