CDC’s HIV Prevention Priorities
This approach combines scientifically proven, cost-effective and scalable interventions, delivered with a focus on the populations and geographic areas most heavily affected by HIV. CDC’s high-impact approach is evident in all aspects of the agency’s work, including its HIV prevention funding to health departments and community-based organizations (CBOs), in its public health guidelines, and through its research and surveillance activities.
CDC’s priority approaches are aligned with the four key strategies of the Ending the HIV Epidemic in the U.S. initiative. Through funding to communities and a range of supporting activities, CDC advances these core strategies as follows:
Testing is the gateway to care for people with HIV, and to PrEP and other prevention services for people who do not have HIV but could benefit from such services. Yet one in seven people with HIV still do not know they have it,24 in part because CDC testing guidelines are not universally followed.25 CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine medical care. Some people are more at risk for HIV than others and should be tested at least annually.26 Sexually active gay and bisexual men may benefit from even more frequent testing (e.g., every 3 to 6 months).27
CDC is focused on making HIV testing simple, accessible, and routine. Key approaches include:
- Using the latest systems and technology to make testing truly routine in healthcare facilities, particularly Federally Qualified Health Centers, sexually transmitted disease (STD) clinics, hospital emergency rooms, and other facilities that are likely to engage people who otherwise have limited access to healthcare.
- Carrying out focused approaches that encourage more people to get tested for HIV more frequently – for example, through mobile HIV testing vans and co-location of HIV testing with other health services.
- Implementing innovative technologies and programs, such as self-testing, to make testing more accessible.
Prevent new HIV transmissions by using proven interventions, including PrEP and syringe service programs (SSPs).
Both of these approaches are highly effective. When taken daily, PrEP reduces the risk of getting HIV from sex by about 99 percent.28,29,30,31,32 Comprehensive SSPs have also been shown to dramatically reduce HIV risk and can provide an entry point for accessing substance abuse treatment and prevent overdose deaths and other infectious diseases like viral hepatitis and endocarditis.33,34,35
Yet both interventions remain greatly underused. Just 18 percent of the estimated more than one million Americans who could benefit from PrEP are using the FDA-approved medications,36 and some of the largest gaps are among populations who need PrEP the most, including gay and bisexual men of color and transgender women.37,38 Many of the U.S. communities threatened by the opioid epidemic and increasing injection drug use have not had the resources or local community and political support needed to establish effective SSPs.
CDC’s PrEP Approach
CDC is focused on increasing availability and use of PrEP among populations who could benefit most, including gay and bisexual men of color, people in the South, Black women, and transgender women. CDC’s programs address both ends of the delivery spectrum:
- Increasing PrEP awareness and demand – through funding local organizations to conduct community-based outreach to people who could benefit most; education campaigns that increase awareness and combat stigma associated with PrEP use; and tools such as CDC’s PrEP Locator, which has information on public and private providers who offer PrEP.
- Increasing accessibility of PrEP – through healthcare provider training, provider education campaigns, support of TelePrEP and pharmacy-based PrEP, clinical guidelines development, and working to offer PrEP and related services through primary care centers, STD clinics, and school-based health centers.
CDC’s Approach to SSPs
CDC has developed an SSP web page and partners with other agencies and works with local communities to implement SSPs where they are needed and permitted by state and local laws. Where SSPs are already established, CDC supports scale-up of programs to reach a greater share of people who inject drugs with services such as vaccination; testing for HIV, other sexually transmitted infections (STIs), and hepatitis C virus; linkage to infectious disease care and substance use treatment; and access to and disposal of syringes and injection equipment. Where SSPs are not established or have only recently been permitted by law, CDC supports development of policies for SSP implementation, followed by program creation and scale-up.
HIV treatment not only preserves the health of people living with the virus – it is also the most powerful prevention strategy available. Research shows that people who receive HIV treatment and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to others.39,40,41,42,43
CDC is focused on quickly linking people with HIV to care and treatment, and re-engaging those who have stopped receiving care. Specifically, CDC works with grantees, partners and providers to:
- Provide immediate – ideally same-day – linkage to care for people with newly diagnosed HIV. All CDC-funded health departments and CBOs, for example, are required to maintain formal linkages to HIV medical care providers to facilitate rapid linkage. CDC also works to improve HIV linkage and navigation services in STD clinics, which provide a critical avenue to reach people with HIV or people who could benefit from HIV prevention services and may not otherwise be engaged with the healthcare system. STIs are associated with a higher risk of acquiring HIV because the presence of an STI might enhance HIV transmission, and because HIV and other STIs can be transmitted the same way – through sex.44
- Expand health department-led “Data to Care” programs that identify and follow up with people who are not receiving care. These innovative programs, developed by CDC with select health department grantees, use routinely collected HIV surveillance data and other health care data to confidentially identify and follow up with people who have received HIV diagnoses, but who are not in care or have persistently elevated viral loads.
