Houston Health Department Logo

Follow us on

Page last reviewed: August 16, 2023

EHE Committees

Complete EHE volunteer form

Outreach & Community Engagement

This committee is focused on conducting outreach and engagement in Ending the HIV Epidemic activities, such as HIV testing, linkage to care and prevention interventions.  Outreach and engagement strategies include street outreach, community-based based testing, mobile testing, home testing, peer navigation and individual and community-level interventions.

Co-Chairs: Cecilia Ligons, Ivan Prater, Miguel Jacquez

Outreach & Community Engagement Meeting Notes

    Diagnose Pillar

    Outreach & Community Engagement Committee: Diagnose Meeting conducted on June 24, 2021

    Challenges/Feedback
    • Testing hours - Hours of testing offered when people are not at the clubs or in sex working environments. E.g., People may visit adult bookstore during their lunch work hour.
    • Who is doing the testing?
      • Some people prefer young, attractive staff.
      • Find people who are not shy and open communicators
    • Agencies may incorrectly categorize all men as being gay
    • Disconnect with people in community - Culture, belief, and/or practices of communities not understood. E.g., Some people believe in holistic practices and may go to an herb doctor for health concern.
    • Hip Hop for HIV offered incentives for people to come out and get tested
    • HIP Hop for HIV and the Rodeo can work to appeal to different audiences.
      • Having a mixture of Pop artist is broader and can help reach more people
      • Young people use their parent’s insurance and may not want their parents to know they are testing for HIV.
        • Consider people (e.g., college students) who are testing for the first time.
        • Target different places
      • Identify teams outside of office/clinic settings, inquire about successes and challenges from doing the groundwork
      • Assess field outreach programs (how many are there?)
      • COVID-19 has put HIV in the back seat. Some COVID-19 activities can be applied to HIV.
      • Need assessment on home testing statistics and costs.
      • Home testing bureaucracy and costs pose challenges
      • Some providers are not comfortable with initiating sexual health conversation and/or discussing HIV testing
      • Billing codes and cost of opt-out testing are challenges
      • Providers have limited time to thoroughly discuss HIV with patients

    Recommendations

    • Adjust testing hours with consideration of intended audiences’ activities (e.g. work schedules and leisure time windows) so people are available and present when testing occurs
    • Selecting the appropriate staff to administer/promote testing
    • Address agency labeling and categorizing of intended testing populations
    • Be culturally specific. Connect with gatekeepers/influencers (e.g., providers, social platforms, LBGTQ) in the community
    • Incentivize HIV testing
    • Make testing events appeal to diverse communities
    • Create an avenue for young people to get tested that addresses ethics, confidentiality, and privacy concerns.
    • Have support available for first time testers with an emphasis on staff presence and consistency
    • Conduct boots on the ground street outreach in unconventional places (e.g., school clinics, sport events, restaurants, hair, and nail salons)
    • Utilize platforms and page administrators to inform testing
      • Can include: Career pages/Social media (e.g., Grindr, Facebook, Instagram, TikTok)
    • Implement motivational interviewing for testing
    • Build up field outreach and build rapport
    • Bundle HIV testing with COVId-19 vaccine
    • Implement Drive-by HIV testing
    • Increase home HIV testing
    • Expand routine/opt-out testing among providers • Provide opt-out education and awareness
    Prevent Pillar

    Outreach & Community Engagement Committee: Prevent Meeting conducted on August 11, 2021

    Challenges/Feedback

    • Fear of the unknown e.g., costs and service process
    • Language barriers for Spanish speakers with finding and accessing information
    • People are unwilling/uninterested to be on PrEP and rather use condoms
    • Health concerns e.g., damage to body organs
    • Cost of lab work and provider visits
    • Perception of risk
      • Age differences relative to risk perception
      • Healthy people may not feel like they need to take a pill everyday
      • PrEP associated with promiscuity
    • PrEP advertisements not practical for end-users
    • Stigma around the medication used to prevent HIV
    • People forget to take medication
    • Funding gaps e.g., Ryan White money needed
    • People have to take time off from work for follow-up appointments
    • Trauma (homophobia/stigma of being gay/PTSD)
    • Condom-less sex from not being circumcised
      • Hispanics may not be circumcised to wear condom
    • Too much focus in the data/media on gay populations e.g., Black MSM
    • Lack of understanding own behaviors
    • Not enough advertisement for Latino community
    • Gender double standards
      • Gender differences don’t have to be reported
      • Laws around underage same sex intercourse is considered child abuse for males but not for heterosexual females
      • Men are more celebrated when compared to women
    • Disconnect with resources and education at a young age
    • Sex is taboo in Hispanic community
      • Embarrassment from buying condoms
    • Agencies shy away from young MSM (men who have sex with men) due to barriers of parental consent/child abuse laws
    • Addictions/disorders with substance use and sex
    • Predators e.g., older men dating younger guys
    • Mental health e.g., Black people may not seek out therapy
      • Gaps between counseling and treatment
    • Less long-term opportunities for risk reduction among those at high risk
    • Work hours – Clinic hours not suitable for day-laborers
      • Transgender sex workers face the barrier of time due to missed money
    • Youth have the hardest time getting access to PrEP
    • Providers don’t know how to prescribe PrEP

    Recommendations

    • Increase advertising of PrEP in different areas/neighborhoods outside of clinical settings
    • Equip clients to acknowledge their risks for HIV
    • People need a long-term preventative method that people don’t have to think about like a shot
    • Provide ongoing counseling for behavior change/risk reduction
    • Harm reduction conversations. People still need STD prevention
    • Make the messaging of programs and initiatives universal and inclusive.
      • Share the stigma
      • Consider early sexual debut
      • Prioritize other populations besides gay men
    • Provide tools with information about them and how to use them e.g., condom distribution
    • Provide incentives for PrEP e.g., transgender population receive hormone replacement therapy
    • Bundle services for a wholistic health visit e.g., cancer screening o Provide additional services around PrEP
    • Support self-efficacy/resiliency to mitigate individual risk and improve sustainability
    • Link more people to therapy and provide more follow-ups
    • Provide case management for HIV negative individuals
    • Explore and understand different methods of taking PrEP e.g., on demand method o Remove prescription requirements and have outreach workers on site when testing in nontraditional areas like clubs.
    • Agencies should go on social platforms like Grindr to engage with people and provide information about PrEP
    • Host social vents to engage community
    • Find people who will disseminate information for you in a way that isn’t lecture-based
    • Be unafraid to have candid conversations on the urgency of HIV
    • Seek family buy-in for youth e.g., focus on moms
    • Provide PrEP education to providers o Encourage them to discuss PrEP with their patients
    • Incentivize Providers to discuss/promote PrEP
    • Provide sex education in school systems
      • Utilize school nurses as liaisons so students don’t have to go through parents
    • Take time to develop individual approaches to behavior change in addition to macrolevel campaigns
    • Assess policies around the HIV positivity rate
      • Refrain from just seeing people as numbers
      • Celebrate negative tests
    • Address misconceptions around HIV
    • Host focus groups of community members in high-risk areas (e.g., Home depot, adult bookstores, transwomen sex workers) and hear from those communities
    • Conduct community assessment with teens and apply the information received
    • Invest in more support groups for peer-to-peer support o Personalize human to human connection
    Treat Pillar

