PACHA Highlights
A Wrap-Up of the 71st President’s Advisory Council on HIV and AIDS (PACHA) Meeting
by Hank Trout

On August 3 and 4, 2021, the President’s Advisory Council on HIV and AIDS (PACHA) held its seventy-first full meeting and streamed the meeting live on the Department of Health and Human Services (HHS) website. Below are some highlights from the meeting.

Day One, August 4, 2021
Carl Schmid, MBA, Executive Director of the HIV + Hepatitis Policy Institute in Washington, D.C., and Co-Chair of PACHA, opened the meeting with brief remarks, including the announcement that the U.S. House of Representatives has voted for a $850 million increase in funding for HIV programs. He also pointed out changes in the Ending the HIV Epidemic plan (EHE). Fellow Co-Chair John Wiesman, DrPH, Professor in the Department of Health Policy and Management at the University of North Carolina-Chapel Hill, pointed out that comments on the proposed changes are still open and those interested should email [email protected].

Dr. Rachel Levine, Assistant Secretary of Health, outlined and reiterated the Biden Administration’s commitment to the EHE and to fighting structural barriers to the prevention of HIV transmissions and the treatment of people living with HIV. She pointed out systemic racism, homophobia, transphobia, a lack of culturally competent outreach, stigma, and other issues she has been charged with fighting.

Harold Phillips, the recently appointed Director of the Office of National AIDS Policy (ONAP) spoke at length about revising the national HIV/AIDS strategy and setting priorities in accordance with the Biden Administration’s commitment to advancing health equity, eliminating stigma, decriminalization of HIV, and expanding healthcare options for PLHIV and those at risk of acquiring HIV. He said the revisions would build on the existing plan, adding strategies addressing social determinants of health care (poverty, racism, etc), and increasing community input into policy decisions. He spoke of the need for a “whole government” approach, getting other federal departments (Housing, Labor, Education) involved in EHE, and the need to provide mental health, substance use, and harm reduction services.

Justin C. Smith, MS, MPH, Director of the Campaign to End AIDS at Positive Impact Health Centers, in Atlanta GA moderated a discussion with PACHA members Gregg H. Alton, JD, of San Francisco CA, and Robert A. Schwartz, MD, of Newark NJ, on the need to approach HIV/AIDS from a global perspective.

The CDC’s new Director of the Division of HIV/AIDS Prevention, Dr. Demetre Daskalakis, discussed the CDC’s grant of $117 million to state and local health departments to rebuild and expand their prevention efforts, which includes $11.1 million for STI clinics. Dr. Daskalakis was adamant about community engagement and holding service providers accountable.

Under “Jurisdictional Planning,” Felicia Pickering of the South Carolina HIV Planning Council reported on efforts to engage PLHIV in all communities, particularly in rural areas of the state, in their prevention and diagnosis efforts. Terrell Coleman of the Philadelphia Department of Public Health discussed engaging local activists and the Philadelphia HIV Integrated Planning Council to address structural barriers to prevention and treatment, with an emphasis on health equity driven by real data. He emphasized that recent COVID-19 disruptions to HIV healthcare have revealed that the healthcare system in the U.S. is broken and needs to be fixed. Angelique Tomsic, Director of the Detroit Health Department, discussed assessing the community’s needs via in-person meetings and an online survey; she also discussed the success of asking Black MSM to design their own outreach program to other Black MSM.

In a long discussion moderated by PACHA’s Justin Smith, Jose de Marco (ACT UP Philadelphia) and Venita Ray (Positive Women’s Network–USA) discussed the importance of approaching HIV “through a health equity lens.” They lamented the lack of Black and other POC in leadership positions at HIV/AIDS organizations, and urged that funding go to organizations run by the people most affected, i.e., Blacks and other POC. They also discussed decriminalizing HIV, building solidarity with straight PLHIV, and the need for a holistic approach to HIV and not just a biomedical approach.

