New Gov't Initiative Tackles HIV at Local Level

There may be new hope on the horizon for bringing the AIDS epidemic to a close. The Ending the HIV Epidemic in the U.S. (EHE) initiative, launched in 2019, takes a locality-based approach, providing "a targeted infusion of new resources and support to local communities in working together and with the federal government" toward the goal of curtailing the spread of the virus.

One area of focus, government website HIV.gov says, is "Incidence," which is "one of the six EHE indicators" used by the initiative in its "America's HIV Epidemic Analysis Dashboard (AHEAD)."

Incidence "provides an estimate of how many new HIV infections have occurred in a year, both diagnosed and undiagnosed," the website explains.

"By fine-tuning the approach of the 4 EHE strategies (diagnose, treat, prevent, respond) and taking action based on the data, local health department officials can adjust local programs to prevent and mitigate future HIV transmissions."

The program's Phase I invests efforts "in 48 counties" around the country, plus "Washington, DC, and San Juan, Puerto Rico, where more than 50 percent of new HIV diagnoses occurred in 2016 and 2017," the site details, "and an additional seven states with a substantial number of HIV diagnoses in rural areas, bringing the total number of Phase I jurisdictions to 57."

The America's HIV Epidemic Analysis Dashboard shows the locations of those jurisdictions, which are a mix of rural areas and urban centers.

California ranks first with eight, including San Francisco County, Sacramento County, Los Angeles County, Orange County, and Sacramento County, among others.

Florida comes in a close second with seven, including Miami-Dade County, Broward County, Palm Beach County, Pinellas County, and others.

Texas has five jurisdictions; Maryland and Ohio each have three; Louisiana has two; Arizona, Illinois, Indiana, Massachusetts, Michigan, New York, Nevada, North Carolina, Pennsylvania, Tennessee, and Washington each have one, as does Puerto Rico.

Information currently available through the site shows how trends have changed over the past few years, from 2017-2020. In San Francisco County, for instance, annual totals of new diagnoses have plummeted. As plotted on a graph, the decline in new diagnoses essentially mirrors a similar chart showing that more individuals have been linked to appropriate medical care. At the same time, the rate of people using PrEP – "Pre-Exposure Prophylaxis," a regimen of daily medication to prevent HIV infection – rose sharply over the same period (though that rate declines sharply after 2019, a result that might be related to the impact of COVID-19).

The data for Broward County reflects similar trends: As "Linkage to HIV Care" rises, "Diagnoses" decline in rough approximation, while "PrEP Coverage" soars. Overall, "Incidence" drops sharply as "Knowledge of Status" makes steady gains.

Similarly, the rate of "Incidence" has declined sharply as the "Knowledge of Status" rate has steadily risen. Though the data is incomplete, the overall picture seems to indicate that improved diagnosis rates and better medical care for more people have had encouraging results.

In Queens County, New York, the results are even more clear-cut, with "Diagnoses" plummeting between 2017-2020, despite an up-and-down "Linkage to HIV Medical Care" during the same time. Again, "Incidence" drops sharply, while "Knowledge of Stats" marks less dramatic but steady increases.

Equally encouraging stats appear to hold true in Travis County, Texas (where Austin is located), Los Angeles County, Philadelphia County, and other locales covered by the site. Even in the case of a place such as , California, where "Incidence" rises sharply even as "Knowledge of Status" follows typical upward progress, "Diagnosis" trends downward while "Linkage to HIV Medical Care" increases.

The Dashboard notes that the information is for 2020 but remains "preliminary" and further warns, "Due to the impact of the COVID-19 pandemic, interpret with caution." The data for an outlier like Sacramento County, with its simultaneously plunging "Diagnosis" and "Linkage to HIV Medical Care," illustrate why COVID's effects must be taken into consideration, as both of those metrics decline precipitously after 2019.

Each county and city has its own data, of course, and the exact details may change as information is updated, but the overall goal remains the same: "The EHE initiative aims to reduce new HIV infections in the United States by 75% in five years and by 90% in 10 years," the site notes.

The site's information and graphics underscore how diagnosis, PrEP coverage, and viral suppression through medication are all key to the endeavor. People living with HIV can begin treatment once diagnosed, keeping themselves healthy while lowering the amount of virus in their blood to non-transmittable levels. Meantime, those who are HIV-negative can take precautions against infection, including PrEP. As much of the available information suggests, the overall effect is a promising decline in HIV transmission.