Ending the HIV Epidemic Newsletter
NASTAD, in collaboration with the National Association of County and City Health Officials (NACCHO), the Council of State and Territorial Epidemiologists (CSTE), and the National Coalition of STD Directors (NCSD), distributes a monthly newsletter to Phase 1 Ending the HIV Epidemic: A Plan for America (EHE) jurisdictions. The newsletter informs recipients of EHE-related policy updates, communications from federal partners, success stories, and other related EHE information. As the CDC PS19-1906 National Partner and HRSA-20-089 Systems Coordinator Provider recipients, NASTAD also launched an EHE website to house programmatic updates, share strategies and outcomes from Phase 1 jurisdictions, and connect health departments with the community. For questions, comments, or content contributions, please contact Mike Weir.
Hill Happenings
FY2024 Appropriations
Congress passed a third continuing resolution (CR) (H.R. 2872) on January 19 to avoid a government shutdown, temporarily extending Fiscal Year 2023 (FY2023) funding levels while appropriators negotiate on a final FY2024 spending package. The new CR establishes a “laddered” deadline for federal spending bills, with some federal agencies and programs facing a new March 1 deadline. Larger agencies, including those funded through the Labor, Health and Human Services, Education, and Related Agencies (LHHS) bill, now face a March 8 deadline, affording lawmakers just under 3 additional weeks to finalize FY2024 spending levels.
On January 7, a bipartisan group of senior appropriators reached an agreement on topline spending levels for FY2024, kickstarting negotiations on programmatic spending levels with less than a month to approve a spending package. However, lawmakers from the right-wing Freedom Caucus in the House of Representatives have blocked all legislative action in the lower chamber in opposition to the bipartisan deal forged by House Speaker Mike Johnson (R-LA-04). As a result, Speaker Johnson will need more time to build approval for the deal within the Republican caucus or renegotiate topline numbers with Democrats.
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
NASTAD Calls on Congress to Fund Health Programs in FY2024
On January 7, NASTAD joined the Coalition for Health Funding and urged lawmakers to avoid spending cuts to health programs in the FY2024 appropriations bill. In particular, the coalition called on Congress to reject a full-year CR that would result in cuts to non-defense discretionary programs and adopt the bipartisan Senate funding framework as a starting point for final negotiations. Over 1,095 organizations signed the letter, highlighting the broad support for quick Congressional approval of a FY2024 spending package.
On January 12, NASTAD and the Partnership to End the HIV, STD, and Hepatitis Epidemics called on Congress to reject major cuts to health programs in the FY2024 spending package. The Partnership highlighted the disparities between House and Senate funding levels for health programs, highlighting the consequences that reduced funding will have on collective efforts to combat the HIV, viral hepatitis, and sexually transmitted infection (STI) epidemics. The coalition also highlighted the $400 million rescission in Disease Intervention Specialist workforce funding that was a result of the bipartisan debt limit compromise, urging Congress to reject any further cuts to the public health workforce and programs that work to improve the well-being of individuals affected by HIV, STIs, and Hepatitis.
Administration Activities
CDC Releases Sexually Transmitted Infections Surveillance, 2022 Report
The Centers for Disease Control and Prevention (CDC) released Sexually Transmitted Infections (STI) Surveillance, 2022. Overall, in 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the United States. According to the report, syphilis cases (all stages and congenital syphilis) have increased 80 percent in the past five years. More than 3,700 congenital syphilis cases were reported in 2022, reflecting an alarming 937 percent increase in the past decade. While reported syphilis cases continued to increase, reported chlamydia cases were level and reported gonorrhea cases declined by nearly 9 percent in 2022. Read NCSD’s press release on the new data here.
National Black HIV/AIDS Awareness Day
February 7 is National Black HIV/AIDS Awareness Day (NBHAAD). Share the social media posts linked below to help spark conversations about HIV and highlight progress being made to reduce HIV among Black or African American people. You can also share Let’s Stop HIV Together campaign resources for Black audiences.
Registration is now open for the National Black HIV/AIDS Awareness Day (NBHAAD) Webinar, “Engage, Educate, Empower: Uniting to End HIV/AIDS in Black Communities.” Hosted by My Brother’s Keeper, the webinar will be held Wednesday, February 7, 2024, at 2:00 PM ET and will feature a panel discussion including CDC’s Division of HIV Prevention Acting Director, Dr. Robyn Neblett Fanfair.
