AJPH EDITORIALS
beverages. J Am Dent Assoc. 2013;144(10):
1148–1152.
5. Singh GM, Micha R, Khatibzadeh S,
Lim S, Ezzati M, Mozaffarian D.
Estimated global, regional, and national
disease burdens related to sugar-sweetened
Increasing Availability of Prevention
to Communities Disproportionately
Affected by HIV
Follow-up on: Nunn A, Yolken A, Cutler B, et al. Geography should not be destiny: focusing HIV/AIDS im-
plementation research and programs on microepidemics in US neighborhoods. Am J Public Health. 2014;104(5):
775–780.
Advances in HIV testing,
treatment, and prevention pro-
duced a decline in the number of
new HIV diagnoses in the United
States over the past 10 years,
with the largest declines seen in
mother-to-child transmission
and among women and people
who inject drugs. However,
diagnoses have only stabilized
among gay, bisexual, and other
men who have sex with men
(MSM) in the past five years,
and increases continue among
Hispanic/Latino MSM.1 Fur-
thermore, disparities persist;
MSM, transgender persons,
African Americans and
Hispanics/Latinos, and persons
residing in the Southern
United States are the most
disproportionately affected
subpopulations.1
The disparities in HIV di-
agnoses are associated with
myriad social, contextual, and
structural factors. The National
HIV/AIDS Strategy for the
United States (NHAS), originally
released in 2010 and updated to
2020,2 describes principles, pri-
orities, and actions federal
agencies should use to guide
a collective national response that
will reduce new HIV infections,
increase access to care, improve
outcomes for persons living with
HIV, and reduce disparities. To
July 2017, Vol 107, No. 7 AJPH
beverage consumption in 2010. Circulation.
2015;132(8):639–666.
6. Singh GM, Micha R, Khatibzadeh S,
et al. Global, regional, and national con-
sumption levels of sugar-sweetened bev-
erages, fruit juice, and milk: a systematic
achieve the NHAS goals, the
Centers for Disease Control
and Prevention (CDC) adopted
a high-impact prevention (HIP)
approach3 that targets the best
combinations of scientifically
proven, cost-effective, and scal-
able interventions to the right
populations in the right geo-
graphic areas. Following up
Nunn et al.,4 we discuss CDC’s
HIV research and programmatic
efforts under the HIP approach.
BIOMEDICAL AND
BEHAVIORAL
RESEARCH
Biomedical and epidemio-
logical studies provide compel-
ling evidence that early and
effective treatment of HIV
infection and the use of pre-
exposure prophylaxis and non-
occupational postexposure
prophylaxis significantly reduce
the risk of sexual HIV trans-
mission. Consequently, CDC’s
biobehavioral prevention efforts
focus on HIV testing (targeted
and general screening) and con-
dom use for persons at risk for or
living with HIV infection; link-
age and retention in care for
HIV-positive persons; and pre-
exposure prophylaxis, non-
occupational postexposure
assessment of beverage intake in 187 sugar-sweetened beverage consumption.
countries. PLoS One. 2015;10(8): Am J Public Health. 2016;106(10):
e0124845. 1865–1871.
7. Falbe J, Thompson HR, Becker CM,
Rojas N, McCulloch CE, Madsen KA.
Impact of the Berkeley excise tax on
conducting comprehensive pro-
gram planning to implement the
HIP approach. Results from
the project showed increases in
funding allocations for HIV
testing and condom distribution
efforts specifically targeting Af-
rican Americans and Hispanics/
Latinos, and they indicated
that health departments
could successfully shift HIV
prophylaxis, and other pre- prevention resources to
vention support services for make progress toward NHAS
HIV-negative persons. This fo- goals.5
cus also includes the provision Four demonstration projects
of efficacious behavioral in- have been funded since the
terventions (Compendium of ECHPP. In 2012, the Care and
Evidence-Based Interventions Prevention in the United States
and Best Practices for HIV project funded eight state health
Prevention; http://www.cdc.gov/ departments—six of them in
hiv/research/interventionresearch/ Southern states—with a focus
compendium/index.html) and on improving linkage, retention,
demonstration projects aimed and engagement in care among
at understanding how pre- racial and ethnic minorities living
vention advances can best be with HIV. Funded jurisdictions
combined and implemented in improved implementation of
various practice settings (e.g., CDC’s new Data to Care strategy
health departments, health (https://effectiveinterventions.cdc.
centers, and community-based gov/en/highimpactprevention/
organizations). publichealthstrategies/DatatoCare.
In 2010, The Enhanced aspx) of using surveillance data
Comprehensive HIV Prevention to identify HIV-diagnosed in-
Planning (ECHPP) Project, the dividuals not in care and link
first demonstration project to them to care. These jurisdic-
address the goals of the NHAS, tions also addressed a variety of
was launched in the 12 US cities social and structural barriers to
with the highest AIDS preva- linkage and retention in care,
lence.5 ECHPP-funded health determined by local relevance,
departments were charged with including transportation,
ABOUT THE AUTHORS
Donna Hubbard McCree, David W. Purcell, Janet C. Cleveland, and John T. Brooks are
with the Office of the Director, Division of HIV/AIDS Prevention, National Center for
HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and
Prevention, Atlanta, GA.
Correspondence should be sent to Donna Hubbard McCree, Associate Director for Health
Equity, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, c/o
1600 Clifton Rd NE, MS D-21, Atlanta, GA 30329 (e-mail: zyr1@cdc.gov). Reprints can
be ordered at http://www.ajph.org by clicking the “Reprints” link.
This editorial was accepted February 28, 2017.
doi: 10.2105/AJPH.2017.303764
McCree et al. Editorial 1027
AJPH EDITORIALS
housing, HIV stigma, coloca-
tion of services, and in-
stitutional racism and
homophobia.
