President Trump announced to the world that our nation would end HIV in the United States by 2030 in his February 2019 State of the Union Address. Shortly after he asked Congress for $70 million in new funding for Ending the Epidemic (ETE), the Department of Health and Human Services’ (HHS) plan for achieving this ambitious goal. The ETE initiative seeks to reduce new infections by 75 percent within the next five years and by 90 percent within the next ten years. The initiative includes four strategies: 1) diagnose all people infected with HIV as earlier as possible; 2) provide antiretroviral therapy (ART) to suppress HIV to undetectable levels; 3) prevent new HIV infections using pre-exposure the use prophylaxis; and 4) respond quickly to possible HIV outbreaks.
Now in the first year of implementation, federal agencies are providing the 48 highest burden counties, Washington, D.C., San Juan, Puerto Rico, and 7 states that have a substantial rural HIV burden with additional resources to scale-up evidence-based strategies. Additionally, the Center for Disease Control and Prevention (CDC) awarded $13.5 million to 32 state and local health departments to develop comprehensive ETE plans for their jurisdictions in October 2019. These one-year planning grants will address each of the four ETE strategies. Further, the Health Resources and Services Administration (HRSA) awarded grants totaling $117 for implementation of ETE strategies to community health centers and Ryan White Program funded clinics.
It is well documented that mental health treatment gaps drive HIV acquisition and poor health outcomes across the HIV care continuum in key populations. For example, anxiety, depression, and substance use disorders may compromise retention in care and adherence to ART. While the importance of addressing underlying behavioral health issues is apparent, investment in changing behavior in the nation’s HIV response has decreased and is disconnected from the rest of the ETE initiative. ETE relies heavily on using anti-retroviral medications because of their proven effectiveness in reducing HIV transmission and suppressing the virus in patients. However, for these approaches to work, patients must adopt or maintain certain behaviors like adhering to medications and staying engaged in care. Yet policymakers have allocated none of the ETE funding to the Substance Abuse and Mental Health Services Administration, the federal agency tasked with leading public health efforts to advance behavioral health.
Working with leading national organizations, APA is calling for a substantial increase for ETE in FY 2021. In addition to seeking increased funding for ETE, we are also asking Congress and the Administration for new resources to integrate behavioral healthcare into national HIV prevention and treatment programs, including the ETE initiative. This includes $160 million for SAMHA’s Minority HIV/AIDS program, an increase of $44 million above FY 2020, and $27 million in new funding for the Indian Health Services for ETE strategies targeted to American Indians and Alaskan Natives, an activity included in the ETE plan but not appropriated funding in FY 2020. Finally, APA supports increased funding for NIH and sustained investments in HIV behavioral and social science research.
With the start of the HIV epidemic in the 1980’s the absence of a vaccine or cure meant early efforts to prevent HIV transmission relied on behavior change. Over time society learned that HIV was mostly commonly transmitted through unprotected sex and shared needles. Psychologists played a leading role in developing the first HIV prevention behavioral interventions such as increasing condom use and developing syringe exchange programs. Their knowledge and expertise in applying psychological knowledge to adopt healthier behaviors remains important even in the current medicalized HIV prevention and treatment environment.