Syndemic Approach Needed to Address HIV Disparities among Transgender Women
“A new Executive Perspective in Public Health Reports discusses the importance of using a syndemic lens in our efforts to end the HIV epidemic in the United States, particularly among disproportionately affected populations such as transgender women. The commentary is co-authored by B. Kaye Hayes, Deputy Assistant Secretary for Infectious Disease and Director of the HHS Office of Infectious Disease and HIV/AIDS Policy (OIDP), and Adrian Shanker, LGBTQI+ Health Equity Advisor in the HHS Office of the Assistant Secretary for Health.”
NASTAD Calls on CMS to Revise Custody Definitions to Ensure Coverage for Older Adults and People with Disabilities
On January 18, NASTAD joined a coalition of aging, disability, healthcare access, and civil rights organizations and called on the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) to revise Medicare’s custody definition to ensure access to health coverage for older adults and people with disabilities who are not subject to institutional confinement. Due to Medicare’s overly broad coverage exclusion for people “in custody,” many older adults and people with disabilities who have a history of involvement with the criminal legal system and are living in the community are unable to access health care services, in turn affecting health, earnings, and recidivism. The coalition highlighted the custody definition change as a critical step to improve health equity and streamline access to health coverage for aging populations.
FDA Announces Shelf-life Extension for Naloxone Nasal Spray
On January 17, the US Food and Drug Administration (FDA) announced that Emergent BioSolutions, the manufacturer of Narcan naloxone nasal spray, is extending the shelf-life of newly produced Narcan 4 mg products. All new Narcan products manufactured by Emergent will be labeled with a 4-year shelf-life, an increase of 1 year over the current expiration dates. FDA requested that Emergent extend the shelf-life of Narcan products in order to expand access to the life-saving opioid overdose reversal product. In March of 2023, FDA approved non-prescription use of Narcan 4 mg nasal sprays.
HHS Finalizes Nondiscrimination in Healthcare Regulation
On January 9, the Department of Health and Human Services (HHS) released a final rule that restores longstanding processes to address conscientious objections and religious discrimination in healthcare settings. The updated rule rescinds much of a 2019 rule promulgated by the Trump Administration that expanded the ability of healthcare professionals to refuse care based on conscientious or religious objections, including HIV and STI services, gender-affirming care, and abortions. Although the Trump-era changes never went into effect due to legal challenges, the updated rule will restore a 2011 framework for handling and enforcing conscientious objections and aims to strike a balance between safeguarding religious and moral rights while protecting access to care. The updated rule will go into effect on March 11, 2024.
FDA Approves Importation of Syphilis Drug
On January 10, the US Food and Drug Administration (FDA) announced that it temporarily approved importation of Extencilline, an antibiotic used to treat syphilis manufactured by Laboratoires Delbert, in order to address Bicillin L-A shortages in the US. Extencilline contains the same antibiotic agent as Pfizer’s Bicillin L-A and is available globally, but it has not been approved by the FDA in the US. Notably, Bicillin L-A is the only syphilis treatment available to pregnant people in the US. After Pfizer reported supply shortages impacting production of Bicillin L-A in April of 2023, many health systems were forced to ration syphilis treatment, exacerbating a dramatic spike in new syphilis infections among pregnant people and perinatal transmission to newborns. Advocates applauded FDA for taking action to address the critical treatment shortage. NASTAD is monitoring this and will continue to provide updates on the implementation.
HRSA Launches Web Page with 340B Patient Definition Compliance Resources, Guidance
On December 12, the Health Resources and Services Administration (HRSA) launched a webpage that compiles existing resources and guidance on 340B Program compliance requirements. The webpage was launched to assist covered entities with 340B Program compliance activities, including patient definition guidelines and information on how HRSA conducts audits and determines non-compliance. The patient definition guidelines include HRSA’s interpretation of several key statutory requirements which continue to guide HRSA’s audit activities, which are currently being challenged in court.
