HIV Prevention in the United States: Federal Investments are Saving Lives and Strengthening Communities, Jeffrey S. Crowley & Sean E. Bland, O'Neill Institute (2018)

This issue brief from the O’Neill Institute offers a snapshot of the epidemic in 2018, including what is known about effective prevention and the communities that continue to experience a disproportionate level of harm from HIV. It outlines concrete action across five areas where the authors believe innovation is most urgently needed.

The brief highlights continuing inequities in the burden of HIV among gay and bisexual men and racial minorities, and also identifies regional disparities, with the Southern U.S disproportionately affected.  The report flags the fact that only 48% of PLHIV in the U.S. have durable viral suppression, and that this is a particular problem among Black PLHIV.

The report concludes by urging federal investment and innovation to more effectively support HIV prevention by (1) integrating surveillance and clinical care data, (2) interrupting HIV transmission within sexual and drug-using networks, (3) improving the tailoring and integration of services to communities with the greatest need, (4) developing long-acting prevention and therapeutic options, and (5) promoting jurisdictional plans to end HIV.  Unfortunately, the report does not reference, let alone prioritize, the societal, legal and systemic issues that block realization of these recommendations: over-policing, over-surveillance of Black communities, over-incarceration, judgmental and punitive approaches to PLHIV who do not always disclose their status or use prophylaxis, criminalization of sex work and drug use, near-complete absence of comprehensive sexual health literacy programming for all Americans, and unaddressed racial and class biases of those who plan and implement care and prevention programs in the U.S.