82nd PACHA Meeting: Global and Domestic HIV Response, U=U, and More

The Presidential Advisory Council on HIV/AIDS (PACHA) convened virtually August 28-29, 2024, for the 82nd full council meeting. During the meeting, PACHA discussed the intersection between the domestic and global HIV responses, the effectiveness of the U=U strategy and need for increased awareness, and how an Affordable Care Act (ACA) risk adjustment model can be leveraged to expand PrEP access. PACHA also engaged with community members during a PACHA-to-the-People session. Meeting highlights are provided below. Read the full Meeting Summary (PDF, 527KB).

Focus on the U.S. Roles in the Global HIV Response

The theme of the first day was “U.S. Government HIV Response: Understanding the Intersection Between the U.S. Government, PACHA, and Global Initiatives.” ADM Rachel Levine, MD, Assistant Secretary for Health, welcomed PACHA members, emphasizing that bidirectional learning and collaboration from the United States’ domestic and global HIV programs is crucial to learning effective and innovative strategies. PACHA Global Subcommittee Co-Chairs Dr. Jennifer Kates, Senior Vice President and Director of Global Health & HIV Policy, KFF, and Dr. Patrick Sullivan, Charles Howard Candler Professor of Epidemiology at Emory University’s Rollins School of Public Health, then provided an overview of PACHA’s purview regarding the global HIV response as well as key themes related to both the global and domestic HIV response. Loyce Pace, HHS Assistant Secretary for Global Affairs, reinforced the importance of sharing real-world experiences to continue to reduce the gap between domestic and global responses to a worldwide epidemic. Watch the videoExit Disclaimer of this opening session.

Members then participated in four sessions, each followed by a question-and-answer period.

• Session 1: History of the U.S. Global HIV Response—Mark Dybul, MD, Chief Strategy Officer of the Center for Global Health Practice and Impact at Georgetown University, discussed the history of the U.S. global HIV response, including the founding of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) during a time when the HIV epidemic was decimating Africa with few systems that could provide antiretroviral therapy. He stressed the importance of strong bipartisan support in ensuring PEPFAR’s success, as well as the fact that PEPFAR is a data-driven, results-driven response guided by country plans with sustainability built in from the beginning. View this discussionExit Disclaimer.
• Session 2: A Deep Dive into PEPFAR—The second session focused on the specifics of PEPFAR. Dr. Rebecca Bunnell, Principal Deputy U.S. Global AIDS Coordinator for PEPFAR, and Dr. George Mgomella, Associate Director of Programmes in CDC’s Division of Global Health and Tuberculosis, Tanzania, described PEPFAR’s current status and parallels between the work the United States is engaged in globally and domestically and discussed how Tanzania has successfully used high-quality data to decrease new HIV transmissions and AIDS deaths. View this discussionExit Disclaimer.
• Session 3: PEPFAR Implementing Agencies & Other U.S. Global HIV Engagement—Leadership from PEPFAR implementing agencies across the federal government provided information about the program’s interagency process and the role their agencies or departments play, given their unique areas of expertise. View this session.Exit Disclaimer
• Session 4: Planning for the Future—The fourth session was led by Michael Ruffner, Deputy Coordinator for Financial and Programmatic Sustainability in the Office of the U.S. Global AIDS Coordinator, who discussed the common challenges of a constrained fiscal environment and health inequities but also the role of the HIV response in creating the global health infrastructure. Focusing on sustainability will help us meet global HIV goals and be prepared to respond to future infections and other health threats. View this sessionExit Disclaimer.

U=U: The Science, the Impact, and Prioritizing People Living with HIV

The second day featured a welcome message from Francisco Ruiz, Director of the White House’s Office of National AIDS Policy (ONAP), who summarized numerous meetings and other activities he has participated in to gather community input to inform ONAP’s three priorities: accentuating science, accelerating programs, and advancing equity. This was followed by a discussion of U=U (undetectable=untransmittable), a community-led movement and prevention strategy that emphasizes the lifesaving message that people living with HIV who maintain an undetectable viral load on treatment cannot transmit HIV to their sexual partners. PACHA members Tori Cooper, Director of Community Engagement for the Transgender Justice Initiative at the Human Rights Campaign, and Deondre Moore, Ambassador, The Elizabeth Taylor AIDS Foundation, led a panel of experts discussing evidence showing the effectiveness and resonance of U=U; the impact it has had on the HIV community, both nationally and globally; equity gaps in its implementation; and the need for increased awareness in the United States. View this discussionExit Disclaimer.

ACA Risk Adjustment Model and Potential for PrEP Expansion

The day also included a panel discussion of the ACA risk adjustment model facilitated by PACHA Ending the HIV Epidemic Subcommittee Co-chair Guillermo Chacón. Presenters shared that the ACA risk adjustment model aims to balance the cost of healthcare across insurance plans by transferring funds from plans with low-cost, healthy enrollees to those with perceived higher-risk, high-cost individuals. The risk adjustment formula could potentially be leveraged to expand PrEP access and advance health equity by incentivizing insurers to cover individuals who might benefit from PrEP. View this discussionExit Disclaimer.

Public Comment Period and PACHA-to-the-People

During the public comment period individuals addressed the health and well-being of older adults living with HIV. The PACHA-to-the-People community engagement session, participants discussed topics including the Juntos y Juntas program in Texas, how providers are responding to the needs of people with HIV who are aging, the need for more HIV services capacity in border communities, and how HIV and non-HIV care providers can partner to deliver more comprehensive services. View the public comment periodExit Disclaimer and PACHA-to-the-People.Exit Disclaimer

Proposed Recommendations, Discussion, and Vote

The meeting concluded with PACHA members discussing three proposed recommendations: a recommendation that PACHA send a request (PDF, 165KB) to the HHS Secretary to support three policies to advance the health and well-being of people aging with HIV, which passed unanimously, and recommendations regarding support for U=U and adding stigma as the 5^th pillar of the Ending the HIV Epidemic (EHE) initiative, which were referred back to committee for further development.

Next PACHA Meeting

The next PACHA meeting will take place December 11-12, 2024, in Montgomery, Alabama. Details will be posted on HIV.gov’s About PACHA page as information becomes available.