The City of Houston (COH), located primarily within Harris County, experiences a higher burden of HIV than both the state of Texas and the whole nation. People of color with male-to-male sexual contact (MSM) especially African American and Hispanic residents, and youth of color (ages 13-24) have been disproportionately impacted by both HIV and other STIs. In 2018, the rate of new diagnoses among the people of color was 7 times that of whites. Majority of the people newly diagnosed with HIV were identified as having MSM. Of these, a majority (87.8%) was MSM of color (MSMOC), with 42.5% African American, 41.7% Hispanic/Latino, and 3.6% Other/Multiple Races. White MSM made up 12.2% of new HIV diagnoses among MSM that year. Evidence indicates increases in HIV transmission is highly plausible without extensive uptake of pre-exposure prophylaxis (PrEP) and increases in viral suppression.
In December 2019, the COH signed the Fast-Track Cities Paris Declaration to end the epidemic by 2030 and committed to meet set of targets. These targets are to ensure that 90 percent of people living with HIV (PLWH) will know their status, that 90 percent of all PLWH will receive sustained anti-retroviral treatment and that 90 percent of all PLWH on anti-retroviral treatment will achieve viral suppression. The current burden in Houston calls for enhanced strategies and activities to achieve these goals and end the epidemic. Of those diagnosed, 75% had at least one HIV medical visit/lab or prescription for treatment in 2018, 60% had been retained in care over the course of the year, and 59% had a suppressed viral load.
In the phase of ending the HIV epidemic by 2030, utilizing PS19-1906 (Accelerate State and Local HIV Planning to End the HIV Epidemic), the Houston Health Department (HHD) in collaboration with other stakeholders in the jurisdiction has initiated the planning process. To implement the activities informed by this plan, the HHD prepared this funding application. In this application, the HHD proposes enhanced and new innovative high-impact HIV prevention activities under four pillars of the EHE Initiative for the core component. Specifically, the HHD will: (1) increase and expand HIV testing through the engagement with non-traditional partners and increasing the HHD’s testing capacity; (2) rapidly link and treat PLWH to increase viral suppression through rapid ART initiation, implementing a viral suppression project, and establishing a real time Data-to-Care system; (3) increase the uptake and participation in PrEP/nPEP by expanding mobile unit hours and capacity, implementing same-day PrEP initiation, developing a 24-hour nPEP hotline and expanding clinic hours to reach vulnerable populations; and implementing a sharps disposal pilot project; (4) respond quickly to potential HIV outbreaks by improving reporting of nucleotide sequences and identifying areas of improvement in programs and services. Implementing these activities, the HHD will achieve the EHE Initiative goals by ensuring increased knowledge of HIV status, increased linkage and re-engagement to HIV medical care and treatment, increased viral suppression, increased PrEP uptake, and improved response to HIV transmission clusters and outbreaks.