The United States Department of Health and Human Services has proposed a new initiative that will leverage scientific advances in treatment and prevention to achieve the goal of reducing new HIV infections in the United States by 75% within 5 years and by 90% within 10 years (HIV.gov, 2019). Although just announced in February 2019, the development of this plan and the review of evidence to support it have been in process for more than a year. Leadership from the United States Department of Health and Human Services (home of Ryan White Programs, Federally Qualified Health Centers, and other points of care), the Centers for Disease Control and Prevention, the National Institutes of Health (in particular, the Centers for AIDS Research), the Indian Health Service, and the Substance Abuse and Mental Health Services Administration is contributing to the infrastructure for this plan (Fauci, Redfield, Sigounas, Weahkee, & Giroir, 2019), which is focused on the following four pillars:
- Testing: identify people as early in infection as possible
- Treatment: rapid and effective treatment to achieve sustained viral suppression
- Protection: proven prevention methods that include PrEP
- Response: rapid response to cluster outbreaks (HIV.gov, 2019).
The four pillars will be supported by new funding, continued support and expansion of effective programs (e.g., Ryan White Programs), and an investment in an HIV Health Workforce with local teams of public health professionals in each jurisdiction dedicated to the initiative.
The initial phase will focus on the geographic and demographic hotspots in the United States (https://files.hiv.gov/s3fs-public/Ending-the-HIV-Epidemic-Counties-and-Territories.pdf). Although there are more than 3,100 counties and county equivalents in the United States (https://www.usgs.gov/faqs/how-many-counties-are-there-united-states), more than half of the new HIV infections occur in 48 counties, Washington, DC, and San Juan, Puerto Rico. These and seven states with high HIV incidence in rural areas will be the focus.
The impact of stigma has been called out. Alex Azar, secretary of the Department of HHS, wrote, And stigma—which can be a debilitating barrier preventing someone living with HIV or at risk for HIV from receiving the healthcare, services and respect they need and deserve—still tragically surrounds HIV. This is not just as a biomedical issue, but a social challenge, too (Azar, 2019, p 9).
The multi-agency effort will be led and coordinated through the Office of the Assistant Secretary of Health under the direction of Brett Giroir, MD, MPH, assistant secretary of health. At a recent meeting in Washington, DC, Dr. Giroir noted that the design of responses in these jurisdictions is to be locally driven, and the Centers for Disease Control and Prevention funding for planning grants will be released from this year's budget.
And there is more notable news. At that same meeting, Dr. Giroir announced that Rear Admiral (RADM) Sylvia Trent-Adams, PhD, RN, FAAN, deputy assistant secretary of health, will coordinate the effort. From 2015 through 2018, RADM Trent-Adams served as deputy surgeon general of the United States Public Health Service Commissioned Corps. Before that, she served as deputy administrator for the Ryan White Programs at the HIV/AIDS Bureau, Health Resources and Services Administration. Before joining the United States Public Health Service, RADM Trent-Adams was a nurse officer in the US Army and a research nurse at the University of Maryland. Sylvia is a champion of nurses and an ANAC member; she gave the opening address at the ANAC 2015 annual conference in Chicago. You know her—she is one of us. Her presence brings a sense of reassurance and confidence to me and to many others in the HIV community.
This is a huge endeavor with audacious goals and many, many challenges. The implementation of this massive effort will include nursing leadership at its best. Vision, insight, listening and open communications, inclusiveness, research- and evidence-based approaches, consensus building, accountability, and compassion and respect for human rights and cultural differences are some of the words that come to mind. Plus … we all know, nurses get things done.
The challenges are great. It is hard to understand how this will happen when the basic requirements for success are being chipped away every day. It is hard to balance the intent of this plan with the reality of budgets that threaten to cut Medicare and Medicaid and administration efforts to gut the Affordable Care Act, wipe out the protected class status of HIV drugs in Medicare, undermine planned parenthood, deny evidence-based programs such as syringe exchange services, and the plethora of policies and messages that further marginalize lesbian, gay, bisexual, and transgender communities, and threaten racial, ethnic, and religious minority communities. There are two polar opposite but parallel tracks operating here. I choose to support the track set forward in the plan while still fighting against policies that harm or threaten our communities. We can do both. The plan is across 10 years—it will straddle administrations and culminate in a future we can imagine but are not living in yet. The compelling need for all of us to participate was laid out at the recent National HIV Prevention Conference by one of the architects of the plan, Anthony Fauci, MD, NIAID director at the National Institutes of Health, “We have an ethical and moral responsibility to do this now that we have the tools to end the epidemic” (Anthony Fauci, personal communication, March 18, 2019).
So, this brings me to the “nurses needed” part of the title. The implementation of this plan, in all of its 57 varieties, will not succeed without nurses. Nurses are the implementers of care and the trusted sources of health information for many. The nursing perspective is at the intersection of quality, evidence-based clinical care, and human rights and social justice. This is our legacy and part of ANAC's history. Nurses must step up and be part of the plan to end AIDS. If you live in one of the 57 targeted areas, attend the start-up meetings, get on the planning committee, ask your health department about their plan, insist that nurses be members of the local HIV health force, think creatively, and innovate and leverage our influence to improve outcomes for people living with and at risk for HIV. In 2016, 7 of 10 people with a new HIV diagnosis saw a health care provider in the previous 12 months without being offered HIV testing (Centers for Disease Control and Prevention, 2017). We must educate our peers and reduce provider bias to normalize HIV testing, expand preexposure prophylaxis education and uptake in communities most affected, and effectively re-engage people who are lost to care. This will require new, innovative, community-level approaches, approaches that will shake up our care systems and may require that care be provided at different places and different times. Nurses and nurse practitioners can lead these innovations, just as we have championed and provided patient-centered care over the 30+ years of the epidemic. Just think—we can end this.
The author reports no financial interests or potential conflicts of interest.