The Trump Administrations HIV Initiative: What Will It Take to End - - PowerPoint PPT Presentation

The Trump Administration’s HIV Initiative: What Will It Take to End the U.S. Epidemic?

April 22, 2019

NOTES: All data are for 2018 except for Canada (2016) and Japan (2015). U.S. estimate based on Bradley et al. “Data-Driven Goals for Curbing the U.S. HIV Epidemic by 2030,” AIDS and Behavior, 2019. All countries defined viral suppression as having a viral load test result of < 200 copies/mL. SOURCES: Public Health Agency of Canada, 2018; The Kirby Institute for infection and immunity in society, 2018; European Centre for Disease Prevention and Control, 2018; Bradley H, Rosenberg ES & Holtgrave DR, “Data-Driven Goals for Curbing the U.S. HIV Epidemic by 2030,” AIDS and Behavior, 2019; Iwamoto A et al., “The HIV care cascade: Japanese perspectives,” PLoS ONE, 2017.

HIV Viral Suppression Rate in U.S. Lowest Among Comparable High-Income Countries

84% 84% 83% 77% 76% 74% 74% 74% 70% 68% 63% 54%

United Kingdom Switzerland Sweden The Netherlands Germany France Australia Austria Japan Belgium Canada United States

National HIV Incidence is no Longer Falling; Epidemic is Concentrated

NOTES: (1) Includes those with diagnosed and undiagnosed HIV. (2) Includes MSM/IDU. SOURCES: CDC. HIV Surveillance Supplemental Report. Vol. 24, No. 1. Estimated HIV Incidence and Prevalence in the United States 2010–2016. 2010 2011 2012 2013 2014 2015 2016

HIV Incidence, 2010-2016 Among all people with HIV1: 50% live in 5 states 42% are Black/African American 45% live in the South 62% are MSM2

$1.1 $1.9 $2.4 $3.2 $3.5 $4.2 $5.1 $6.1 $6.4 $6.5 $6.8 $7.3 $7.7 $7.7 <$0.0 $0.0 $0.1 $0.1 $0.3 $0.6 $1.5 $2.3 $2.6 $3.3 $3.9 $4.8 $5.8 $6.3 $6.5 $6.7 $7.0 $7.5 $7.1 $7.3 $7.7 $7.7$7.6 $7.8 FY 1981 FY 1983 FY 1985 FY 1987 FY 1989 FY 1991 FY 1993 FY 1995 FY 1997 FY 1999 FY 2001 FY 2003 FY 2005 FY 2007 FY 2009 FY 2011 FY 2013 FY 2015 FY 2017 FY 2019 Source: Kaiser Family Foundation analysis of data from OMB, CBJs, Congressional Appropriations Bills, and personal communication with agency staff. Notes: Funding includes both domestic and global HIV accounts; The decrease in 2006 reflects methodological changes at CMS. For additional information about recent budget trends see KFF fact sheet, U.S. Federal Funding for HIV/AIDS: Trends Over Time. https://www.kff.org/global-health-

policy/fact-sheet/u-s-federal-funding-for-hivaids-trends-over-time/

Federal Funding for Domestic Discretionary HIV Programs Has Been Relatively Flat for Several Years

Funding in Billions

$257 $656 $1,436 $2,018 $2,138 $2,337 $2,319 $2,319 $2,389

Ryan White Funding, FY1991- FY2020 Budget Request (BR)

3% over FY19 funding

$6 $136 $378 $498 $617 $750 $732 $732 $823 $787 $789 $929

18% over FY19 funding

Funding in Millions Funding in Millions

CDC HIV Prevention Funding, FY1981- FY 2020 Budget Request (BR)

FY 2020 Budget Request Would Mark First Significant Increase for Ryan White & CDC in Years

SOURCE: Kaiser Family Foundation analysis of data from OMB, budget request, CBJs, Congressional Appropriations Bills.

Southern Region 23 counties 6 states

DC

% Uninsured > National Avg. 31 counties 3 states % in Poverty > National Avg. 30 counties 6 states Medicaid Expansion 30 Counties 2 states DC + San Juan Ryan White Part A 47 counties 2 states DC + San Juan Community Health Centers 48 counties 7 states DC + San Juan State Prohibition on Syringe Access 7 counties 6 states

Demographic & Policy Snapshot of Targeted Jurisdictions

SOURCES: HHS, Ending the HIV Epidemic, List of Counties, Territories, and States. KFF State Health Facts; CDC Supplement Surveillance Report.

• Vol. 23, No. 7: HIV and AIDS Data through December 2016 Provided for the Ryan White HIV/AIDS Program, for Fiscal Year 2018; US Census

American Fact Finder; NASTAD. Syringe Service Program Policy Environments Across the United States. HRSA Fact Sheets from data.hrsa.gov.

Majority Say HIV/AIDS is a Serious Issue for the U.S. Today; Half Say it is a Serious Concern For People They Know

SOURCE: KFF Health Tracking Poll (conducted March 13-18, 2019). See topline for full question wording and response options.

How serious

• f an issue do

you think HIV/AIDS is for the U.S. today? How serious of a concern do you think HIV/AIDS is for people you know?

Very serious 34% Somewhat serious 46% Not too serious 13% Not at all serious 4% DK/refused 3% Very serious 24% Somewhat serious 22% Not too serious 25% Not at all serious 24% DK/Refused 4%

Most have not heard about the Administration's “Plan to End HIV,” but are Optimistic about its Goals

Have Heard (8%) Have Not Heard (92%)

Share of Americans that have heard of Administration's “Plan to End HIV”

Can Accomplish (52%) Cannot Accomplish (48%) Don't Know (2%)

Share of Americans that believe the goal

• f reaching zero

new infections by 2020 can be reached.

SOURCE: KFF Health Tracking Poll (conducted March 13-18, 2019). See topline for full question wording and response options.

27% 15% 45% 37% 7% 13%

4%

12% 17% 22%

Very effective Somewhat effective Not too effective Not at all effective Don’t know

SOURCE: KFF Health Tracking Poll (conducted March 13-18, 2019). See topline for full question wording and response options.

Significant Gaps Remain in the Public’s Knowledge of HIV Treatment and Prevention

How effective are ARVs at improving the health of people with HIV? How effective are ARVs at preventing the spread of HIV to sexual partners? As far as you know, is there a prescription medication that people who are HIV-negative can take to lower their risk of getting HIV?

42% 40% 18%

Yes No Don't know

Panelists

• Heather Hauck, Deputy Associate Administrator, HIV/AIDS Bureau,

Health Resources and Services Administration (HRSA)

• Kendra Johnson, Director, STD/HIV Office, Mississippi Department
• f Health
• Michael Kharfen, Senior Deputy Director, HIV/AIDS, Hepatitis, STD

and TB Administration, District of Columbia Department of Health

• Jesse Milan, Jr., President and CEO, AIDS United
• Dr. Melanie Thompson, HIV physician and researcher, Atlanta, GA