In 2014, the Partnerships for
Care Project was funded to
develop collaborative and sus-
tainable partnerships between
four CDC-funded state health
departments (Florida, Maryland,
Massachusetts, and New York)
and 22 Health Resources and
Services Administration–funded
health centers in those same ju-
risdictions. Eligible health de-
partments were selected on the
basis of the HIV prevalence
(> 5000 cases statewide) among
African Americans and
Hispanics/Latinos as well as the
presence of laws and regulations
requiring laboratory reporting
of HIV viral load and CD4 data
at all levels. The goal is to
strengthen partnerships between
health departments and com-
munity health centers and to
identify promising new models
for HIV service delivery. These
models include implementing
routine testing and establishing
new access points for care and
treatment.
Finally, two demonstration
projects began in 2015: “Tar-
geted Highly Effective In-
terventions to Reverse the HIV
Epidemic” (THRIVE) and
“PreP Implementation, Data to
Care and Evaluation,” (PrIDE).
THRIVE prioritizes MSM of
color living with or at high risk
for HIV infection and supports
collaborations between health
departments, community-based
organizations, health care clinics,
and behavioral health and social
service providers to develop
comprehensive models of pre-
vention and care. Project PrIDE
supports state and local health
departments to implement pre-
exposure prophylaxis and Data
to Care projects for MSM and
transgender persons of color.
1028 Editorial McCree et al.
Dating back to the ECHPP,
all of these demonstration pro-
jects involved extensive co-
ordination across multiple federal
agencies, which mirrors the
collaborations between state
and local health departments
and other key public health
partners.
PROGRAMMATIC
EFFORTS FOR
COMMUNITIES
Programmatic efforts—that is,
funding to state, local, and ter-
ritorial health departments and
direct funding to community-
based organizations to comple-
ment the work of health
departments—represent CDC’s
single largest investment in HIV
prevention. Consistent with
the HIP approach, these pro-
grammatic efforts focus on HIV
testing and diagnosis, linkage to
and retention in prevention and
care services, condom distribu-
tion, increased awareness and
uptake of preexposure pro-
phylaxis, and support for be-
havior change with select
interventions and strategies.
Community engagement and
mobilization are key components
of research and programmatic
efforts. Integrated HIV Pre-
vention and Care Planning
Groups engage stakeholders to
ensure that programs are relevant
and appropriate for the intended
audiences, prevention and care
services are implemented to im-
prove linkage to and retention in
prevention and care services, and
communities are aware of the
HIV prevention and care efforts
in their jurisdictions. CDC also
supports several national com-
munication campaigns. These
include Doing It, which en-
courages HIV testing and
awareness of status for all adults;
Let’s Stop HIV Together, which
promotes HIV awareness and
fights stigma; and HIV Treat-
ment Works, which addresses
barriers to the care and treatment
of persons living with HIV. Social
media platforms such as Twitter
and Facebook are used to increase
awareness and to engage com-
munities. Finally, a new five-
year community partnership,
Partnering and Communicating
Together to Act Against AIDS
(PACT), was recently launched
with 15 national civic, social, and
media organizations. The pur-
pose is to raise public awareness of
the importance of testing, pre-
vention, and care, and to leverage
partners in communication,
mobilization, and outreach
activities.
FUTURE DIRECTIONS
The CDC HIV Prevention
portfolio uses the HIP approach
to combine targeted research
with cutting-edge programmatic
efforts to change the course of
HIV infection in the United
States. Additional research is
needed to better understand the
complex set of behaviors that
support HIV preventive efforts,
including testing, linkage to care,
and consistent engagement in
care. Efforts are also needed to
identify the pathways through
which social, contextual, and
environmental factors interact
to create HIV-related risk and
geographic disparities. Outcomes
from these efforts may be used to
inform the development, evalu-
ation, and implementation of
the right combination of in-
terventions to address HIV-
related disparities in the United
States.
Donna Hubbard McCree, PhD,
MPH, RPh
David W. Purcell, JD, PhD
Janet C. Cleveland, MS
John T. Brooks, MD
CONTRIBUTORS
All of the authors contributed equally
to this editorial.
ACKNOWLEDGMENTS
We acknowledge Eugene McCray, MD,
director, Division of HIV/AIDS Pre-
vention, for his review of and feedback
on drafts of this editorial.
REFERENCES
1. Centers for Disease Control and Pre-
vention. HIV surveillance report, 2015;
vol 27. Published November 2016.
Available at: http://www.cdc.gov/hiv/
library/reports/hiv-surveillance.html.
Accessed January 25, 2017.
2. White House Office of National AIDS
Policy. National HIV/AIDS Strategy for
the United States: updated to 2020.
Available at: https://www.aids.gov/
federal-resources/national-hiv-aids-
strategy/nhas-update.pdf. Accessed Janu-
ary 25, 2017.
3. Centers for Disease Control and Pre-
vention. High-impact HIV prevention:
CDC’s approach to reducing HIV in-
fections in the United States. Available at:
http://www.cdc.gov/hiv/policies/hip/
hip.html. Accessed June 2, 2016.
4. Nunn A, Yolken A, Cutler B, et al.
Geography should not be destiny: focus-
ing HIV/AIDS implementation research
and programs on microepidemics in US
neighborhoods. Am J Public Health. 2014;
104(5):775–780.
5. Fisher HH, Hoyte T, Purcell DW, et al.
Health department HIV prevention pro-
grams that support the National HIV/
AIDS Strategy: The Enhanced Compre-
hensive HIV Prevention Planning Proj-
ect, 2010–2013. Public Health Rep. 2016;
131(1):185–194.
AJPH July 2017, Vol 107, No. 7
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