Washington, DC: The American Academy of HIV Medicine (AAHIVM), today, highlighted critical barriers to ending the HIV epidemic as identified by HIV care providers in the hardest hit areas of the country. The survey participants – made up of AAHIVM members and HIV credentialed providers – reside in the 50 counties, urban jurisdictions and seven rural states identified as initial geographic targets within the Trump Administration’s Ending the Epidemic (EtE) initiative. According to respondents, the most urgent challenges include a critical workforce shortage, homelessness/unstable housing, HIV stigma, and transportation barriers.

In the State of the Union Address on February 5, 2019, President Trump announced his Administration’s goal to end the HIV epidemic in the United States within 10 years. The stated goals are to reduce new HIV infections in the US by 75% in five years and 90% by 2030.

“The Administration’s ambitious goals seem remarkably achievable if you are simply focused on the clinical tools available, such as treatment therapies and prevention options including PrEP,” stated Bruce J. Packett II, executive director of AAHIVM. “But this survey tells us that we are not looking at the whole picture.  We have to address the real problems and barriers articulated by the people on the ground and in the fight every day, including issues like stigma and unstable housing. Administration officials in charge of fund allocation need to understand the greatest areas of concern in order to maximize results.”

AAHIVM conducted an online survey of their membership and credentialed providers specifically in the EtE geographic jurisdictions in July and August of 2019. There were 325 total respondents, representing 10.2 percent response rate among targeted providers in 43 out of the 50 jurisdictions and in all seven states. One quarter of the respondents have been treating people living with HIV for more than 20 years.

Key findings include:

  • Nearly half of providers treating patients with HIV have caseloads of over 200 patients currently, and over half of respondents anticipate the HIV patient caseloads to increase over the next 12 months. The few providers who anticipated a decrease in HIV patient caseloads are nearing retirement or leaving the field of HIV medicine. This strongly suggests a critical workforce shortage of clinical providers to treat people with HIV in these high-incidence jurisdictions.
  • Providers cite homelessness/unstable housing, HIV stigma, and transportation barriers as the three biggest barriers to care. They also cite the homeless/unstably housed, people with substance use disorders, and people with mental health disorders as the hardest to bring into care; however, long acting agents coming to the market soon may play a role in the ability to treat these populations.
  • Across the care continuum, providers in every jurisdiction consistently said their community needed significant improvement on getting pre-exposure prophylaxis (PrEP) into the hands of people who need it the most and who ask for it. Some of the data, especially in the South, point to providers not believing certain populations are at risk for HIV.  More education needs to be offered to all health professionals in these areas around the effectiveness of PrEP and how to identify risk.
  • Providers’ assessment of the local epidemic varies based on their practice setting. Clinicians in private practice and Ryan White Funded clinics typically view their community as better off in terms of their management of the local epidemic than those in Hospitals and Health Center settings.
  • The data indicates that the U.S. is experiencing two HIV epidemics. In urban jurisdictions where there is an historical HIV epidemic, clinicians believe their community is faring better across the HIV care continuum, there are more providers available to treat people with HIV and provide PrEP, and there are fewer barriers to care. In jurisdictions where HIV is emerging and in the rural southern states targeted by the EtE, there is a general shortage of clinical providers, pervasive barriers to providing care and community stigma around HIV and its risk factors.

AAHIVM plans to utilize this data as a needs assessment for AAHIVM’s education and training activities for providers in 2020 and beyond.

“This data indicates that the Academy needs to continue to provide education and training to support the clinical HIV workforce, but we need to redouble our efforts to ensure that providers are entering the field,” stated Packett. “We also look forward to sharing this data with the members of the Administration in hopes of providing insights that can lead to meaningful steps in ending the epidemic.”

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The American Academy of HIV Medicine is the nation’s leading independent organization of healthcare professionals dedicated to providing excellence in HIV care and prevention. Our membership of practitioners and credentialed providers manage the health of the majority of people with and at risk for HIV in the United States.  AAHIVM’s mission is to ensure health care professionals have the resources needed to provide prevention, treatment and care for those living with or at risk for HIV and related conditions to achieve optimal health.