Ending the HIV Epidemic: Jurisdictional Plans

An increasing number of cities, counties, and states are developing plans to “End the Epidemic” in their jurisdiction. These plans are dynamic and will be updated as progress continues. Click on the links below to jump to the jurisdiction and access the current versions:

The following jurisdictions are in the process of developing plans: 

  • Alabama
  • Baltimore, Maryland
  • Baton Rouge, Louisiana
  • Birmingham, Alabama
  • Hennepin County, Minnesota
  • Jackson, Mississippi
  • Louisiana
  • Minnesota
  • Nashville, Tennessee
  • New Orleans, Louisiana
  • North Carolina
  • Oakland, California
  • Pennsylvania
  • Providence, Rhode Island
  • South Carolina
  • St. Louis, Missouri
  • Texas

Arizona

Victory Through Unity - This visually striking plan is a comprehensive five-year strategy to "wipe out HIV in Arizona." The plan was created through the HIV Statewide Advisory Group and the Phoenix Ryan White Planning Council, guided by the NHAS and care continuum, and took over two years to develop. The plan identifies three paths to victory, each initiating from a single scenario: (1) tested positive; (2) out of care; or (3) staying negative. It also recognized that a one-size-fits-all approach wouldn't work in Arizona, so the state was segmented into regions. Each has their own objectives, strategies, and activities to achieve the vision mapped out in the plan.

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California

Laying a Foundation for Getting to Zero - In 2013, the State of California released their first Integrated HIV Surveillance, Prevention and Care Plan. In 2016, California’s Integrated Plan was updated to articulate their vision for “Getting to Zero” through improving HIV surveillance strategies, preventing new HIV infections, and caring for those living with HIV. California believes this can be achieved by using existing resources through collaboration with multiple partners throughout the state and a determined effort to implement evidence-based strategies to prevent HIV and provide care for people living with HIV.

The Integrated Plan responds to California’s HIV epidemic, in which gay, bisexual, and other MSM represents the majority of those living with HIV and those who are newly infected. California’s collective efforts in response to the epidemic have led them to more effective approaches to engage with the communities who are disproportionately affected by HIV, and develop a clearer understanding of the direct relationship between social and health inequities. California believes that a holistic framework that encompasses social and structural determinants of health is necessary for all communities experiencing HIV related disparities. The Integrated Plan is meant to give a voice to those at risk for and living with HIV and to implement strategies that recognize the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of those most affected by the epidemic. This Integrated Plan demonstrates California’s commitment to collaboration, efficiency, and innovation to achieve a more coordinated response to HIV while establishing a layout for achieving HIV prevention, care, and treatment goals.

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Colorado

Colorado HIV/AIDS Strategy (COHAS) - The Colorado HIV/AIDS Strategy (COHAS) is an integrated HIV prevention and care plan by the Colorado Department of Public Health and Environment and the Denver Office of HIV Resources and the Colorado Department of Public Health and Environment.

The Colorado Model for HIV Prevention and Care is based on a Behavorial Health Services Model from the U.S. Institute of Medicine. Underlying this model are two sets of foundational strategies, including Promotion and Policy Interventions, and mental health, substance use, psychological support, and intensive services for people experiencing critical events.

These two foundational strategies are built around the following goals from the National HIV AIDS Strategy (NHAS):

  1. Reduce new HIV infections
  2. Increase access to care and improve health outcomes for people living with HIV
  3. Reduce HIV-related disparities and health inequities

Key Components of the Colorado Model for HIV Prevention and Care

  1. Universal, Selective, and Indicated Prevention
  2. Promotion and Policy
  3. Adherence to medication
  4. Retention in Medical Care
  5. Linkage to Care
  6. Re-engagement in Care

At the center of the Colorado Model is HIV Testing. This provides the oppprtunity to link to early HIV care, which greatly increases the likelihood of clients achieving viral suppression and maintain high quality lives while achieving HIV prevention goals.

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District of Columbia

Ending the HIV Epidemic in the District of Columbia by 2020 - In 2015, Mayor Muriel Bowser and the DC Department of Health announced a partnership with DC Appleseed Center for Law and Justice and the Washington AIDS Partnership to develop and implement and ending the epidemic plan. The leadership consulted other city and state health departments that had already done ETE work, including New York State, Chicago, and New York City. They also relied on partnerships with local universities and other local governments offices.