    Outreach & Community Engagement Committee: Treat Meeting conducted on July 14, 2021

    Challenges/Feedback

    • Delayed services for newly diagnosed persons in area clinics
    • Clinic appointment availability (small CBOs and large institutions)
    • Bureaucracy impedes Rapid-Start e.g., eligibility processes /required paperwork
    • Organization and staff accountability post outreach events
    • After-hours outreach testing impacts linkage to care
    • Workforce development gaps among staff e.g., customer service, competency levels, follow-up/follow-through efforts
    • Linkage process overwhelms clients
    • Overlap in HIV treatment services
    • Lack of urgency for HIV treatment
    • Case manager locations and proximity to clinics
    • Internal gaps of Ryan White Public Health system
    • Medication adherence does not align with the whole person/lifestyle
    • Mental health services are disconnected from HIV treatment
    • Gaps between HIV outreach prevention and care systems e.g., policy, providers/staff, and funding
    • CDC/HRSA/Houston planning bodies funding limited to certain populations
    • Lack of focus on wholistic health
    • Warm handoffs are ineffective
    • Providers uneducated/unaware about Rapid-Start
    • People may not understand whether they need to be on treatment
    • Transportation for mental health referrals
    • Stigma—HIV data, outreach practices, and funding allocations create stigma for people of color
    • Public health workforce intrusion in public spaces i.e., respect for privacy/confidentiality
    • Equal representation that HIV affects all populations

    Recommendations

    • Train new and existing staff to improve customer service, competency levels, follow-up/follow through around HIV treatment
    • Improve internal organizational systems on rapid start reflecting a one-stop shop for treatment
    • Simplify the linkage process — focus on necessary requirements and reduce turnaround time from diagnosis to care
      • Develop a clear next step for linkage to care
    • Link people to care at non-conventional hours
    • Improve workforce accountability through quality assurance
    • Make HIV treatment urgent
      • Create a message in the community that HIV treatment is important
      • Embed outreach workers and case managers within clinics
        • In-house clinic relationships can reduce treatment barriers
      • Conduct provider outreach to identify how HIV care is being provided
        • Provide education to providers about Rapid-Start
        • Build rapport with medication providers
        • Identify people on private insurance
        • Build better connections with providers and obtain provider buy-in
      • Address internal challenges with Ryan White Public Health system
      • Make mental health and behavioral health a part of HIV treatment
        • Provide additional support for mental health and behavioral health with HIV diagnoses/treatment
        • Build and implement a mental health model for HIV treatment and care
          • Embed personnel in provision of services
        • Recognize emotional triggers attached to HIV
        • Offer mental health services on a wider scale
        • Take mental health services to people affected by HIV
      • Collaborate with partners/agencies conducting health fairs
        • Do not separate HIV from other morbidities such as diabetes
      • Provide internal reach and cross-knowledge efforts across departments/programs
      • Normalize and routinize HIV treatment without breaching privacy/confidentiality
      • Provide education and awareness on what it means to be out of care
      • Assess and address root causes of why people fall out of HIV care
      • Propose dual 50/50 funding for HIV prevention and care programs
      • Promote primary care for all health needs i.e., wholistic health
      • Incorporate peer support groups for treatment
      • Improve warm handoffs between organizations, departments, and programs
      • Promote inclusivity with HIV data on populations at-risk
        • Address behavior of HIV without strong emphasis on race
      • Promote inclusivity across television, social media, and radio platforms
      • Utilize effective social marketing to improve treatment strategies
        • Consider generational differences across social platforms
      • Commit to recruiting and training community members to join the expanded HIV workforce.
        • PLHIV are the subject matter experts on programs that support PLHIV and are expert navigators.
        • Encourage a creative approach to valuing lived experience as qualification for these positions beyond formal education requirements. o Increase representation of people living with HIV to the HIV workforce at all levels of leadership
      • Develop a process to solicit input from, engage and consult with local networks of people living with HIV, etc. Positive Women's Network, Texans Living with HIV, etc. and include meaningful involvement of people living with HIV indicators in the final version of the EHE plan.
      • Incorporate sex workers and immigrants living with HIV as priority populations throughout the local response.
      • Utilize outreach efforts to learn from people who are pregnant and living with HIV, especially from vertical transmissions.
      • Center the most marginalized communities when developing recommendations
      • Identify trusted partners/gatekeepers to guide people with HIV through treatment
        • Conduct outreach with Pharmacists to provide HIV treatment
        • Consider cultural differences e.g., undocumented immigrants may go to a pharmacy before a doctor’s office
    Respond Pillar

    Outreach & Community Engagement Committee: Respond Meeting conducted on August 19, 2021

    Challenges/Feedback

    • Invasion of privacy on molecular HIV Surveillance (MHS) /Cluster Detection and Response (CDR)
    • Fear, confusion, misconception from patient advisory council on MHS/CDR
    • Terminology jargon, language used on MHS/CDR
    • Lack of consent forms in Texas
      • Loopholes on consent impact expectations of privacy
    • Stigma on HIV status
    • Fear of sharing hook-ups/partner identification and determining directionality
      • Project Poder was not a good experience for people of color
      • Domestic violence/fatalities associated with HIV transmissions
      • Fear of how personal information will be used
    • Delayed data collection
    • Lack of understanding of similarities/differences between MHS and CDR
    • HIV criminalization laws
      • Ambiguity on DNA test warrants
      • Lack of protection/privacy
    • Uncertainty around MHS/CDR technological advances
    • CDR does not sound like prevention and should not be a scare tactic
    • Too much money put into MHS/CDR to expect it to not be used

    Recommendations

    • Educate community on MHS/CDR
      • Formally present to community at large about MHS/CDR and how clusters are identified and what is done with the information
      • Improve public and individual understanding of what information is available to the government o Discuss changes on MHS/CDR and surveillance with larger community
      • Provide a realistic picture of how the system works
      • Emphasize there is no way of knowing how people are a part of a cluster
    • Utilize systems to go by zip code to identify clusters
    • Keep personal information confidential to a facility where it was received and not on a statewide system
    • Target neighborhoods where people spend their leisure time instead of just where they live
    • Encourage individual accountability and willingness to change around HIV
    • Provide education on the tools governmental agencies use
    • Systems should identify people who don’t know their status without names to get them into care
    • Improve public and individual understanding of what information is available to the government
    • Agencies should be more transparent to advocate for privacy/protection around MHS/CDR

    Education and Awareness

    This committee is focused on the provision of HIV education and awareness that can occur in various forms, such as presentations, community conversations or social media, marketing, and texting campaigns.

