1. H. Dawn Fukuda Director, Office of HIV/AIDS Massachusetts Department of Public Health United States Conference on AIDS Washington, D.C. September 10-13, 2015 HIV/AIDS State Plans The importance of local approaches to end a national epidemic—Massachusetts

2. Steps to end an epidemic “101” 1) Contain and control 2) Vaccine 3) Cure

3. So, how do we end the epidemic? Ensure universal access to high quality medical care Increase the number of people with HIV on treatment Reduce viral loads at the individual and community level Fully meet the prevention and care needs of persons living with and at risk for HIV infection

4. State Plan: Where did we start? Highlight assets Inventory deficits Identify of key priorities Outline concrete objectives List specific action steps

5. What is working? Medicaid expansion State health care reform HIV Drug Assistance Program Affordable Care Act High rates of viral suppression CHC and hospital infrastructure Syringe deregulation and Needle Exchange Programs Marriage equality Declining HIV incidence

6. Missed opportunities? Silos of prevention and care Suboptimal use of data Limited direct public health intervention Underutilization of health insurance Persistent health disparities Racial/ethnic minorities Gay and bisexual men & MSM Persons who use injection drugs Individuals non-US born

7. What are the priorities? Integrate prevention and care systems and services Innovate uses of data to improve prevention and care Maximize opportunities under health care reforms Redefine roles of medical and non-medical agencies Support HIV/AIDS leadership during an evolving epidemic

8. Where are we now? Near complete phase out of rapid HIV testing Implementation of serum draws and 4th generation HIV screening in all publicly-funded sites Full integration of HIV and HCV testing, syphilis is next Near universal co-location of HIV prevention and medical case management services Unification of prevention and care contract management Acute HIV infection response and expedited linkage by DIS Surveillance-driven (re)engagement in care programs STD and HIV billing project underway Medical case management acuity pilot Creation of Drug User Health and PrEP communities of practice. Gay Men’s Health initiated later this year.

9. Where must we go? Social determinants of heath Health inequities Institutionalized racism Homophobia and Transphobia Unjust Criminalization Incomplete Medicaid expansion

10. So, how do we (really) end the HIV epidemic?

11. Thank you H. Dawn Fukuda Director, Office of HIV/AIDS Bureau of Infectious Disease, Massachusetts Department of Public Health Dawn.Fukuda@state.ma.us