The title of the plan spells out the goals 1.) 90% of all District residents with HIV will know their HIV status. 2.) 90% of District residents living with HIV will be in substained treatment. 3.) 90% of those in treatment will reach "viral suppression." 4.) these and other efforts will lead to a 50% reduction of new HIV cases by 2020. According to the statistical models created by researchers at the DC Department of Health, The George Washington University, and Howard University, a 56% reduction of new HIV cases is possible by 2020 if the District (1) continues the effective policies that have been implemented over the last 10 years, (2) meets the 90/90/90 targets, and (3) increases the number of District residents taking advantage of preventive interventions-especially PrEP. To increase access to PrEP the plan details policies that focus on groups at the highest risk for HIV as well as expanded access post-exposure prophylaxis. Additionally, the plan calls for improvements in youth education and expanded funding for syringe access programs.

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Fulton County, Georgia

Building the Strategy to End AIDS in Fulton County - Recognizing the importance of an ETE plan, the Fulon County, GA Strategy to End AIDS was conceived in three phases and compeleted over several years. The first phase drafted objectives, the second involved a resource and gap analysis, and the third created SMART objectives and action plans with evaluation metrics. The Strategy was created by the Task Force on HIV/AIDS for Fulton Count, which included County Commissioner appointees, content experts, key stakeholders, and health officials. From the original objectives came 10 dynamic guiding principles and priorities that were used to inform each step in the process. These guiding principles include (1) stigma kills, don't tolerate it; (2) make care and services client-centered; (3) make it easy to get into care and stay healthy; (4) everyone should be tested for HIV; (5) HIV is preventable; (6) no more babies born with HIV; (7) education is HIV prevention; (8) housing is HIV prevention and treatment; (9) mental healtha and substance use services are care; and (10) create policies that promote health.

The call-to-action, "OUR time is NOW," serves as a reminder that while Fulton County is an epicenter of the epidemic, they are behind some of their peers in this work. The plan is notable dedicated to social justice, invoking the jurisdiction's legacy as the birthplace of the Civil Rights Movement.

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Houston, Texas

Roadmap to Ending the HIV Epidemic in Houston - Through a grant from the Ford Foundation and AIDS United, Houston's HIV leaders developed a a citywide roadmap that offers more than 30 recommnedations to end the epidemic. Their primary goal is to decrease new cases of HIV by half, over five years. The plan also strives to reach the 90-90-90 goals. The Roadmap outlines five core areas for both HIV and non-HIV communities to reach this goal. Those include: (1) prevention of HIV; (2) access to care for those living with HIV; (3) social determinants that exacerbate HIV; (4) criminal justice reforms to slow HIV; and (5) public policies and funding to manange HIV. In these five areas, the Roadmap makes more than thirty recommendations, drawing on solutions from the medical, policy, faith-based, criminal justice, and education communities.

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Illinois

Getting to Zero: A Framework to Eliminate HIV in Illinois - This framework was developed by the Getting to Zero Exploratory Workgroup with the aim to convene a larger group of leaders to develop a ten-year plan to impact the epidemic. The document argues the financial benefits of Getting Zero for the state of Illinois and includes a call to action to elected leaders (Governor and Mayor of Chicago jointly) to appoint a year-long task force to develop a blueprint and oversee implementation. The framework includes a list of potential partners for the task force, a contact form for volunterring, a listerv for updates on its progress, a sign-up to participate in a workgroup, and a timeline of the project, with a launch goal of June '18.

The framework itself focuses on outcomes that provide the greatest potential impact for reducing transmission: PrEP and treatment. According to workgroup estimates, increasing PrEP uptake from 10% to 30% and treatment adherence from 50% to 70% would achiev a functional zero (fewer tha 100 news infections) within the state. The framework walks through the continuum needed for uptake of antiretroviral therapy for PrEP or treatment, and states that the steps must be implemented in ways that are non-coercive, trauma-informed, and respectful to people's choices and lived experiences.

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Los Angeles County, California

Los Angeles County HIV/AIDS Strategy (LACHAS) - This intiative was launched on December 1, 2017. Its goal is to significantly reduce the amount of new HIV infections annually and help bring an end to the HIV epidemic in Los Angeles County once and for all.

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Massachusetts

Getting to Zero MA - This plan was created through the Getting to Zero Coalition, and began with nearly 30 organizations partners in all six health service regions in the state. Since then, many more have joined. It uses the 90-90-90 framework and has incorporated it into the new state integrated plan. When the coalition compared the framework to their state Care Continuum, they recognized how close they are to achieving this goal. During construction, 10 community forums and 10 working group meetings were hosted to collect input and frame key priorities. the working groups were (1) prevention, (2) comprehensive care, and (3) data and evaluation. In the plan, the recommendations are categorized into seven priority activities and ranked by potential to impact the epidemic. The plan is meant to serve as an advocacy tool and guiding document for change. It also includes "next steps" which focus on forming new external partnerships, creating new working groups, and evaluating progress. The seven priority activities are noted below:

  1. Identifying undiagnosed individuals and linking them to care;
  2. Retention in care and achievement of viral suppression for people living with HIV;
  3. Initiation of pre-exposure prophylaxis for eligible persons;
  4. Reduce HIV-related health disparities among people living with HIV;
  5. Strengthening of services for key populations;
  6. Enhancement of the health surveillance and data reporting systems;
  7. Adoption of sexual health as a human right; and
  8. Alignment with external getting to zero effots.