    Co-Chairs: Dr. Dominique Guinn, Ian Haddock, Steven Vargas

    Education & Awareness Meeting Notes

      Diagnose Pillar

      Education & Awareness Committee: Diagnose Meeting conducted on June 14, 2021

      Challenges/Feedback

      • Healthcare and hospital systems are not reaching the priority populations, such as black and brown communities.
      • Spanish speaking populations are not receiving HIV information in their preferred language and often left out of conversations.
      • Homeless youth are often forgotten and need to have special outreach for them.
      • People still don’t think HIV affects them. Lack of personalization for individuals to act – get tested. They don’t need to worry because it won’t happen to them.
      • People have competing priorities like food, housing, employment, and transportation.

      Recommendations

      • Examine whether community-based organizations are really better equipped at reaching the priority populations and see if improvements need to be made for them to be successful.
      • Have conversation about HIV prevention/testing at beauty shops and other nontraditional venues. One suggestion like Comic Palooza where you can do an education session.
      • Ensure HIV information and services are in all languages, especially Spanish.
      • Use Radio and Television to reach out to communities that are not currently involved in HIV efforts.
      • Utilize mediums like Facebook Live to get messages out. Or NPR local.
      • Virtually have private rooms to have conversations.
      • Require events that use City of Houston facilities like the George R. Brown to have a space for providing HIV prevention or testing information.
      • Connect with Social Media influencers to have conversations and get the information disseminated.
      • Brand college school supplies
      • Use local antenna t.v. channels that serve multiple languages to reach non-English speaking populations
      • Create very distinct campaigns for specific populations, such as talk to youth about what message will feel personalized to them.
      • Ask gate keepers to help craft personalized message to specific populations.
      • Identify community influencers and work with them to engage micro messaging versus mass campaigns. Set a goal to do a set number, such as three, micro messaging campaigns.
      • Find community influencers not only from high-impact populations, but also look for the influencers from neighborhoods or areas that have high prevalence/incidence rates.
      • Find key stakeholders/businesses in those geographic areas to help reach their neighbors.
      • HIV may be a concern but is so far down the list. Dovetail testing with other things they’re doing in life so that they don’t have to choose among priorities. Such as events that draw people in like a legal clinic, clothing closets, food banks, and clinics.
      • Bring back “Hip Hop for HIV” events with artists that appeal to different audiences and offer bundle of clinics. Or do festival over a few days.
      • Go to people that don’t see HIV as a concern rather than wait for them to come to test. Make routine testing a requirement for providers.
      • Offer home tests at local neighborhood places like beauty places or during Tupperware parties.
      • Have a Pride float that is informative and celebrate Ending the HIV Epidemic.
      Prevent and Treat Pillar

      Education & Awareness Committee: Prevent & Treat Meeting conducted on August 3, 2021

      Challenges/Feedback

      • Knowledge disconnects of who does HIV testing
        • Testing overlap — need proof in order to count people
      • Delays in data collection and analyzation
        • Takes 1-2 years to clean data so we are always behind
        • Cleaning data is lengthy process but also necessary to ensure positive results are not duplicated by multiple testing entities
        • Knowledge gaps and language barriers around in terminology used
          • People express knowledge of PrEP but unfamiliar with U=U
        • Hours and times that PrEP commercials run
        • Media/ad fear tactics around HIV medications create misconceptions
        • Public misconceptions about HIV transmission risks
        • Fear
          • HIV transmission does not go away for people living with HIV
          • HIV criminalization
        • Stigma about living with HIV being a death sentence
        • Missed doses

      Recommendations

      • Agencies need to track the number of tests that are provided with their funding and report on the data that they have.
      • Adopt everyday language instead of vague terminology to use in promotions o Update messaging based on what’s current
      • Increase education and awareness around the concept of U=U
        • Enter the Pop culture (like PrEP) with simple messaging for U=U so that it gives a sense of consistency
        • Get public’s input (e.g., poll to young generations and/or Project Leap students) on language to use and how to promote U=U
        • U=U can help reduce stigma about living with HIV
      • Address misconceptions with education
      • Viral suppression can lift the burden of fear around HIV transmission
      • Emphasize the benefits of HIV medications (e.g., more time to live)
      • Reflect on the history of HIV medication and the progress made today
      • Tailor medication adherence to the individual’s lifestyle
      Respond Pillar

      Education & Awareness Committee: Respond Meeting conducted on August 10, 2021

      Challenges/Feedback

      • Differences in support for PLWH and people living without HIV e.g., help with rent, those desperate conditions
      • “coin model”- privilege and no privilege
      • Controversy of Molecular HIV Surveillance (MHS) technology may get to the point of directionality
      • HIV criminalization — No laws in Texas yet, but laws are trying to be passed so there are no guarantees
      • Lack of information sent to understand MHS and new use of genetic material, protocol, and/or drugs
      • Lack of consent around MHS
      • Stigma is a key driver around HIV
        • Not adequately addressed in the household
      • State-funded work on stigma is at a halt
      • Lack of wholistic thinking with government
      • MHS has national impact but every health department is different
      • Difficult to get community perspective outside of the HIV workforce
      • Tools for racial/social justice not developed to use
      • Social media can influence people not being well-informed due to popularity

      Recommendations

      • Level up — Look at what the providers and funders are doing in addition to community members and get them to make structural changes
      • Understand differences in support and duplicate the support provided for PLWH to also reflect support for those without HIV
      • Handle laws before pushing MHS to combat concern of HIV criminalization
      • Use a different mechanism instead of MHS such as the sewer system for COVID cases to identify HIV in high incidence areas/neighborhoods
      • Revamp and revive events like Hip Hop for HIV Awareness and Houston’s Rodeo to get people aware of and tested for HIV
        • Provide incentives such as concert tickets and have events occur annually
      • Create environments where there is no stigma like Hip Hop for HIV
      • Cultivate a health habit for people and translate for other health conditions
      • Let community address MHS Implementation Plan and HIV Criminalization
      • Look at other states’ laws on who face criminalization issues (e.g., Missouri, Oklahoma, Kansas) and states who have been more progressive with addressing HIV laws
      • Reach outside the state to other sources (e.g., Gilead, AETC, NMAC) to address stigma through trainings like anti-bias/stigma training for providers/PLWH
      • Provide family education sessions for households

      Status Neutral Systems

      This committee is focused on a status-neutral approach to HIV care, which means the same approach of initial engagement happens with all people, regardless of HIV status. It all starts with an HIV test. Any result, positive or negative, kicks off further engagement with the healthcare system, leading to a common final goal, where an HIV infection doesn’t occur.

