1. Summit to End HIV/AIDS in America Putting the Pieces Together One Community Moving Forward
H. Dawn Fukuda, Director
Office of HIV/AIDS
Bureau of Infectious Disease
Massachusetts Department of Public Health

2. The HIV/AIDS Landscape Paradigm shift flashbacks
HAART is recommended for all PLWHA
Current guidelines promote routine HIV testing
HIV medicine is redefined as non-specialized
HIV prevention and care are aligned
The new basis for a client encounter is from outreach to viral suppression
Increased expectations regarding use of data to drive program design and timing of client engagements
Emphasis on “high-impact prevention” activities
Pressure to leverage third-party reimbursement for low threshold HIV/AIDS services
The promise of health care reform
In the late 1990’s when protease inhibitors became established components of treatment regimens for PLWHA (or the birth of HAART), many of us in the treatment education community started using the phase “paradigm shift.”
And what we meant by that, was that the opportunity of effective treatment for HIV infection (at last) treatment that actually halted disease progression and promised an extension of life and health – changed HIV from an acute/fatal disease to a chronic/manageable condition.
This moniker of HIV as a chronic disease is so ingrained for many of us now, but then it was revolutionary.
I believe the developments of the past few years, in prevention research, treatment science, and health policy, combined with what I believe is the greatest resurgence of community advocacy and consumer voices in the last fifteen years, has us on the cusp of yet another paradigm shift towards ending HIV/AIDS in America.

3. The HIV/AIDS System Response through Redesign
Break down the silos and stay responsive
Integrate HIV/AIDS prevention and care capacities (staff, programs, services, planning)
Design complementary, functional alliances between CBOs and medical providers
Build partnerships with state Medicaid programs
Critically assess state ADAP coverage components
Define essential HIV/AIDS services, and determine which will be sufficiently reimbursed post-ACA
Determine populations in your state who will be left out or remain vulnerable, both HIV+ and at-risk
Train the workforce and consumers to navigate a new and complicated system of care and insurance coverage
But In order to meaningfully respond to the new pressures in the health care system and the governmental public health (notably the potential for reduced discretionary funding for HIV/AIDS and the need to redefine our services in a post-health care reform context), there are a number of steps state health departments can take now, together with CBO partners and consumers, to ready our systems to evolve yet again.

4. Opportunities and Strategy Plan for our lives
Defend the importance of HIV/AIDS funding at the federal, state, and local level
Articulate specific examples of how these funds are instrumental to ensure timely access to care and treatment for PLWHA
Demand the implementation of ACA and the continued investment in HRSA Ryan White and CDC Prevention as linked investments and that BOTH are required to end the epidemic
Reinforce that these funding streams assure “coverage completion” services for vulnerable populations living with and at-risk for HIV/AIDS
Anticipate that the system must evolve, and that CBOs remain key leaders, advocates, educators. and direct service providers
We in public health need to do a better job explaining why the content of the HIV/AIDS service system is NOT “AIDS exceptionalism,”
but that when public health has the opportunity to intervene in a disease outbreak or epidemic that has implications for both population and individual health, and when these implications have substantial human and economic costs, that we have an ethical mandate to respond with all the proven effective tools are at our disposal
We respond using science and a strong evidence-base to guide us, as we have always done that in HIV/AIDS services, and now is not remotely the time to stop.
We need to support our federal partners at CDC and HRSA to sustain these investments, and to be open to dialogue with them about what is needed to evolve the system at this historic moment in time

5. Moving Forward Shared Priorities
Maximize resources
Define our roles, clearly
Engage consumers
Prepare the workforce
Link community-based and health care programs
Leverage 3rd party billing
Synchronize and focus our messages
Align, coordinate, partner, streamline, build efficiencies to stay nimble, responsive, and strong for the people who we are charged to serve
So what do I imagine as our shared priorities.
In my current role I am the state HIV/AIDS Director for the Commonwealth of Massachusetts, but I also spent the first decade plus of my career as a case manager, medical advocate. and treatment educator in community-based agencies
I know public health alone cannot accomplish an end to HIV without BOTH community-based agencies and consumer engagement
But if we stay aligned with one another, share information, and consult on strategy; if we convene a united front, I am beginning to believe we may see an end to this epidemic in my life time.