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About the Ending the HIV Epidemic in the U.S. Pillars
The Ending the HIV Epidemic in the U.S. (EHE) initiative focuses on scaling up four science-based strategies that form the pillars of the initiative and, together, can end the HIV epidemic: Diagnose, Treat, Prevent, and Respond. With sufficient resources, strategies within these pillars can be scaled up to reach people who can benefit from HIV prevention and care and achieve EHE’s goal of reducing new HIV infections in the United States by 90% by 2030.
Visit the Resource Hub for tools and resources to support local implementation of EHE strategies.
Diagnose
Diagnose all people with HIV as early as possible
Knowing one’s HIV status is a critical step in accessing powerful prevention and treatment tools. CDC collaborates with communities and federal, state, and local agencies to expand HIV testing according to CDC guidelines, so all people with HIV receive a diagnosis.
Diagnose Strategies
To decrease the number of new HIV infections and help more people get tested and know their status, CDC is:
Using the latest systems and technology to increase testing in healthcare facilities (e.g., routine screening in emergency departments, sexually transmitted infection [STI] clinics, and Federally Qualified Health Centers)
Applying innovative approaches to make HIV testing more accessible in nontraditional settings (e.g., mobile testing units, co-location of HIV testing with other health services, and self-testing)
Establishing ways to regularly test people who may experience higher likelihood of acquiring HIV
Operating GetTested, a national testing locator to find nearby free or low-cost HIV, STI, and hepatitis testing
Treat
Treat people with HIV rapidly and effectively to reach sustained viral suppression
HIV treatment preserves the health of people with HIV and is one of the most powerful HIV prevention strategies available. People with HIV can live long, healthy lives and will not transmit HIV to a partner through sex if they take medication as prescribed and maintain an undetectable viral load (known as treatment as prevention, and sometimes referred to as “Undetectable = Untransmittable,” or U=U).
Treat Strategies
To increase the number of people with HIV who are on treatment and who are virally suppressed, CDC is:
Supporting early initiation of antiretroviral therapy by rapidly linking people with newly diagnosed HIV to treatment and care
Supporting retention in care and adherence to medication by expanding innovative models of service delivery, including through telehealth and long-acting injectable antiretroviral therapy
Supporting re-engagement in care by scaling up linkage services and data-to-care programs by expanding the reach of partner programs to engage or re-engage people who are not currently in care
Collaborating with partners to optimize resources and synergize approaches to address the needs of people with HIV
Identifying evidence-based interventions and strategies made publicly available through the Compendium of Evidence-based Interventions and Best Practices for HIV Prevention
Providing training, technical assistance, and educational resources to health departments, community-based organizations, providers, and the public in EHE-funded communities
Prevent
Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs)
PrEP and SSPs are highly effective HIV prevention strategies. When taken as prescribed, PrEP reduces the risk of getting HIV from sex by about 99% and reduces the risk of getting HIV from injection drug use by at least 74%. Comprehensive SSPs have also been shown to dramatically reduce HIV transmission and can provide an entry point for accessing substance use disorder treatment and prevent overdose deaths and other infectious diseases.
Prevent Strategies
To prevent new HIV transmissions and increase access to HIV prevention services, CDC is:
Supporting state and local communities to expand innovative strategies to increase availability of PrEP, including TelePrEP, same-day PrEP delivery, long-acting injectable PrEP, and pharmacy-based access to PrEP
Maintaining clinical guidelines for prescribing PrEP, supporting PrEPline as a resource for clinicians interested in providing PrEP, and updating the PrEP Locator tool with public and private providers nationwide who offer PrEP
Increasing the number of clinicians offering PrEP and post-exposure prophylaxis (PEP), which includes working with HRSA to train healthcare providers on prescribing PrEP and PEP, and managing PrEP adherence
Providing funding flexibilities to funding recipients to allow them to cover the costs of PrEP-related services, like laboratory tests and physician visits
Developing and delivering education campaigns to healthcare providers and the public to increase PrEP awareness and demand, and combat stigma associated with PrEP use and HIV, including She’s Well, which focuses on PrEP for women
Increasing access to and use of SSPs, including by working with SAMHSA and local communities to implement SSPs where they are needed and permitted by state and local laws
Supporting scale-up of SSPs to provide comprehensive care to people who inject drugs (PWID), including vaccination; testing for HIV, other STIs, and the hepatitis C virus; linkage to infectious disease care and substance use disorder treatment; and access to and disposal of syringes and injection equipment
Issuing guidance on how to deliver PrEP and SSP services during clinical service disruptions (e.g., during public health emergencies, including COVID-19)
Respond
Respond quickly to potential HIV outbreaks to get vital prevention and treatment services to people who need them
Real-time response systems are key to ending the HIV epidemic in the United States. Cutting-edge public health strategies, including new epidemiological approaches, help us quickly identify communities affected by rapid HIV transmission. Rapid transmission occurs when affected communities are not being reached by existing services due to factors such as stigma, discrimination, racism, poverty, and other social and structural factors. HIV cluster detection and response helps health departments, community-based organizations, and other partners respond to address inequities and make sure that resources are reaching the people and places that can benefit from them.
Respond Strategies
To get vital HIV prevention and treatment services and resources to people who need them, CDC is:
Providing comprehensive support and technical assistance to ensure all jurisdictions have the capacity to identify, investigate, and respond to potential HIV clusters and outbreaks quickly
Supporting local implementation of cutting-edge public health approaches that can pinpoint areas of rapid HIV transmission and mobilize resources for HIV treatment, prevention, and other related services in the most affected local communities
Collaborating with communities and partners to understand local needs and better implement comprehensive, tailored HIV prevention and other health and social services and programs
Supporting health departments to integrate, protect, and use routinely reported data to identify communities experiencing rapid HIV transmission, gather additional information to understand the needs of affected communities, direct resources to where they are needed, and limit collected data to use in public health
Learn more about HIV cluster detection and response.
Learn more about evidence for effectiveness of HIV cluster detection and response.
Read examples of HIV cluster response in action in CDC’s Community Spotlights.
Find more Respond Pillar resources here.