      Co-Chairs: Kevin Anderson, Amy Leonard, Oscar Perez

        Diagnose Pillar

        Status Neutral Committee: Diagnose Meeting conducted on June 1, 2021

        Challenges/Feedback

        • Providers are unlikely to ask black women to test because they don’t see them as vulnerable to HIV.
        • Non-HIV provider are less likely to offer HIV testing.
        • Women and girls think HIV is still a gay disease and that it does not affect them.
        • There’s a perception that HIV is vile or nasty and then when it comes back negative, they’re like whoo-hoo and then don’t want to be tested again.
        • Stigma is still a large reason behind the lack of HIV testing.
        • Stigma has been created by “targeted” testing.

        Recommendations

        • Look at HIV testing as a whole health approach. Use any kind of health care encounter to engage someone in a conversation that leads to an HIV test. The drivers are going for a wellness exam, my annual exam, when the HIV test is presented there it’s easy to say yes because they’re there for their entire body not specifically HIV. When thinking about health as a whole, even mental health, I’m going to reach out for these services for whole body. It’s readily accessible. They see its right there.
        • There shouldn’t be a prescription with no follow-up. Ongoing engagement to support medication adherence with PrEP or HIV with a person’s care team eliminates any barriers or concerns.
        • Better education and awareness need to happen for black women and girls, so they know they should get tested.
        • Providers need to be educated that HIV impacts more than gay men and to test all individuals.
        • Ideas to get individuals from education to an HIV test?
          • Incentivize testing.
          • Representation in advertisement or the news influences a person’s self perception of vulnerability. Images of people with HIV looking frail negatively impacts a person believing they need to get tested.
          • Similarly, there needs to be representation on what thriving with HIV looks like to combat the idea that it is taboo an HIV test.
        • Have representatives from the community explain HIV – educate.
        • HIV testing through other services like for a physical, makes it easier to “normalize” HIV and combat stigma.
        • Stigma reduction through messaging
        • Creating collaborations by placing billboards near where greatest access already exists. Place by any clinic even if it is one that is not associated with HIV prevention, it may be one that is trusted by the community.
        • Create some population-based messaging.
        • Create neighborhood specific messaging. • Change target language to priority population or those that are most vulnerable to HIV.
        • Train providers to be trauma informed as well as HIV.
        • Get out of the silos, COH, County, FQHCs, talk to providers that are not in traditional HIV spaces.
        • Let’s normalize the conversation in spaces like basketball courts and brunch parties and where people are.
        • Identify community partners, clinics, hospitals, and others most trusted by communities to utilize as a gateway to increase awareness and knowledge of HIV status.
        • Dive in deeper to layers of things that may have been attempted or things that did not work well. Looking beyond what is the norm. • We need to invest in communities enough to know where to go and conversations to have. We may find there’s an area we haven’t been before and where incentives [can] be helpful.
        • Bring in non-traditional partners like for-profit, schools, research.
        Prevent Pillar

        Status Neutral Committee: Prevent Meeting conducted on August 10, 2021

        Challenges/Feedback

        • Do people know about PrEP?
        • People are starting to know about PrEP, they know it’s out there, but may not know the name. They’re seeing the commercials and beginning to ask about what it is, but not really knowing what it is.
        • People don’t know exactly what PrEP does but are hearing about it. Some fear that it may impact liver.
        • Having actors from Pose in the PrEP commercials does help to bring awareness to PrEP
        • People do not know about nPEP.
        • PrEP is still advertised towards LGBTQIA+ community, but not to women. Women don’t believe it is for them. Marketing is miss leading – it is for everyone.
        • It is only talked about with heterosexuals when it is an HIV discordant couple, one is living with HIV and one is not.
        • There is not a marketing campaign specific to Black cis-gender women.
        • Black and brown people don’t see themselves as vulnerable to HIV.
        • When you focus on one population, the other populations do not think HIV is in their community.

        Do people know how to access PrEP

        • No, people do not know how to access PrEP
        • Facebook is supporting PrEP awareness and pushing marketing about PrEP
        • The intake packets given out is impersonal and cumbersome.
        • What resources do people seeking PrEP need to access and retain PrEP?
        • Education, Transportation and Housing are needed for people seeking PrEP
        • PrEP is not a priority to many who need it because they have other competing priorities like food and housing insecurity
        • The frequency of PrEP labs and visits creates a barrier when PrEP is not the largest priority in their lives.

        Recommendations

        • Put resources or funding towards digital ads to really promote PrEP to wide audience via social media.
        • Look for local area/neighborhood or community-based organization FB pages or social media outlets to place PrEP digital ads.
        • Have a community person who is on PrEP to be at community events; someone who represents community to be out there discussing PrEP.
        • Need to educate people, such as Doctors’ offices/OB/GYN or therapists, that have access to the people. Teaching those that have access to the people to provide PrEP information.
        • Passive Education moments via video. Use TV that are in the lobby of medical offices to put up PrEP education or ads. Put PrEP informercials in medical exam rooms and in rooms in non-profit. Also, use informercials in waiting room of other types of businesses within neighborhoods/community and in places like homeless shelters or food pantry.
        • Provide PrEP information during medical institutions’ “rounds.”
        • PrEP information is better received coming from a person that looks like them and/or comes from a person’s neighborhood. That includes the doctors that look like them.
        • Advocate to make changes at the funding source, example: intake packet.
        • Have a conversation with the patient in order to get information that the organization needs for the intake packet, not just hand them a long packet to fill out.
        • Intake packet has not changed in many, many years. Needs to be reviewed and remove unnecessary questions. Only need the pertinent information to enter into care.
        • The way you gather information can be less intrusive.
        • Should do a better job of explaining why the information being completed is important.
        • Having navigators for PrEP at the point of an HIV test.
        • Find resources, such as housing, transportation, food assistance, for people who are HIV negative and seek PrEP will help them maintain PrEP adherence.
        • Have peer navigators for PrEP, individuals that are representative of community and taking PrEP themselves. Navigators similar to HIV case manager, should be for PrEP –checking on access to care, labs, meds, as well as support system to stay on PrEP. Also, to check in on other health issues, such as STIs. Check in on feelings around being on PrEP, are they experiencing negative impact or internalized stigma. Train navigators on trauma informed care.
        • Provide subrecipient/funded organizations with payment points for linking people to PrEP, as well as keeping appointments and then link people on PrEP to housing and supportive services.
        • Have a warm line to talk to someone else that’s on PrEP.
        • Host focus groups about what people do or don’t know about PrEP/why people aren’t buying into it. In particular, do focus groups with black women. 
        Treat Pillar

