Funding Communities for HIV Prevention

HIV Prevention in the United States: Mobilizing to End the Epidemic

HIV prevention ultimately happens at the community level.

While an effective national strategy and federal resources are central to ending the HIV epidemic, success requires commitment by state and local health officials, community organizations, healthcare providers, and people with HIV, and others from communities overrepresented in the epidemic. CDC carries out its HIV prevention strategy largely through funding to states and local communities nationwide.

Today, approximately 89 percent of CDC’s domestic HIV prevention funding* is directed to state and local health departments, CBOs, local education agencies, and other organizations to implement and strengthen HIV prevention. These funded programs are true partnerships, combining local knowledge and expertise with the financial and technical resources of CDC and its national partners to achieve the greatest possible impact.

*Percentage reflects adjusted extramural program funding

Major CDC funding programs include the following:

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Integrated HIV Surveillance and Prevention for Health Departments

 CDC’s flagship funding program remains its largest investment and the cornerstone of national HIV prevention efforts. Through the longstanding program, CDC most recently awarded approximately $400 million to state, territorial, and local health departments in 2020 to support HIV surveillance and prevention efforts across the country. To maximize impact, the funding awards are fully aligned with the current geographic distribution of HIV. By awarding every jurisdiction a minimum amount of $1 million per year, they are also designed to maintain core HIV surveillance and prevention capacity across the country.

Matching Surveillance and Prevention Funds to HIV Prevalence

CDC’s core HIV surveillance and prevention funding for health departments through its flagship funding program (PS18-1802) is fully aligned with the current geographic distribution of HIV.

Proportion of Americans with Diagnosed HIV (2018)46*

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* Prevalence is based on most recent known address for each person with HIV rather than residence at the time their infection was first diagnosed, to account for geographic mobility.

Proportion of CDC HIV Surveillance and Prevention Funding (2020)**

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** The funding levels reflected in these maps do not include funds designated for health departments through the Ending the HIV Epidemic initiative.

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Ending the HIV Epidemic Planning and Implementation

CDC is playing a lead role in the multi-year initiative, working with other federal agencies and local stakeholders to implement tailored plans to expand key prevention strategies in each geographic area. Specifically, CDC is funding the following activities:

Development of Local Ending the HIV Epidemic Plans

In 2019, CDC provided funding to 32 eligible, CDC-funded state and local health departments representing the initial jurisdictions supported by the initiative. Grantees are tasked with developing tailored local plans that advance the four national Ending the HIV Epidemic strategies while fully accounting for local challenges and community needs. Because community engagement is paramount to the success of the plans, the funding supports jurisdictions to engage their local communities, HIV planning bodies, HIV prevention and care providers, and other partners in a collaborative process (see State and Local Planning Components).

Funding the Implementation of Local Plans

In August 2020, CDC awarded $109 million for the first year of a new, five-year funding program to support jurisdictions’ implementation of their Ending the HIV Epidemic plans. The program complements and expands on the strategies and activities already supported by CDC’s flagship funding program for health departments with locally targeted and designed efforts to address the unique barriers to prevention and care in each community.

The new awards provide robust support for all four pillars of the Ending the HIV Epidemic initiative. The program includes a range of specific requirements to help overcome some of today’s most urgent HIV prevention challenges. For example, the program requires grantees to focus on linking newly diagnosed people to care within just seven days; supports PrEP uptake by establishing locally driven peer networks of Black and Latino PrEP users; and requires that health departments engage their local communities fully in efforts to detect and respond to potential HIV outbreaks. In addition, the new program provides supplemental funding to a subset of jurisdictions to strengthen HIV testing, prevention, and care services at dedicated STD clinics.

State and Local HIV Planning Components
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Engage with existing local prevention and care integrated planning bodies that have experience representing local populations and stakeholders about the best HIV prevention and care strategies. These collaborative efforts should include working with HRSA-funded Ryan White Part A and B recipients.

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Prepare a current epidemiologic profile to provide a comprehensive overview of the local HIV epidemic, which can be shared with local planning bodies and partners.

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Prepare a brief situation analysis that provides an overview of strengths, challenges, and needs related to key aspects of HIV prevention and care activities within the jurisdiction.

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Involve people with HIV and members of local communities most heavily affected by HIV in the planning process, which is crucial to ensure programmatic activities are conducted in ways that are acceptable to and adopted by affected local populations.

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Engage with local HIV service providers who deliver prevention, care, and other essential services for people with HIV. This engagement is critical for developing a feasible and sustainable plan that can accommodate the increasing number of individuals who will be seeking these services.

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Reach agreement on the new or updated Ending the HIV Epidemic plan with local planning groups.

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Prepare a final Ending the HIV Epidemic plan for the jurisdiction that describes the specific strategies that will be employed locally to achieve the objectives outlined in the initiative. This document will be used to guide future funding for programmatic activities.

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HIV Prevention Awards to CBOs

Community-based organizations have long been critical partners in HIV prevention. While relatively small in comparison to CDC’s health department commitments, direct funding to CBOs is an important component of DHAP’s prevention portfolio. CDC currently funds 90 CBOs and their clinical partners nationwide to deliver HIV prevention services to people who could benefit most from prevention services, including people of color, gay and bisexual men, transgender individuals, and people who inject drugs. Each of the funded organizations has demonstrated experience and expertise working with their local populations most affected by HIV. CDC also provides targeted funding to 30 CBOs with expertise delivering comprehensive HIV prevention services to young gay and bisexual men of color and young transgender people of color. This funding aims to reduce new HIV infections, increase access to care, and advance health equity among these groups.

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Preventing HIV and STIs Among Adolescents

CDC’s evidence-based school health program provides students with knowledge and skills that support prevention of HIV, STIs, and unintended pregnancy among adolescents through sexual health education, promoting safe and supportive environments in schools and increasing access to sexual health services. CDC funds 28 local education agencies around the country to deliver training and professional development for school nurses and other staff; provide referrals to community providers for health services; and improve the use of school-based health centers to provide on-site services.

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Strengthening the HIV Prevention Workforce

Effective HIV prevention cannot happen without a skilled HIV prevention workforce. To build and maintain this foundation for ending the epidemic, CDC funds 18 organizations with deep HIV prevention expertise to provide national training, regional technical assistance, and other critical expertise to the staff of CDC-funded health departments, CBOs, and other HIV prevention and care providers. Each year, thousands of HIV prevention professionals participate in these CDC-supported capacity building assistance (CBA) programs to sharpen their skills and increase their impact. CDC is also working with Ending the HIV Epidemic jurisdictions to enhance their local HIV workforce capacity, such as leveraging CDC’s Public Health Associate Program (PHAP) to place highly motivated early-career public health professionals in interested jurisdictions.