This year’s annual U.S. Conference on HIV/AIDS (USCHA) concluded on October 21 with a plenary session featuring several federal HIV leaders and I was honored to be included. I am grateful to NMAC for convening this conference virtually during the COVID-19 pandemic, enabling the community along with federal and state partners to continue to share important information, strategies, and experiences about HIV, sexually transmitted infections, viral hepatitis, leadership, and race. Following are some highlights of what I shared with the participants.

Status and Next Steps for the Ending the HIV Epidemic Initiative

Naturally, participants wanted to know about the status of Ending the HIV Epidemic: A Plan for America (EHE) given all that has happened this year and what lies ahead for this national initiative. I reiterated that EHE remains a priority at the U.S. Department of Health and Human Services and that its agencies and offices are moving forward with implementation activities. Some important EHE developments include:

• The 57 jurisdictions prioritized in the initiative’s first phase are working to revise their EHE Plans based on feedback CDC, HHS, and HRSA shared on the draft plans back in March. Acknowledging the impact of the response to COVID-19 on state and local health departments and their key community partners, the deadline for submitting the revised plans was extended to December 31, 2020.
• The Ready, Set, PrEP program, which provides PrEP medications at no cost to individuals who qualify, made some COVID-related adaptations earlier this year to help ensure patient retention in ongoing PrEP care and adherence to medications, and also reduce the burden on the nation’s health care providers and health care systems. The program authorized 90-day prescription fills and implemented automatic enrollment eligibility extensions between June 1 and September 29. We’ll be making enhancements to GetYourPrEP.com , the enrollment portal for Ready, Set, PrEP in the coming weeks. Soon you’ll see additional Ready, Set, PrEP marketing assets featuring real people who take PrEP telling their stories of how PrEP has affected their lives.
• In August, we launched America’s HIV Epidemic Analysis Dashboard, known as AHEAD. It’s an online data visualization tool designed to help jurisdictions, researchers, public health professionals, HIV service organizations, and others across the country track progress towards meeting EHE goals. AHEAD displays graphical representations of data on the six EHE HIV indicators for the 57 jurisdictions prioritized in the initiative, as well as state data for the 21 states in which EHE counties are located. In collaboration with our partners at CDC, additional data was recently added to the site. The new indicator data includes preliminary 2019 data and data on the first quarter of 2020 on HIV diagnoses and linkage to HIV medical care.
• To continue making progress on EHE’s Diagnose strategy, HHS, CDC, HRSA, IHS, and SAMHSA are encouraging and facilitating HIV self-testing options in communities where there has been a reduction in availability of in-person HIV testing due to COVID-19.  Self-testing can be an effective on-going strategy to help identify and link individuals to needed HIV prevention and care services in a post-COVID-19 world.  Jurisdictions are encouraged to explore ways HIV self-testing can help us meet our EHE targets for HIV diagnoses.
• The Prevention through Active Community Engagement (PACE) officers, a team of U.S. Public Health Service Commissioned Corps officers supporting EHE activities in HHS Regions 4, 6, and 9, continue their work to facilitate broad community involvement in the development and implementation of jurisdictional EHE plans. They are also facilitating discussions about the intersection of HIV disparities and social determinants of health and racial inequality.

Damián Cabrera-Candelaria, Treatment Program Manager at NMAC , the USCHA conference convenor, also asked me about efforts to combat racism in health services, whether employment opportunities for people with or affected by HIV will result from EHE, and responding to HIV in Puerto Rico, which was to have hosted this year’s USCHA.

The closing session also featured remarks from my federal colleagues and partners in the EHE initiative: CDC’s Dr. Jonathan Mermin, HRSA’s Dr. Laura Cheever, SAMHSA’s Dr. Neeraj Gandotra, NIH’S Dr. Maureen Goodenow, and NIH’s Dr. Anthony Fauci.  You can view the closing plenary on YouTube. 

Joining many colleagues from across the HIV community, I commend NMAC for innovating this year to make USCHA possible once again and salute their staff along with the many presenters and participants who shared ideas and learned from one another throughout the conference.

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The 9th SA Aids Conference in Durban ended on Friday with the eThekwini Declaration: “A Radical Call to Action – Reinvigorating and Revolutionising the HIV Response”.

Here are 10 things you need to know from the conference:

• “Reawaken the urgency of HIV and Aids as a devastating public health crisis still requiring an emergency response” – The eThekwini Declaration, handed to vice-president David Mabuza, who closed the conference;
• This is why it matters – South Africa has 7.9-million people currently living with HIV and at least 4.4 million on treatment, but there is inadequate progress towards the UN 90-90-90 global targets: 90% of people will know their HIV status, 90% with HIV will get sustainable antiretroviral therapy, 90% on treatment will have viral suppression;
• New HIV infections in South Africa are declining but the infection rate among young people, particularly teenage girls and young women, is still shockingly high;
• Almost four women per 100, aged 16 to 35, are getting HIV every year, a study on the safety of three contraceptives including Depo-Provera found. The contraceptive is safe. Nearly 8,000 women from South Africa, Kenya, Zambia and Swaziland took part in the clinical trial, and the results were announced on Thursday by Prof Helen Rees, one of the trial leaders and director of the Wits Reproductive Health Institute (WRHI);

• Professor of medicine Francois Venter, head of Ezintsha, a WHRI sub-syndicate, says of the ECHO results: “If ever there was a wake-up call for the family planning sector, this is it: we should be treating women accessing these services as an emergency for access to HIV prevention, especially PrEP –pre-exposure prophylactic treatment”;
• Key vulnerable populations, such as sex workers, need to be prioritised for better care and treatment, researchers and activists urged. They have higher infection and death rates. All groups on treatment in the public health system are at risk of antiretroviral drug stockouts, which are common;
• The good news is that South Africa is at the forefront of HIV vaccine research. Four large-scale HIV vaccine efficacy clinical trials are taking place at research sites across the country, says Prof Glenda Gray, president of the SA Medical Research Council and director of the HIV Vaccine Trials Network Africa Programmes;

• HIV/Aids donor funding to South Africa has reached a high point says Dr Fareed Abdullah, director of the Office of AIDS & TB Research at the South African Medical Research Council. Pepfar has pledged about US$730m for the current year and for the next year, following uncertainty about whether they would, and The Global Fund has increased its allocation to US$369m to South Africa for the next three-year cycle;
• Despite this, HIV/Aids activists and clinicians raised concerns on and off stage at the conference that service delivery by some organisations, or “implementing partners”, is threatened following unforeseen shifts in donor funding. They called for greater transparency and participation in the awarding of grants; and
• The theme of the conference was Unprecedented Innovations and Technologies: HIV and Change. More than 3,000 delegates attended, about 25% of them from other countries. Prof Refilwe Phaswana-Mafuya, deputy vice chancellor research & innovation at North-West University, chaired the conference.

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