        Status Neutral Committee: Treat Meeting conducted on July 27, 2021

        Challenges/Feedback

        • Lack of knowledge about how to navigate the healthcare services or how to understand insurance benefits
        • Social determinants hinder access to services
        • Once an outside Linkage Worker, such as with City of Houston, links a person to services at an organization for PrEP or HIV services, they step away and there is not always another person within the organization to help with continued navigation.
        • There are so many individuals being served at an organization that they do not receive one-on-one, individualized navigation or ongoing support.
        • Once there is linkage to services, Service Linkage workers from the City of Houston Health Department turns the person or case over to that organization. Can only follow them for 90 days. But the personal connection was made with the initial Service Linkage Worker and the loss of that connection can result in the person not continuing on with care.
        • Housing is a barrier for people who need both PrEP and HIV services.
        • Funding for more Service Linkage Workers, Navigators, Housing Case Managers is lacking. Need to build up the workforce by identifying additional funding for staff, increasing pay, racial/ethnically diversifying the workforce, and giving more respect to the role. All of these things would result in strengthening services and create an increase of people accessing services.
        • People don’t access services because they don’t see people that look like them and they feel intimidated. It’s not a priority for them to go into places where they don’t feel comfortable.
        • Often people don’t have the time it takes to receive services.
        • A barrier is having one partner who is living with HIV go to one case manager and the partner who is negative go to another person for PrEP.
        • Having locally funded organizations conduct HIV testing via blood draws versus CDC funded organizations do rapid/rapid tests creates a barrier because of the challenge to get venous blood draws processed.
        • Paperwork to establish HIV eligibility for services is a barrier. You have to go to a record owning facility site.
        • People feel like just a number and not being seen.
        • Gap that PrEP education is not needed once someone is diagnosed for HIV. However, they have partners, so education is still important.
        • People newly diagnosed are being quickly pushed to Rapid Start without taking in account their mental health, feelings around stigma, readiness to begin taking meds and integrating a new diagnosis into their self-identity. No follow-up is happening post medical check boxes.
        • PrEP shaming is still happening.
        • Linkage is defined as a medical appt or medication. However, linkage should be helping someone figuring out where they feel most comfortable receiving care.
        • People want to be served/helped by someone that looks like them or shared experiences, example transgender experiences. But not all organizations offer diversity in care, and they do not feel the organizations understand their needs or feel a connection. It’s not the/e alphabet that we’re servicing. We are people, human and deserve services and to be understood when we go to places to receive services.

        Recommendations

        • Need patient navigators to help with either PrEP or HIV care and be able to link and streamline services.
        • Fund one navigator for Status Neutral to help with all, PrEP, or HIV services. Break away from navigators that can only help with people living with HIV because of Ryan White funding restrictions.
        • Change the 90-day window for Linkage Workers. Allow them to continue to be involved with an individual once they are linked into care, regardless of whether it is PrEP or HIV care services.
        • Have Service Linkage workers funded for two types of services – PrEP and HIV Care, even if from two different funding streams. Depending on the linkage/navigation services, the Service Linkage Worker would bill the appropriate funding source.
        • Housing is treatment and should reach out to New York about their program to offer housing regardless of HIV status.
        • Service providers should be more mobile and go to the people, like with mobile units.
        • Virtual tele-PrEP services is more desirable. It is easier and helps to combat stigma, transportation, etc... Similar with HIV, easier access to go to them if in person or virtual.
        • Use Peers to provide navigation services and hire them with respectable wage.
        • They do not have to have a PhD. More powerful to hire peers. Representation of the people you serve is important.
        • Important for Linkage Worker/Navigators to be able to engage with partners, for example an HIV negative partner or someone living with HIV. Having a staff member who can do both regardless of funding would ensure both partner’s needs are met. One stop shopping module! Keeping partners together creates supportive environment for retention.
        • Drive up testing, such as what occurred during COVID, would add accessibility to HIV testing.
        • Make blood drawing easier, make them more available/accessible to get labs drawn, perhaps utilize pharmacies. Create better partnerships to take lab services to community. This would complement the virtual provider visits.
        • Reduces transportation barrier.
        • Allow locally funded community HIV testing partners to use rapid/rapid method sanctioned by CDC rather than require venous blood draws. This removes the barrier of finding labs to process specimens.
        • Remove barrier of paperwork by instilling patient portal to upload their own paperwork – discontinue the practice of record owning facilities. State DSHS is about to embark on patient portal system. Seek guidance from them.
        • For tele-health providers, have a peer navigator/representative of the community served on the phone to help with status neutral navigation of system, answer questions, referrals or share resources will help to build trust among underserved populations. Also, eliminate phone tree so people don’t have to press a lot of buttons to get to a live person.
        • Services should be more holistic, not just about physical care, would help with trust. Caring about more then just the appt. Interacting with the individuals in community setting. Showing up in spaces like the local gym and then sitting down to discuss nutrition.
        • Change check-in process to ask, “How are you doing?” and check-out process to include “How was your visit?” It results in people feeling much more engaged with the clinic because someone taking an interest made them feel like a human being and not a number. Helps with trust and retention. Invest with funding in good customer service.
        • Create a process or routine of education and linkage to PrEP for a partner of someone living with HIV.
        • Provide mental health check-in for people starting medication whether PrEP or HIV Rapid Start. Train case managers, linkage workers or navigators to treat people more sensitively and more than a number. The overall needs to be overhauled! More user-friendly services.
        • Train case managers, linkage workers or navigators on helping people find a good fit for them on receive services.
        • Create Trauma informed training series and ongoing refresher courses so that it’s more than a one and done training. Require providers from funded entities to participate. 
        Respond Pillar

        Status Neutral Committee: Respond Meeting conducted on August 24, 2021

        Challenges/Feedback

        What challenges have you witnessed or experienced with Disease Intervention Specialist?

        • People struggle with confronting their own shame and difficult to have a conversation with someone when dealing with their own shame/internalized stigma, especially in the Latino community • Stigma is beyond not wanting to talk to DIS and, talking about it makes it real.
        • The need for representation is important. The person often asking personal questions about partners does look like the person that’s newly diagnosed.
        • The person being told a partner has tested positive for HIV [and] that they’ve been exposed, feels shock and exposed. And anger, may feel they were lied to.
        • People are not aware of what DIS role or partner services is.

        COVID Lessons:

        • COVID has brought more conversations about HIV and transmission. Also, about the immune system and how HIV impacts immune system. And how HIV is transmitted and understanding U=U.
        • There were alerts when a certain area had high cases of COVID.
        • There was constant COVID messaging and curb testing. But not the same for HIV.
        • Stigma of being COVID positive felt similar to being dx’d with HIV.
        • COVID shed a light on contract tracing.

        Recommendations

        If there is an HIV outbreak what ways can the City HHD reach out to a community to respond to
        that outbreak without stigmatizing that community? What would you do to notify a community
        of an HIV breakout?

        • Billboards, Social Media, using local radio – make the broadcast general to avoid stigmatizing the neighborhood or community.
        • Create an alert via phone to say when there is a high outbreak area and you may want to call a number for more information or where to get tested.
        • Offer in multiple languages.
        • Need more vast advertising with HIV like [what] has happened with COVID.

