Principles for Ending Human Immunodeficiency Virus as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association

Abstract

The National HIV/AIDS Strategy for 2022-2025 and the federal Ending the HIV Epidemic (EHE) initiative1,2 have an ambitious goal of dramatically reducing new HIV infections in the United States. by 90% by 2030. While we have the tools to achieve that, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people living with HIV. The necessary structural changes require actions by federal, state and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse ID and HIV workforce. This paper outlines ten key principles for policy reforms that if advanced would make ending the HIV epidemic in the U.S. possible and could have much more far-reaching effects in improving the health of our nation.

Do HIV Care Outcomes Differ by Provider Type?

“…[2][3][4] Achieving the goals of the National HIV/AIDS Strategy for the United States 2022-2025 5 will require increasing the number of infectious disease (ID) physicians, primary care physicians (internal medicine and family medicine), nurse practitioners (NPs), and physician assistants (PAs) who know how to select an antiretroviral therapy (ART) regimen and recognize and respond to obstacles affecting adherence to ART and retention in care, such as mental health and substance use disorders, structural barriers to care, and internalized HIV-related stigma. 6,7 This will require increases in formal training opportunities and incentives to choose a career in HIV medicine, such as higher compensation for HIV care, reduced administrative burden, and assurance of safe and sustainable caseload. 8 However, it is unclear how various provider types should be prioritized in these rebuilding efforts.…”

Ending the HIV Epidemic

“…Key principles critical to expanding and improving health care services to reach the aforementioned at-risk communities have been outlined and include ensuring access to affordable and comprehensive health care for all and funding innovative care models, particularly delivering health care “where people are.” In addition, policies that address social determinants of health associated with structural racism and that fight stigma and discrimination should be adopted, along with repealing and reforming laws and policies that criminalize people with HIV, interfere with patients’ rights to receive medical care, and violate the sanctity of the patient-clinician relationship.…”