New Acting Director Named for NIH Office of AIDS Research
On December 17, 2023, Diana Finzi, Ph.D. assumed the role of NIH Acting Associate Director for AIDS Research and Acting Director of the National Institutes of Health (NIH) Office of AIDS Research (OAR) while a nationwide search for a new director continues. Dr. Finzi was formerly the Director of the Basic Sciences Program (BSP) the National Institute of Allergy and Infectious Diseases (NIAID), where she oversaw an extensive global HIV/AIDS research portfolio with grants and contracts in structural biology, basic science, pathogenesis, targeted interventions, cure, and epidemiology. Finzi is replacing Bill G. Kapogiannis, M.D., who served as the NIH Acting Associate Director for AIDS Research and Acting Director of OAR before accepting a new role in the Biomedical Advanced Research and Development Authority (BARDA) within the Administration for Strategic Preparedness and Response (ASPR).
NASTAD Urges HHS to Finalize Nondiscrimination in Healthcare Regulation
On December 21, NASTAD joined a coalition of 260 organizations to call on HHS to quickly finalize the HHS Office for Civil Rights (OCR) final rule implementing Section 1557 (Sec. 1557) of the Affordable Care Act (ACA). Section 1557 of the ACA establishes nondiscrimination provisions that protect access to care for everyone in the United States regardless of race, ethnicity, national origin (including language), age, sex (including sex stereotypes; sex characteristics, including intersex traits; pregnancy or related conditions, including termination of pregnancy; sexual orientation; transgender status; and gender identity), and disability. The Biden Administration first issued the proposed changes on July 25, 2022 to restore and strengthen civil rights protections for patients and consumers in certain federally funded health programs and HHS programs after the Trump Administration issued a rule in 2020 that limited its scope and power to cover fewer programs and services.
Resources
NASTAD RFI: Existing Programming for Populations Aging with or Vulnerable to HIV
NASTAD, as part of the 2023-2024 Chair’s Challenge, is requesting information from health departments, CBOs, and other subrecipient organizations on existing programming that addresses the specific needs of populations aging with or vulnerable to HIV. We are interested in learning about what programming your health department or organization currently has in place, or what gaps exist in your available programming, to provide services to populations aging with or vulnerable to HIV (this is inclusive of those 50+ living with HIV, Long Term Survivors, those who have been living with HIV for 20+ years, those born with HIV, and other subgroups so defined by your programs). Questions will ask you to overview existing programming, identify the funding stream(s), and contextualize the scope of the intervention or service provision.
Please complete the RFI by COB on February 9, 2024.
- Overview and Methodology of the National HIV Behavioral Surveillance Among Transgender Women — Seven Urban Areas, United States, 2019–2020
- Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Structural and Psychosocial Syndemic Conditions and Condomless Anal Intercourse Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Nonprescription Hormone Use Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Transgender Women Experiencing Homelessness — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Prevalence of Discrimination and the Association Between Employment Discrimination and Health Care Access and Use — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Social Support and the Association Between Certain Forms of Violence and Harassment and Suicidal Ideation Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
CDC MMWR: Mpox Outbreak
During the summer of 2023, mpox spread at lower levels than in 2022 but at higher levels than previous months.
Advocates for Youth: Recruiting National Youth HIV & AIDS Day Ambassadors
“Every year, Advocates for Youth pays young people (ages 13-24) to work in their own community or campus to share factual sexual health information, organize actions to address the impact of HIV & AIDS on youth, and create community spaces for healing and reflection. This year, we are selecting 50 young people (ages 13-24, of any gender) for the program. Ambassadors will be trained in HIV policy and community engagement in order to promote a message of prevention, treatment, care and youth empowerment. They will be given a $150 stipend for their work.”
Join CAI’s TAP-in EHE Community of Practice for EHE Managers and Coordinators
We welcome EHE managers and coordinators to join the monthly virtual Community of Practice (CoP) meetings which are a space to connect with your peers across the 47 HRSA-funded EHE jurisdictions that are working towards ending the HIV epidemic. CAI has completed six sessions so far with one more CoP sessions scheduled in Year 4 of EHE, on February 14th, from 12:00 - 1:30 PM ET. Our next topics is Monitoring EHE Strategies. If you have any questions or would like to receive a registration link for future CoP sessions, please email us at tap-in@caiglobal.org and include “Community of Practice” in the subject line.
NACCHO’s Marketing and Communications Survey
NACCHO and KFF are interested in understanding how health departments are currently leading with marketing and communications work and what health departments are interested in learning more about to help better inform their communications efforts. Please have a team member who is familiar with your digital communications respond to this short survey!
