By Angel Fabian, M.D. and Saurav Jung Thapa, M.A.
The U.S. HIV National Strategic Plan: Roadmap to End the HIV Epidemic 2021–2025 (HIV Plan) was recently released. The HIV Plan follows the National HIV/AIDS Strategy (NHAS) that was released by the Obama Administration in 2010. The NHAS was the first time that the U.S. government produced a strategic plan to address the HIV epidemic in the country and dependent territories. The NHAS and its successor HIV plan seek to reduce HIV infections by intensifying prevention efforts in high-risk communities, increasing access to care for people living with HIV, reducing healthcare disparities, and achieving a coordinated national response.
The Department of Health and Human Services (HHS) – which produced the HIV Plan – states that it was developed through an inclusive process that included input from community groups and organizations that work on HIV issues. However, most of the suggestions made in December 2020 by MPact and its national partners were unfortunately not incorporated into the HIV Plan.
During the course of this year and beyond, MPact’s Fijate Bien Program will follow the suggestions made by MPact and its national partners to HHS that were not incorporated into the HIV Plan. These suggestions, which are outlined below, seek to address structural barriers impacting Latinx (including Afro-Latinx and Indigenous-Latinx) gay and bisexual men and other men who have sex with men in accessing HIV prevention, care and treatment services.
The suggestions that MPact and our partners made to HHS for the HIV Plan are guided by a declaration of the Racial Justice Framework Group which states in part:
“It is our contention that any struggle for justice or equity in HIV must become a racial justice movement. Health inequities faced by Black, brown, and indigenous people, historically and in our present moment, are structured by historical and present-day racism…it is our responsibility to pressure institutions from the clinic to the government, from funders to the courtroom, to act in the service of racial equity and justice…We assert that any response to the HIV epidemic is incomplete without leadership, active participation, and guidance of Black and brown people…”
Although the HIV Plan is a good start, it can do much better. The modifications/additions suggested below to the HIV Plan should be incorporated into a revised HIV Plan by the Biden administration:
- An explicit commitment to addressing health inequities is essential. This should be done by centering the voices and lived experiences of Black, Indigenous, and People of Color (BIPOC) living with HIV and affected by HIV. The top-down approach to create the HIV Plan via a Steering Committee with superficial community engagement contradicts HHS’ stated goal of community ownership and makes effective implementation difficult.
- The Centers for Disease Control and Prevention (CDC) should be encouraged to convene a national panel of Latinx gay, bisexual, and other men who have sex with men activists, patients/clients, program implementers, researchers and policymakers to formulate specific indicators and targets and inform the implementation process.
- Add the following text to the Plan’s vision statement:“This vision includes all people regardless of immigration status.” Studies have shown that a major barrier to accessing timely HIV services by undocumented people is fear of harsh immigration policies. As most new HIV infections among Latinx gay and bisexual men occur among recent immigrants, connecting them to HIV services is important.
- Include and name specific funding mechanisms and effective tracking metrics to meet the Targets, Objective, and Strategies and ensure that resources reach those for whom they are intended. The HIV Plan should acknowledge that BIPOC communities will bear the greatest burden in federal, state, and local budget cuts during the ongoing COVID-19 pandemic, thus exacerbating local HIV/STI/HCV epidemics.
- Recruit linguistically competent Latinx gay and bisexual men at the federal, state, and local levels to reach underserved Latinx gay and bisexual communities affected by HIV.
- Provide adequate funding to Latinx-specific community organizations that deliver stigma-free, culturally/linguistically competent, evidence-informed, and rights-based comprehensive sexual health programs.
MPact and Fíjate Bien recognize that structural barriers such as homophobia, transphobia, discrimination based on language and immigration status, HIV stigma, and poverty can harm Latinx gay and bisexual men and BIPOC gay and bisexual men in general. These communities have disproportionate rates of new HIV infection and lack access to HIV services tailored to their needs. We acknowledge the inclusion of Latinx gay and bisexual men as part of the HIV Plan’s priority populations. Representation and inclusion are important in order to address the HIV epidemic’s harmful impact on Latinx gay and bisexual men. By adopting the recommendations above, the Biden administration can contribute to ending the HIV epidemic and reducing harm for vulnerable communities.