        DIS or partner services

        • Do more education with HIV workforce and community on the roles of partner services.
        • Educate on how to explain the PS role to people getting an HIV test.

        How can we bring in more voices into the HIV work?

        • Representation – seeing people like them in any particular demographic helps encourage peers to join the efforts.
        • Have more people out in the community/neighborhood to be visible providing education and mirror what the community looks like.
        • Talk to HIV professionals/providers to encourage people to enter the field.
        • Will people enter the field because public health has been on the front lines with
        • COVID? Time will tell…
        • Make the distinction from “Community” and “Neighborhood.” Example- there’s a gay community and geographic community.
        • Reach out to young influencers that can reach out to younger population and incentivize them to get involved.
        • Education, awareness, and PSAs delivered to young people.

        Is public health focusing too much on PrEP?

        • Young people think PrEP is only for gay individuals. The commercials depict flamboyant individuals. Should make it more about wellness and integrate in images of being healthy.
        • Risk reduction messaging needs to be out there for people that aren’t ready for PrEP
        • Would be great if PrEP was like a plan B!
        • Broader social marketing campaigns
        • Implement social services/resources/navigation for people on PrEP
        • Check in with people on PrEP -keep engaging with them – send a f/u email. Same that is done with HIV. 

        Research, Data, and Evaluation

        This committee is focused on identifying existing data, supplemental data, metrics, sources, data collection, measurement, and reporting methods in order to determine if EHE activities are contributing effectively toward Ending the HIV Epidemic.

        Co-Chairs: Kevin Aloysius, Chelsea Frand, Kendrick Clack

          Diagnose Pillar

          Research Data & Evaluation Committee: Diagnose Meeting conducted on June 10, 2021

          Challenges/Feedback

          • AFH currently provides testing at these locations. How can we collect more data on tests occurring at these locations?
          • HHD currently funds a couple of community-based organizations for priority and routine testing.
          • People need to be better informed about HIV, especially possible exposure.
          • Utilize partner services data from the HHD.
          • Legacy currently does an HIV self-test program; however, the program is not very popular.
          • Has the mobile unit reached the priority populations?
          • Promote a whole health approach to reduce stigmatization.

          Recommendations

          Approach providers with HIV positive tests to see if they can provide information on all tests
          (those that are negative). MMP as a potential resource for data.

          • Look at providers who are conducting STI testing and ensure that they are also providing HIV tests (bundled testing).

          Use CBO data for testing data and their positivity rate. RUSH program with opt-out HIV testing
          and ER's contracting with HHD (need more information on data collected). Implement opt-out
          testing in additional hospital systems.

          • Create systems to collect data at other CBO's that are not funded.

          Pre/Post surveys with providers before and after public health detailing.

          • Gather information on their attitudes/beliefs related to opt-out testing. How will we target the providers, especially those who have a potential bias?
            • Collab with institutions/hospital systems to buy-in.
            • Review literature about provider bias with HIV testing.
          • Maybe target urgent care facilities.
          • Incentivize providers for participation. Look at areas where priority populations have burden to understand bias among providers.

          Utilize social media platform "We Chat" to send a generic message about HIV exposure. Utilize a program to send out a message letting someone know they should be tested.

          • Look at the number of messages sent out.
          • Utilize a code that can be used that is associated with that person to track whether or not they receive testing.
          • Offer PrEP to partners.

          Conduct an assessment on the feelings/attitudes around self-testing. Assess programs/CBO's thoughts/beliefs around HIV self-testing.

          • Look at current research on HIV self-testing programs.
            • Survey the people who are currently using HIV self-tests.
          • Use advertisements to increase awareness of self-testing kits.
            • Determine the public's interest in this project.

          Look at the testing provided using the mobile unit to ensure that priority populations are provided testing. Utilize "ambassadors" in the community to promote testing among younger populations. For example, reaching parents and grandparents to influence young adults.

          • Review the locations based on the demographics of people who are provided tests.
          • Review the positivity rate of tests provided by the mobile unit based on location.
          • Review all these metrics routinely to inform planning.

          Promote HIV testing when screening for other conditions. Look for opportunities to provide
          testing at other events, such as vaccination sites, etc.

          • Partner with education and ancillary services.
          • Conduct community consultations/assessments to see where we should prioritize testing.

          Receive feedback from the community to determine locations.

          Prevent Pillar

          Research Data & Evaluation Committee: Prevent Meeting conducted on August 12, 2021

          Challenges/ Feedback

          Define each of the measures. Create a database for entry of data. Track adverse health effects and reasons out of care. Education in different languages.

          • Measuring awareness and utilization and prescriptions.
          • Measure clinic days/hours. # of visits. Origin of clients via zip codes
          • Measure # prescriptions written. Consider refills.
          • Measure # of prescription. Exploring policy changes or interpretations.
          • Measure the utilization of kiosks.
          • Measure the number of officials who are in support.

          Investigate current practices and knowledge around same-day PrEP.

          Recommendations

          Develop a system of all PrEP providers into referral of eligible patients. Creating criteria for
          eligible people.

          Investigate awareness and accessibility for PEP. Identify prescriptions for Truvada/Descovy and
          HIV test completed. Mobile PrEP clinic. Normalizing PrEP/PEP conversations within PCP visits.
          Explore feasibility of PrEP DAP.

          Survey clients for preferred entry points. Measure utilization by priority population. Explore
          feasibility fully implementation of telemedicine services.

          Survey current PrEP providers. Create ECHO. PCP Certification Modules.

          • Canvasing and outreach

          Provide best practices for same-day PrEP. Feasibility and workflows, tools to support
          implementation.

          • Side by side campaigns.
          • Create a provider summit.
            • Measuring number of providers reached.
            • Measure provider and clinic KAP.
            • Measure changes in behaviors (pre-post)

          Measure utilization. Explore feasibility of co-current delivery of gender affirming care and PrEP.

          Treat Pillar

          Research Data & Evaluation Committee: Treat Meeting conducted on August 12, 2021

          Challenges/ Feedback

          1. Reach out to those entities that do Rapid Start to see how they are being done.
          2. Reach out to the AETC (Dr. Patel) who is working with Carin & the RWGA to develop the rapid start protocols
          3. Create a system on how to combine all the data from different institution.

          Where is HHD referring their clients? City will have the ability to measure it themselves.

          Administer an initial and follow up survey.

          Measure number of new clients serviced that were rapid start or return to care.

          Measure proportion of individuals that are virally suppressed.

          Do folks have access to devices and utilities/internet?

          Recommendations

          HHD had a plan to detail providers on RW system and resources available. Did they measure outcomes? We should be able to get this data.

          • A follow-up assessment done at 3- and 6-month mark to check knowledge retention.
          • Learning Collaborative - AETC to train providers and do follow-up
          • Where does doctor detailing take place? Should be based on prevalence and incidents.
            • Do they know how to prescribe rapid start? [Follow up with those neighborhoods to see what the impact was on viral load and PrEP uptake].

