The first of two reports, “Blueprint for HIV Biomedical Prevention: State of the State,” was released on December 3, 2016 at the National HIV PrEP Summit in San Francisco.
The report was written by Jeffrey S. Crowley, distinguished scholar and director of infectious disease initiatives at the O’Neill Institute, and Sean Bland, associate at the O’Neill Institute and lead author.
The State of the State report provides an overview of policies and programs that are critical to effective biomedical HIV prevention in communities of color. The report highlights current health department and community efforts to implement the new science. It also includes descriptions of the roles played by selected federal agencies in supporting biomedical HIV prevention and identifies some of their key recent initiatives.
Biomedical HIV prevention strategies offer a range of tools that can effectively prevent HIV infection. These tools include treatment as prevention (TasP), pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP).
TasP provides early and sustained treatment for people living with HIV that first and foremost treats their HIV infection, but is also a very powerful tool for preventing HIV transmission to others. PrEP involves a reduced dose of HIV medication given to high-risk HIV negative individuals to prevent HIV infection. PEP provides persons who may have had a very recent exposure to HIV a short course of treatment (about a month) to prevent them from becoming infected.
In addition to these strategies, new long-acting agents have the potential to make biomedical HIV prevention even more effective.
“These strategies offer an unprecedented opportunity to end the HIV epidemic or dramatically curb the impact that HIV has in the United States and around the world,” says Crowley and he cautions, “We could squander this opportunity if our approach to biomedical HIV prevention is not built around meeting the needs of communities of color. We need a fully developed approach that begins with getting all people with HIV engaged in care and that integrates PrEP, PEP, along with condoms, and a range of behavioral and other services that can facilitate adherence to these interventions and improve HIV prevention outcomes.”
The report identifies a number of issues surrounding biomedical HIV prevention in communities of color. These include issues for the HIV community (including community-based organizations and social services providers), issues for clinical providers, and issues for the health system (including both health care and prevention services).
“To inform the report, we interviewed a diversity of community members and advocates, researchers, clinicians, and services providers as well as representatives from a state Medicaid agency, and state and local health departments,” says Bland. “Our goal was to distill the range of actions needed to support effective biomedical HIV prevention in communities of color.”
The authors urge community leaders, policymakers, funders, public health leaders, health care providers, and the private sector to consider taking the following actions:
Support the HIV Community in Overcoming Challenges and Barriers • Promote biomedical HIV prevention tools through community education and awareness campaigns• Tailor efforts to effectively reach young people of color• Clarify messaging about biomedical HIV prevention and more clearly state that PrEP is safe and effective• Strengthen health literacy and actively counter mistrust of providers and the health system• Bolster community resiliency• Integrate HIV prevention into broader efforts to strengthen our communities
Prepare Providers to Provide Leadership in a Changing Prevention Landscape • Expand efforts to train more providers to be equipped to navigate across cultures and communities and provide up-to-date and sensitive HIV prevention services• Directly address provider attitudes around sexual behavior and concerns around STI transmission• Work to build sustainable systems for PrEP enrollment and monitoring
Build a Health System to Meet the HIV Prevention and Other Needs of Communities of Color• Push for expanded Medicaid in states that have not taken up this option• Invest in increased capacity and effective models to deliver PrEP, PEP, and HIV treatment• Work to ensure that insurance coverage is comprehensive and affordable• Fund public health programs to fill in gaps left by insurance for biomedical prevention
“HIV exposes the inequities and the discrimination affecting people of color, including parts of our communities, such as young women and girls, transgender women, gay and bisexual men, and others, which have built up over decades and generations,” the authors write in the report. “The deployment of TasP, PEP, and PrEP is not a magic bullet that will make all of this better. But if we use these tools in a manner that recognizes that our health systems and programs were not built to equally benefit all of us and we take deliberate steps to tailor programs and services for communities of color, then we can seize the opportunity presented by the current moment in HIV prevention to reduce disparities, prevent HIV transmission, and heal our communities.”
The State of the State report was written for a general audience, but is also intended as a reference tool for public and private stakeholders implementing biomedical HIV prevention in communities of color.
The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. 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.###
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