Day Two, August 4, 2021
Today’s meeting focused on PrEP.
Jeff Wu, JD, Acting Director of the Center for Consumer Information and Insurance Oversight for Medicare and Medicaid, discussed private insurance to cover PrEP. As of June 2020, private insurance companies are required by law to cover PrEP as well as HAART. Recognizing that preventing HIV transmission is more than just taking a pill every day, private insurers are also required to cover other services such as counseling, risk reduction, clinical assessments, and other support services for PrEP users. They are also required to cover HIV, HCV, and HPV screenings.

Judith Steinberg, MD, Chief Medical Office at the Office of Infectious Disease Prevention at HHS, discussed public insurance coverage (Medicare, Medicaid). Under Medicare, all ARTs are covered (with a possible copay), as are PrEP medications (with a sliding-scale copay) and PrEP-related doctor visits and lab work. Medicare also covers Cabotegravir, the monthly injectable form of PrEP. Under Medicaid, forty-three states cover PrEP without a copay.
Dr. Steinberg also discussed the Veterans’ Administration healthcare system. The VA is the single largest HIV-medication/services provider in the US. They provide HIV testing and care, including PrEP and harm-reduction syringe services. The VA Dashboard also identifies veterans at risk for outreach as well as tracking patients to enhance medication adherence.
She also briefly discussed the Ready Set PrEP program, which provides counseling and medication at 32,000 pharmacies across the country.

PACHA members from Tennessee, Texas, and Massachusetts discussed PrEP success stories in their jurisdiction. Kirk Myers, MPH, Founder and CEO of Abounding Prosperity, Inc., in Dallas, reported that his agency has seen the number of PrEP users grow from two in 2019 to 1,001 in 2020; it also provides telescreening for PrEP and mobile units for testing and follow-up care. Eboni C. Winford, PhD, Director of Research and Health Equity at Cherokee Health Systems in Tennessee, discussed outreach and delivery of PrEP in isolated rural areas where Cherokee Health is the only healthcare provider. Their work integrates PrEP into other HIV services. Ellen LaPointe, JD, CEO of Fenway Health in Boston, reported that the group currently has 6,400 patients on PrEP (mostly cisgender white gay men). Their services also provide housing assistance and other services.

Co-facilitators Mike Saag and Ada Stewart of PACHA led a discussion of barriers to prescribing and acquiring PrEP. These barriers include: homelessness; adolescents’ hesitation to access PrEP through their parents’ insurance; a lack of knowledge about PrEP; stigma; making services available when and where the patients are; training providers about PrEP; the cost of doctor visits and lab work; and a lack of pharmacies engaged in Ready Set PrEP. To that last point, Dr. Winford pointed out that there is only one pharmacy in all of Tennessee enrolled in the program.

To overcome patient resistance to using PrEP, panelists agreed that HIV care and PrEP providers need to partner with community groups and others whom the patients already trust and have a relationship with, and to create community partnerships even with non-HIV providers.

Also, Assistant Secretary for Health Dr. Rachel Levine swore in eight new Council members. The new members are: Marlene McNeese, Assistant Director, Houston Health Department; Guillermo Chacón, President, Latino Commission on AIDS, and Founder, Hispanic Health Network; Tori Cooper, MPH, Director of Community Engagement for the Transgender Justice Initiative, Human Rights Campaign; Raniyah Copeland, MPH, President and CEO, Black AIDS Institute; Leo Moore, MD, MSHPM, Medical Director for Clinic Services, Los Angeles County Department of Public Health; Kayla Quimbley, National Youth HIV and AIDS Awareness Day Ambassador, Advocates for Youth; Adrian Shanker, Founder and Executive Director, Bradbury-Sullivan LGBT Community Center; Darrell P. Wheeler, PhD, MPH, MSW, Provost and Sr. Vice President for Academic Affairs, Iona College. One of the new members, Marlene McNeese, will assume the role of PACHA co-chair, alongside Dr. John Weisman. Carl Schmid will remain a member of PACHA.

Hank Trout writes the For the Long Run column for A&U.