Bolstering State Efforts to Implement the National HIV/AIDS Strategy

"Four years since the release of the National HIV/AIDS Strategy for the United States [US], significant activities have taken place in states and communities throughout the country to strengthen the response to the domestic HIV epidemic."

This US-based policy advocacy document for state governments within the US both reviews state progress in nurturing a policy environment for operating effective HIV programmes and sets out recommendations for "concrete actions that all states can take ...to seize the opportunity to increase their impact." This project, involving the Foundation for AIDS Research (amfAR), working in collaboration with the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law at Georgetown Law, seeks to build upon the State HIV Prevention Progress Report, issued in 2014 by the US Centers for Disease Control and Prevention (CDC).

Though US state governments are in differing situations concerning levels of resources available, priorities of elected officials, and the epidemiology of HIV, priority actions call for a more coordinated national response through:  integrated state plans consistent with the National HIV Strategy; collaboration between state and local health departments and human services agencies; and strong public engagement in HIV policy, including annual consumer-friendly reports on progress.  For example, regarding public engagement: "States should explore ways to work with external partners including community stakeholders, foundations, and corporations to create consumer-friendly annual reports and dashboards of key metrics that enable the public to both monitor state progress and identify areas where further emphasis is needed. These reports should highlight subpopulations that are being reached by programs, those that require greater attention, and geographic hotspots where more focused interventions are needed."

Communication-related actions for reducing new HIV infections include services aimed to reach gay men of all races and ethnicities, services aimed to keep patients in the treatment system, and broader access to sexuality education.  Actions include:

• "Use public health data to inform policy and optimize allocation of resources": For example, "Louisiana’s public health system, with grant funds from HRSA, has developed a state-wide HIV electronic medical records (EMR) system that notifies clinicians when they are seeing patients who have fallen out of care based on public health surveillance data. The system automatically identifies patients who are missing recent expected lab test results that indicate they have fallen out of care, and notifies authorized clinicians that patients require HIV follow-up assessments. "
• "Systematically track prevention and care metrics for key subpopulations": For example, analyse resource allocation with special attention to "assess... both funding levels and programmatic activities to determine whether gay and bisexual men (and gay men of color and young gay men in particular) are receiving the proportionate level of services needed to effectively reduce the number of HIV infections in their communities."
• "Ensure broader access to sexuality education": For example, "[P]rovid[e] complete and accurate information about STIs [sexually transmitted infections] and how to reduce risk...includ[ing] information on condoms and other risk reduction strategies....[H]ealth departments are encouraged to engage with education leaders, legislators, and parents in order to build consensus on expanding uniform and consistent access to exemplary sexual health education that includes medically accurate risk reduction information. Health departments also can assist with identifying communities that would benefit from programs for young people at disproportionate risk, helping those communities select and implement programs, and assuring that targeted programs complement the overall sexual education curriculum in that community’s schools."

Among recommendations for states and federal-level policymakers, the document concludes that community stakeholders, including those living with HIV and their advocates, need to identify shortcomings in their state and push for changes in policy and for new resources, including reminding the public of success and increasing commitment to education and advocacy with state leaders.

The amfAR website lists separate key indicators by state - Annexure: Key Indicators for Policymakers and Stakeholders by State.