The Paradigm Shift in HIV Prevention

1. The Paradigm Shift in HIV Prevention  HIV Prevention Planning Council 2/10/11

2. What do we mean by �paradigm shift�? �Paradigm shift" � a radical change in underlying beliefs or theory a �change from one way of thinking to another. It's a revolution, a transformation, a sort of metamorphosis. It just does not happen, but rather it is driven by agents of change.� �scientific advancement is not evolutionary, but rather is a �series of peaceful interludes punctuated by intellectually violent revolutions�, and in those revolutions �one conceptual world view is replaced by another�.� Thomas Kuhn wrote The Structure of Scientific Revolution, 1962

3. What is the paradigm shift in HIV Prevention? �Combination� prevention, a combination behavior change and biomedical interventions Increased emphasis on biomedical interventions and other behavioral change (e.g. treatment adherence) Decreased emphasis on sexual behavior change �De-siloing� (increased collaboration across health issues) Use of data for public health purposes Higher level of accountability to funders, communities, partners Merging of prevention into medical settings (importance of medical home)

4. Combination prevention approach

5. Some of the factors that contributed to the shift: Better HIV testing technologies (rapid, pooling) New discoveries in HIV medicine Better treatment for HIV Virus more toxic than the meds Health Care Reform Dwindling resources (decrease in tax revenue) Allocating funds to where the epidemic is Scalability and feasibility of interventions (increase percent of people reached) Shared mission between prevention and care (flexing resources, environmental approach) National strategy and resources to support it Political will

6. The paradigm shift in HIV prevention The National HIV/AIDS Strategy Enhanced Comprehensive HIV Prevention Planning and Implementation (ECHPP), and New Directions represent a paradigm shift for HIV prevention

8. What is ECHPP? Implementation of NHAS goals Reduce new HIV infections Increase access to care and improved health outcomes for PLWH Reduce HIV-related disparities Coordinated national response Funds 12 MSAs with highest 2007 AIDS cases

10. ECHPP Each jurisdiction develops enhanced plan to meet objectives of NHAS Biggest impact on HIV incidence Identify and address gaps in prevention among priority populations Enhance coordination between prevention, care and treatment Implementing the optimal combination of prevention, care and treatment activities to maximally reduce new infections Biomedical, behavioral, and community/structural Level of investment matches the risk

11. ECHPP as the marker for the paradigm shift � the 14 required interventions Routine opt-out screening for HIV in clinical settings HIV testing in non-clinical settings to identify undiagnosed infection Condom distribution to HIV-positive and high-risk people PEP Structural interventions to address barriers to prevention, care, and treatment Linkage to care, treatment, and prevention for HIV-positive people not in care Retention/re-engagement for HIV-positive people Policies and procedures promoting implementation of current treatment guidelines Treatment adherence STD screening for HIV-positive people Perinatal prevention Ongoing partner services Behavioral risk screening and risk reduction for HIV-positive people Linkage to medical and social services for HIV-positive people

12. Next Steps Part 2: Enhanced Comprehensive HIV Prevention Planning and Implementation (ECHPP) overview Part 3: Small Group Activity: Discuss question: �What do these changes mean for you as an HPPC member and for HPPC in general in its planning role?� Part 4: Report Back and Discussion from Activity