The Ending the HIV Epidemic in the U.S. Initiative: An Interim Assessment and Policy Recommendations

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The Ending the HIV Epidemic in the U.S. (EHE) initiative is a promising federal program launched by the U.S. Department of Health and Human Services (HHS) in February 2019 with the aim of reducing new HIV infections by 75 percent by 2025 and 90 percent by 2030 (from a baseline of more than 38,000 new diagnoses in 2017). While the EHE initiative set ambitious targets for ending the HIV epidemic in the United States in the context of a sound and sensible plan, it is at present off track.

Now, three years in—at the midpoint of the first EHE phase, which has a target of reducing new HIV infections to 9,250 people or fewer by 2025—is an opportune moment to assess its status and the challenges it faces. After a review of progress to date, this report examines the collision between the logical plan behind the EHE initiative and the complicated patchwork of programs that provide HIV prevention, care, and treatment to the diverse communities affected across all EHE jurisdictions. The analysis is informed by several roundtable discussions convened by CSIS with the participation of a representative group of people living with HIV/AIDS (PLWHA), community advocates, physicians, service providers, researchers, and policymakers who are implementing the EHE initiative around the country.

The report concludes with policy recommendations in four areas: (1) meet people where they are by building programs that are centered on the needs of populations directly affected by the HIV epidemic; (2) address flexibility in design and implementation; (3) improve data, metrics, and accountability; and (4) heighten political advocacy to ensure future funding of the EHE initiative. A strong theme that runs throughout the report is that lessons from the global HIV response—the importance of building interventions from the ground up, of engaging with affected communities, and of taking an integrated approach across a spectrum of biomedical, clinical, social, behavioral, economic, and political dimensions—can inform and strengthen the U.S. domestic response to HIV/AIDS.

This report is a product of the CSIS Global Health Policy Center, generously supported by the Bill & Melinda Gates Foundation.

Jeffrey Sturchio
Senior Associate (Non-resident), Global Health Policy Center
Maclane Speer
Research Assistant and Program Coordinator, Global Health Policy Center