The U.S. Ending the HIV Epidemic (EHE) Initiative: What You Need to Know

The Ending the HIV Epidemic (EHE): A Plan for America is an initiative launched by the federal government with the aim of addressing the HIV epidemic in the United States. The initiative was announced by President Trump during the State of the Union address in February 2019 and aims to reduce new HIV infections by 75% in five years and by 90% in ten years by focusing first on the hardest hit areas of the country. The EHE includes four “pillars”: diagnose, treat, prevent and respond.

The goal of reducing new HIV infections by 75% in five years and by 90% in ten years, if successful would, according to the federal government, avert an estimated 250,000 new infections.  

There are four “pillars” to the initiative that serve as a road map for achieving EHE goals:

1. Diagnose: Currently, 14% of people in the United States with HIV are unaware of their infection and 40% of all new HIV infections result from someone who did not know they were HIV positive. This strategy pillar seeks to diagnose all people in the US as soon as possible after infection.
2. Treat: HIV Treatment is important for optimal individual health outcomes and harnessing the benefits of “treatment as prevention”– that is when someone is virally suppressed, they cannot transmit HIV to others. This pillar aims to treat people with HIV rapidly after diagnosis to help achieve and maintain viral suppression.
3. Prevent – While the rate of new HIV infections has slowed since its peak, progress has stagnated in recent years and racial disparities persist. The prevent pillar seeks to use proven prevention interventions to stop new HIV infections from occurring with a specific focus on bolstering PrEP uptake.
4. Respond – The respond pillar is focused on rapidly responding to potential HIV outbreaks to disseminate prevention and treatment services as needed and in part relies on harnessing public health strategies, such as molecular surveillance.

The EHE goals are ambitious and the strategy to reach them is grounded in science, yet one model suggests that the goal of reducing new infections by 90% in ten years “is likely unachievable with the current intervention toolkit.” However, these researchers also note that while the goals may not be fully realized, HIV infections could be reduced by up to 67%with higher levels of engagement in care and increased PrEP uptake.