- Increase adolescents’ access to key health services including HIV and STI testing and prevention services, subsequent referrals to care and treatment, and other risk screening through school-based health services.
- Provide behavioral interventions and other support to help people with HIV stay in care and adhere to treatment, and to help providers engage people with HIV in ongoing care. For example, CDC supports HIV Treatment Works, a communications campaign that shows how people with HIV have overcome barriers to get into care and stay on treatment and offers resources on how to live well with HIV.
HIV transmission affects different communities and areas in different ways. Cutting-edge public health approaches now make it possible to quickly identify areas with rapidly accelerating HIV transmission, where prevention and treatment services are most urgently needed. These approaches have already benefitted local communities ranging from rural Indiana to cities in northeastern Massachusetts. They involve quickly detecting rapid transmission through a variety of approaches and then addressing gaps in long-standing, proven public health strategies, including prevention and care services. These strategies are key to protecting people’s health and ending the HIV epidemic.
CDC works to ensure that all jurisdictions have the capacity to identify, investigate and respond to potential HIV outbreaks quickly. Specifically, CDC is providing comprehensive support and technical assistance in areas such as response planning, data management and analysis, informatics, communications, multi-state coordination and expansion of HIV prevention services to help local jurisdictions improve response to potential outbreaks and interrupt transmission by directing HIV services to the most affected communities.
CDC supports a range of activities, including research studies and data analyses, focused on improving and refining its core HIV prevention strategies. CDC findings guide prevention efforts and provide vital information that grantees and other public health partners need to design and deliver effective, high-impact HIV prevention programs.
CDC conducts scientific investigations and other research activities in four major areas:
- Strategic analysis of HIV surveillance and survey data and the development of new survey and data collection tools
- Testing new HIV prevention interventions – including biomedical, behavioral and structural interventions – through clinical trials and other research studies
- Conducting implementation research on best ways to deliver proven prevention interventions – for example, through research with health departments and other federal, state and local public health partners
- Launching demonstration projects that explore promising HIV prevention strategies and innovative programs in real-world settings, which can be implemented or scaled up nationwide
CDC disseminates research findings and fosters scientific discussion through publications in its Morbidity and Mortality Weekly Report (MMWR) and other journals, presentations at scientific meetings, collaborations with other federal agencies and universities, and hosting the National HIV Prevention Conference.
Recent examples of CDC-led projects include:
- Evaluating how the administration of emerging biomedical interventions like PrEP affects HIV diagnostic test responses
- Analysis of national survey data that showed most Americans have not been tested at least once for HIV as recommended by CDC
- Partnering with NIH to conduct clinical trials that demonstrated the effectiveness of PrEP in different populations
- Analyses showing how syringe service programs can increase use of HIV testing and prevention services
- Demonstration projects of innovative PrEP delivery strategies for gay and bisexual men
- Research estimating the proportion of new HIV infections among gay and bisexual men attributable to gonorrhea and chlamydia
- Analyses and reports on progress towards HIV care outcomes – including, most crucially, rates of viral suppression
- Demonstration projects to increase the use of CDC’s Data to Care approach with gay and bisexual men of color
- Developing sensitive tests for identifying hidden HIV drug resistance, which can impact viral suppression
- Research showing how molecular analysis approaches helped to slow an outbreak tied to injection drug use in rural Indiana
- In partnership with local public health staff, using bioinformatics tools to help focus resources to the leading edges of HIV transmission
To maximize the impact of its core strategies, CDC conducts an array of complementary HIV prevention and research activities:
Condoms remain an essential HIV and STI prevention tool. Since consistent and correct use is critical to avoid transmission, condoms should be made available to all who could benefit.45 Condom distribution is a required component of all CDC-funded prevention programs. CDC encourages its partners to coordinate these services with local community organizations, health centers, STD clinics, health care providers, bars, clubs, and other settings where people in need of HIV prevention can be reached.
Behavioral Interventions and Linkage to Social Services
Rigorous studies have identified effective behavior-change strategies for both people with HIV and others who could benefit. CDC continually assesses evidence on behavioral interventions to determine which have the greatest potential to reduce HIV transmission risk; improve linkage to, retention in, and re-engagement with care; increase adherence to HIV medications; and improve engagement in PrEP care. CDC supports the use of these evidence-supported approaches by its health department and CBO grantees. CDC also supports efforts to link individuals to other essential services they need to remain in care or avoid infection, including substance use disorder treatment, mental health services, housing, and transportation.
Social Marketing Campaigns
CDC’s Let’s Stop HIV Together campaign empowers communities, partners on the ground, and health care providers to reduce HIV stigma among all Americans, prevent HIV among the hardest-hit populations, and help people with HIV stay healthy. The campaign includes partnership information and resources to address HIV stigma and promote HIV testing, prevention, and treatment. CDC also partners with other organizations to extend the campaign’s reach. These partners range from community-level and online community leaders to large national organizations, and they use their own unique voices, skill sets, and platforms to deliver HIV prevention messages with credibility and impact.