NACCHO Webinar: Sexual Health Services in Jails (Part 2)
Join NACCHO on Wednesday, February 21st at 2:00 PM EST for part two of our Sexual Health Services in Jails series! During this session, we will highlight several jail projects across the country, including Seattle-King County, Pueblo County, Alabama Department of Public Health, and San Francisco Department of Public Health. Similar to the first session, we will discuss how these projects were developed/implemented, key staff involved, as well as lessons learned/best practices. We hope you can join us and if interested, please register here.
NCSD: National Network of Disease Intervention Training Centers (NNDITC)
NNDITC is now offering interactive training courses for 2024 on topics of STI/HIV interviewing, self-care for DI professionals, cultural humility, and much more! Register for an upcoming session at NNDITC.org.
NCSD: STI Engage: Shaping the Nation's Health
STI Engage 2024 is known as the place for STI professionals to hear from national leaders – government officials, researchers, clinicians – as well as their own peers, as always, with top-notch production, game-changing content, and a lot of fun. Building on the momentum of STD Engage 2023, when more than 1,200 STI professionals joined us in New Orleans, we’re bringing the STI sector’s signature conference to the nation’s capitol. Register & Book Your Hotel
NCSD: DIS Scholarships Available for STI Engage
NACCHO and NCSD are pleased to offer scholarships for disease intervention specialists (DIS) who work in local and state health departments to attend NCSD’s annual meeting, STI Engage! Scholarships will cover conference registration, lodging, travel, and per diem expenses. Apply Here
NCSD: DIS Funding Support Job Aid
While NCSD continues our national advocacy work to increase funding for DIS, our policy team created a job aid that provides strategies for funding and sustaining the DIS workforce. It includes ideas for alternative funding sources, data on the importance of DIS, and messaging about how DI professionals reduce STI transmission. Check It Out
Generic Daily HIV Prevention Pill for Young Men Who Have Sex with Men Could Save Lives, Lower Costs, NIH-funded Study Suggests
“Compared to annual HIV screening alone, generic daily oral HIV pre-exposure prophylaxis (PrEP) with HIV screening every three months would result in fewer HIV acquisitions, longer life expectancy, and fewer HIV-associated costs among young men who have sex with men in the United States. Researchers applied an established simulation modelExit Disclaimer to better understand the costs and benefits associated with the PrEP strategy among young men considered at elevated risk of acquiring HIV. The study was primarily funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Additional support was provided by the National Institute on Drug Abuse and the National Institute of Allergy and Infectious Diseases. The findings appear in Clinical Infectious Diseases.”
JAMA:
“In the US, the prevalence of HCV is higher in people who are Black than in people who are not Black. Point-of-care HCV tests, patient navigation, electronic health record prompts, and unrestricted access to HCV treatment in community-based settings have potential to increase diagnosis and treatment of HCV and improve outcomes in people who are Black.”
“HDV infection affects approximately 12 million to 72 million people worldwide and is associated with more rapid progression to cirrhosis and liver failure and higher rates of hepatocellular carcinoma than infection with HBV alone. Bulevirtide was recently approved for HDV in Europe, whereas pegylated interferon alfa is the only treatment available in most countries.”
“In this difference-in-differences cohort study, the first 2 government-sanctioned OPCs in the US were not associated with significant changes in measures of crime or disorder. These observations suggest the expansion of OPCs can be managed without negative crime or disorder outcomes.”
University of Pennsylvania Survey: PrEP Use Across EHE Jurisdictions
The Social Action Lab at the University of Pennsylvania is inviting health departments across the EHE jurisdictions to participate in a research study. The purpose of the study is to explore strategies to improve PrEP use across EHE jurisdictions. Through a survey link, the research team is looking to collect data on structural determinants of PrEP use and policy implementation factors in your EHE state/county. Participants will be invited to a PrEP promotion conference fully sponsored by the team at the University of Pennsylvania and to participate in research publications resulting from the project.
If you are interested in participating, please contact Bita Fayaz Farkhad at bitaf@upenn.edu to learn more and to receive the link to the survey. We hope you will consider participating.
Please contact Natalie Cramer or Kristina Santana with questions.