          Collaborate with Texas DCFAR Dr. Giordano and other institutions to plan research projects in partnership with community for this measure (Initial and follow-up survey).

          Measure from detailing - new PCPs who start treating HIV and/or PrEP and increase a number of patients. Measure referrals to integrated health (mental health, dietician, case management, dental and vision).

          Local U=U campaign

          Get folks involved: Ryan White Case Manager, Public Health Educator
          Community Assessment to ask clients how they would like to receive this education (survey).

          • What does exist and ask the folks serving questions. Would people come to support programs
            dentify the route of how info should be provided - provider's message - (TRUTH Project - support group)
          Respond Pillar

          Research Data & Evaluation Committee: Respond Meeting conducted on August 12, 2021

          Challenges/ Feedback

          Identify staff members involved in cluster detection activities.

          • Increase knowledge clinic personnel.

          Identify spaces of significant growth in clusters.

          • Measure # PLWHIV from cluster linked into care.

          Measure number of sequences received. Measure provider knowledge around purpose
          sequencing test.

          • Investigate provider perspective around sequence reporting.

          Measure time linkage among cluster members. # of agencies offering same day starts. # of
          prescriptions provided.

          Measure number of contracted CBOs. Measure timeline for completion of investigation.

          Recommendations

          Develop community education events and measure participation and knowledge retention.

          Assess the make up of the CAB and evaluate service provide. Compare composition of CAB with
          people impacted.

          Measure community participation. Develop survey to capture gaps or needs perceived by
          participants

          Increase communication from DIS to CBOs.

          Add a separate line in CBO performance metrics for these screenings, so it doesn't negatively impact their positivity rates if testing is high but newly diagnosed transmissions is low.

          Policy and Social Determinants

          This committee is focused on exploring and identifying policy and social determinants that impede Ending the HIV Epidemic. The committee will provide recommendations on policy changes or creation, as well as interventions that effectively address complex and intersecting health and social conditions. Ultimately, the committee seeks to recommend activities that will reduce health disparities among the most vulnerable and marginalized populations.

          Co-Chairs: Januari Fox, Crystal Townsend, Michael Webb

            Diagnose Pillar

            Policy & Social Determinants Committee: Diagnose Meeting conducted on June 29, 2021

            Meeting Notes: Challenges/Feedback

            • Not seeing new funding or very little coming into Houston/Harris County• Legislators, DA, and the City of Houston are not educated on HIV issues
            • Transgender or Gender Identity is not universally being collected and therefore essential data is missing in reports.
            • The ongoing approach of targeted testing needs to change because it’s not all inclusive.
            • Communities feel like they are just being used as numbers for testing goals.
            • Trans youth have difficulty finding shelter so relying on HIV testing through shelters will miss the trans youth population. Policies don’t support them being in those spaces.
            • Due to COVID a lot of people are more comfortable in their home and not interested in going to get a test or participate in testing events. And transportation is still difficult for many.
            • Concerns with Home Testing and linkage to care, mental health, and continued followup.
            • Concerns with lack of representation of people in marketing of HIV testing and services.
            • People don’t live single issue lives.
            • Many monolingual individuals are not aware of HIV services and miss out on HIV education.
            • Pop testing is not necessarily increasing access to care and systemically access the medical system. It’s not routing testing and normalizing HIV testing that’s trying to be fostered.
            • Concern that Pop up Testing is not giving communities of color navigation or the tools they need if they test positive for HIV.
            • Language for Partner Services is insensitive, e.g., “suspects”
            • Stigma is still a barrier to HIV testing and connection to care.
            • Need for all stakeholders, such as pollical partnerships with Texas Medical Association,
            • Association of Medical Providers, MCOs, to be on board with routine testing.
            • Individuals working in HIV prevention are not all culturally competent about the populations they’re serving.

            Recommendations

            • Create a policy for organizations receiving funding to collect gender identity and report for services being funded.
            • Change Activity to “Increase HIV Testing to achieve a 1% new positivity rate by funding community-based organizations that have demonstrated experience engaging more impacted communities (e.g., trans communities, black women, black gay men, etc.)”
            • City of Houston and Harris County need to come up with a funding source to meet the needs of the community.
            • Policy recommendation regarding shelters/transitional housing – include policies that protect people of trans experience when accessing shelters and transitional housing.
            • Policy change for recipients to receive public funding they must take a cultural competency training and have policies in place to protect marginalized communities, especially transgender communities.
            • Include opt-out HIV testing at shelters
            • Provide multilingual education and resources with at-home testing
            • Couple HIV testing with other services, e.g., PrEP and nPEP/PEP, COVID, service linkage, etc.…
            • Modeling virtual care that was done during COVID for Home Testing
            • Promote overall health as promoting and normalizing HIV testing.
            • Provide routine testing on mobile unit that conducts other services
            • Increase staff capacity for testing to be able to do follow through, navigation and partner services
            • Incentivize testing through culturally appropriate incentives.
            • The HIV Prevention Community Planning Group must review any work plans submitted by the Houston Health Department to funding entities (CDC)
            • Mandate opt-out HIV testing and HIV care in county jails in the Houston EMA.
            • Standardize Data collection to include gender identity.
            • Have the ETE Coordinator in partnership with community representation from the ETE  development cohort(s) provide quarterly updates/presentations on developments and progress to City Council and Commissioners Court.
            • Free HIV testing and/or Health Screenings Day (free rides on Metro and/or Ride Sharing such as Uber/Lyft).
            • Address gender-based violence and sexual and reproductive health.
            • Increase faith-based involvement
            • Reduce stigma and discrimination
            • Obtain funding in the public budget for HIV/AIDS services
            • Increase access to health care for all Texans
            • Strengthen the data to care strategy in Houston
            • Fund syringe exchange programs
            • Enact opt-out testing legislation
            • Expand comprehensive-based sex education throughout the Houston Independent School District
            • Eliminate the use of stigmatizing language
            • Create an information hub for key stakeholders to influence decision makers
            • Recommendation: Support inclusionary research
            • Advocate for an expansion of eligibility and coverage for the AIDS Drug Assistance Program (ADAP)
            • Stop efforts to criminalize people living with HIV
            • Address freedom from domestic violence as it relates to HIV prevention, testing and treatment.
            • Increase community-government-private partnership through a collaborative review process (twice/year or quarterly) to review data on new diagnoses, care, social determinants, and gaps to map out next steps collective
            • Include HIV testing in high schools and colleges
            • Train individuals, especially workforce, on people first language. Include routine refresher trainings.
            • Advocate for syringe exchange programs
            Prevent Pillar

            Policy & Social Determinants Committee: Prevent Meeting conducted on August 24, 2021

            Challenges/Feedback

            Remove the terminology “high-risk” (Stigmatizing language)

            How are unincorporated/ rural areas outside Harris County served? Has to be Part B. The City can partner with clinics in surrounding areas that are already testing or would like to test and designate days people can go to a specific doctor.