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New York

Ending the Epidemic 2015 Blueprint - Led by the Governor's office, this plan defines the end of the AIDS epidemic as when the total number of new infections has fallen below the number of HIV-related deaths. This leads to two ultimate measure of success, to reduce new infections from 3,000 to 750 and to reduce the rate at which persons progress to AIDS by 50%. The Governor named three points in this work:

  1. Identify persons who are undiagnosed and link them to care;
  2. Link and retain people living with HIV to health care to maximize viral suppression; and
  3. Facilitate PrEP and nPEP access. 

To achieve this, the Governor organized the the Ending the Epidemic Task Force to create the 2015 Blueprint. The Task Force, comprised of state and local officials and community advocates, was divided into four committees in which they made recommendations. Recommendations were then reviewed and ranked based upon three criteria: (1) it must contribute to one of the Governor's three points; (2) it must cite evidence that it's achievable; and (3) it must fall within the authority of the state. From this point the Tasl force constructed the plan, going so far as to include a "getting to zero" plan with key social, legislative, and structural barriers that would need to change to reach a state of zero new HIV infections.

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Oregon

End HIV Oregon - This simple, easy-to-read guide was developed thorugh Oregon's integrated HIV/VH/STD Planning Group (GP). The Strategy introduces baseline measures, goals and activities, and explains how they will measure progress and report back to the community. The Strategy has three key points:

  1. Testing is easy;
  2. Prevention works, and;
  3. Treatment saves lives.

From these key points, a baseline was established and goals and activities for year one were developed. As the implementation progresses, Oregon's IPG will track progress on key measures and issue a report card each year on World AIDS Day.

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Pittsburgh, Pennsylvania

Executive Summary 
One-Pager 

AIDS Free Pittsburgh is an intiative of Allegheny County and brings together public, private, and community based organizations to achieve no new AIDS cases in the county by 2020 and to reduce the rate of HIV infections by 75% in the same timeframe. The intiative will use three strategies: (1) normalize testing; (2) increase access to PrEP; and (3) standarize early linkage to care, to meet their five goals noted below:

  1. Diagnose early;
  2. Link to and engage persons in care within 48 hours;
  3. Achieve 95% viral load suppression rate for patients receiving HIV care;
  4. Support efforts to reduce the HIV transmission among high-risk groups; and
  5. Build capacity for PrEP service delivery

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San Francisco, California

Getting to Zero San Francisco's 2015 Strategic Plan - San Francisco is on the path to become the first municipal jurisdiction in the US to achieve the UNAIDS version of "Getting to Zero." in 2014, the city established the SF Getting to Zero Consortium. The short-term goal is to reduce HIV infections and HIV-related deaths by 90% from their current levels by 2020. The plan calls for a three-pronged, comprehensive program that includes advocacy for access to affordable healthcare for all, with the respective prongs being "Stigma", "HIV Prevention Programming", and "HIV Treatment Programming." Through, these they have developed three signature intiatives: (1) PrEP expansion; (2) RAPID ART; and (3) ART Retention. To achieve this, the approach calls for investment and participation by public health, universities, private foundations, health systems, pharmcaceutical industry, and business sector partners, and aims to augment existing services while leveraging currently funded programs.

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Washington

End AIDS in Washington - The HIV Planning Steering Group, the state treatment and prevention body, was directed by the Governor's Proclamation to End AIDS in Washington in 2014 to create a task force to propose recommendations on how the state could achieve its goals to end AIDS. They establshed the End AIDs Sterring Team and established five goals:

  1. Reduce by 50% the rate of new HIV diagnoses;
  2. Increase to 80% the percentage of people living with HIV who have a suppressed viral load;
  3. Reduce by 25% the age-adjusted mortality rates for PLWH;
  4. Reduce HIV-related health disparities among people living with HIV; and
  5. Improve quality of life for people living with HIV.

The Steering Team prioritized recommendations that would advance one or more of the five stated goals, and focused on recommendations that would complement, supplement, and/or expand upon existing efforts. The report makes 11 recommendations to achieve the goal of End AIDS Washington, and each recommendation includes specific action items. Stigma reduction and disparities reduction are their own recommendation areas, though these themes also run through the other nine recommendation areas.

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