NASTAD and RAISE Webinar Series
The Research Alliance in Implementation Science to End HIV (RAISE) Hub aims to advance the implementation of EHE initiatives through evidence-based interventions. NASTAD is proud to collaborate with The University of Washington/Fred Hutch Center for AIDS Research on the RAISE Hub on this initiative which includes a monthly webinar series. To learn more about RAISE and view previous webinars, click here.
HIV Cluster Detection and Response Learning Collaborative: Apply Now
CAI’s Technical Assistance Provider – innovation network (TAP-in), together with the New York State AIDS Institute’s Center for Quality Improvement and Innovation (CQII), is launching an HIV Cluster Detection and Response Learning Collaborative. This Collaborative aims to improve HIV cluster detection and response efforts to reduce the number of new HIV diagnoses and better link people newly diagnosed with HIV to care. Join other EHE jurisdictions funded by HRSA to participate in a 15-month learning collaborative that will build community partnerships, share lessons learned from other jurisdictions, discover the latest evidence-based practices, and provide strategies for updating HIV cluster and detection plans. For more information and to apply.
CSTE Infectious Disease Peer-to-Peer TA Consultancy Form - HIV
The CSTE Infectious Disease Program is pleased to offer coordination of peer-to-peer technical assistance. CSTE's HIV peer-to-peer technical assistance will be conducted virtually at this time. To give or receive peer-to-peer technical assistance, please complete the CSTE Infectious Disease Peer-to-Peer TA Consultancy Form. If you have any questions regarding HIV peer-to-peer technical assistance, please reach out to Symone Richardson at srichardson@cste.org. If you have any questions about completing the consultancy form, please reach out to Akila Simmons at asimmons@cste.org.
EHE Community of Practice (CoP) on NASTAD’s Online Technical Assistance Platform (OnTAP)
NASTAD and NACCHO manage a virtual Community of Practice (CoP) to support peer-to-peer learning and mentorship for EHE jurisdictions. The EHE CoP is housed on NASTAD’s online technical assistance platform (OnTAP) for those leading their jurisdictions' EHE efforts at local and state health departments to share resources and news, discuss challenges and successes, access notes from monthly EHE Office Hours calls, and request technical assistance (TA). If you need access to OnTAP, please contact Krupa Mehta.
Ending the HIV Epidemic Jurisdictional Directory
NASTAD maintains an Ending the HIV Epidemic (EHE) Jurisdictional Directory. NASTAD has recently updated the EHE Jurisdictional Directory, which lists local and state points of contact for all EHE Phase 1 jurisdictional activities. This directory is used to communicate with EHE Phase 1 jurisdictions, disseminate resources, and gather information. Health department staff members are encouraged to update their jurisdiction’s information using this brief form.
Jurisdictional Map of Phase 1 EHE Final Plans
NASTAD released a resource that provides access to Phase 1 EHE websites and plans. Please email Krupa Mehta additional Phase 1 EHE plans for inclusion in this resource, as well as any changes to existing plans.
Job Postings
Senior Program Manager, Health Departments & Community Partnerships - KFF
KFF is looking for a Senior Program Manager to work “with state and local health departments on localized iterations of our campaigns designed to address local priorities and extend the reach of limited public resources. We also have a large-scale ongoing partnership with Walgreens to bring health department and community partners into stores on National HIV Testing Day (June 27) to provide free testing and the latest information about prevention and treatment.”
News Bulletin
How History Has Shaped Racial and Ethnic Health Disparities
“This timeline offers a historical view of significant U.S. federal policies and events spanning the early 1800s to today that have influenced present-day health disparities. It covers policies that directly impacted health coverage and access to care, relevant events in medicine, social and economic policies and developments that influence health, and efforts to tackle inequalities.” – KFF News
The Supreme Court will decide whether local anti-homeless laws are ‘cruel and unusual’
“The Supreme Court agreed Friday to review lower-court rulings that make it harder for cities in the western United States to prevent people from sleeping on the streets when there aren’t enough beds in homeless shelters. The justices will hear an appeal from the city of Grants Pass, in southwest Oregon, that has the backing of California Gov. Gavin Newsom, a Democrat, as well as other Democratic and Republican elected officials who have struggled to deal with homelessness brought on by rising housing costs and income inequality.” – AP News