            More widespread education is needed about available resources like Mistr and Sistr platform.

            Legislation has a lack of education about SSPs.

            • Some political figures see SSPs as enabling.

            If we are going to end HIV, we must include and center people living with HIV.

            EHE has a limited viewpoint of prevent.

            How can we create a policy to try an enhance sex education programs for adolescents in the
            county?

            • Abstinence only that’s going to be really tough to change
            • Safe love, safe expression should be taught

            Recommendations

            Partner with local HIV organizations to provide same-day PrEP start with evening hours.

            Have HHD/ Texas Department of Health partner with rural areas Doctor offices/ FQHC to
            provide PrEP/ HIV testing.

            Public health campaign to educate people on PrEP engagement opportunities

            • Public campaign on Mistr and Sistr and Q Care on telehealth.

            Model SSP after various programs that include insulin and/or hormone therapy

            • Austin program

            Engage health care schools and programs to educate students (e.g., medical, nurse practitioner,
            nursing, and any other healthcare program) on PrEP and HIV prevention.

            Partner with out of school or local libraries (city and county) to reach the same or similar
            populations.

            • Funding workaround
            • Incentivize participation

            PrEP being made available or able to be prescribed over the counter by pharmacists- pass a
            law!

            • Similar to programs in Nevada, California, and North Carolina

            Implement a state gap program or city program.

            • Drug assistance program like that in Washington State (start PrEP, labs, visits)

            Have our city and county officials declare that Houston/ Harris County has an HIV epidemic
            which can open up more funding.

            • Prioritize preventative care

            New policy recommendation: With new initiatives bringing in new providers, each institution
            should have some type of community advisory board or group they are doing this in alignment
            with and that the group should include people living with HIV.

            • People, providers, advisory boards- In terms of advisory boards, sometimes they are needed and other times they are not. Providers or whomever should tap into networks that already exist to get feedback when developing strategies including people living with HIV to make sure what’s being proposed will work.

            PrEP should be free for everyone.

            CP should be offering PrEP at wellness checks.

            Provide funding for the initial and ongoing lab work that is required for people on PrEP.
            Healthcare should be free.

            Increasing access to electronic hardware needed to communicate.

            Have a safe location where people are able to use and have its staff with a healthcare provider
            RN/NP.

            End abstinence only programs in schools and teach healthy sex education!

            Perhaps partner with local churches to teach sexual health to the youth. Of course, the scope of
            the education and participation will vary.

            Create a drug abstinence program funded by the city and/or county to support PrEP
            accessibility.

            Safe injection site

            Treat and Respond Pillars

            Policy & Social Determinants Committee: Treat & Respond Meeting conducted on July 27, 2021

            Treat Challenges/Feedback

            • City of Houston Health Department is not known for a place to receive HIV services. They primarily link out to other clinics for HIV treatment and care services. Launching Rapid Start at their clinics could be very positive; however, recognition for that service will be a struggle. They are known more for STD treatment.
            • HIV testing partners don’t have direct access to link people to ARTs. They are referred to entities that can provide Rapid ART which can delay reaching goal of within 72 hours.
            • Not many outlying clinics that offer Rapid ART.
            • Very few clinics offering hormone therapy.
            • If there was a clinic that did offer access to HIV care, transportation is a barrier for outlying areas to access Rapid ART within 72 hours.
            • St. Hope is the only one that offers transportation to outlying areas. A lot of hoops to go through to make it happen.
            • Telehealth can help keep individuals in care.
            • Homelessness and housing insecurity is a barrier to getting and staying in care.
            • Hard to get data from private HIV providers about Rapid Start efforts.

            Treat Recommendations

            Goal: Ensure 90% of clients are linked to care with a medical provider and started on ART within
            72 hours of HIV diagnosis or return to care. Ensure 90% of clients are retained in care and virally
            suppressed.

            • Fund actual adherence to the 90-90-90 goals. By 2020, 90% of all people living with HIV will know their status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
            • Increase education and build relationships with sex work community (potential partners – https://swopusa.org/chapters/) to decriminalize sex work in the Greater Houston area (Work with the District attorney and law enforcement).
            • Improve health outcomes for people living with HIV/AIDS with co-morbidities. This can be done by coupling services like COVID vaccinations and/or testing.
            • Publish complete and accurate data for transgender people (this has been requested for YEARS) and those recently released from incarceration.
            • Access to mental health care should be integrated into HIV care, as well as housing.
            • Include HIV education with COVID canvassing.
            • Refer all people newly diagnosed with HIV to a Social Worker to ensure ART linkage and community resources
            • Enhance the health care system to better respond to the HIV/AIDS epidemic especially in the “outer loop” and surrounding counties.
            • Increase access to mental health services and substance abuse treatment.
            • Increase education and access to care for undocumented communities.
            • Initiate the first ever trans specific health care clinic in the Houston area.
            • Initiate the first ever sex workers clinic, such as COIN clinic in New York.
            • Train DIS and Service Linkage staff on cultural competency or humility especially for trans communities and LGBT+ communities.
            • Regularly rotate popup clinics and increase FTEs to cover them.
            • Increase broadband access – explore how can HB4 support this from the 87th legislative session.
            • All staff [complete] cultural competency trainings center focusing on the LGBTQIA+ community, particularly the transgender community.
            • Increase retention in medical care through rapid treatment initiation and implementation of low barrier structural changes (e.g., telehealth, mobile care services (at home phlebotomy and testing services, eligibility documentation requirements) that increase access and meet the needs.
            • Rollout telehealth options for clients with challenges with transportation that includes mailing HIV treatment meds in discrete ways.
            • Increase access to telehealth options, telehealth pay parity.
            • Increase access to electronic hardware needed to communicate with telehealth and other services.
            • When implementing ART benchmarks, include partnerships with all healthcare entities,
            • such as FQHCs and private medical providers, who provide medical services to people living with HIV.
            • Increase education and access to care for undocumented communities.
            • Create a pilot program that funds a one-stop shop housing program for people living with HIV (newly diagnosed) who are experiencing unstable housing or homelessness, the program funds a housing center that includes a primary HIV specialist or provider on staff to help treat the participants while providing them stable housing, incorporates job training/finding programs, and connects participants to additional resources (e.g. SNAP benefits, longer term housing, ADAP, etc.) for their first 6 months when newly diagnosed with HIV.

            Respond Challenges/Feedback

            • Concerns with Molecular Surveillance as it is conducted without a person’s consent or knowledge. Once a person is diagnosed with HIV and their lab work is done, their name and identifiers and health information are uploaded into a data base. Information can be used for research and multiple different agencies have access to the data. There aren’t any security mechanisms in place to make sure ICE or criminal justice agencies don’t have access to it. So, where is the assurance that this information cannot be used to criminalize someone’s HIV status or used for ICE to track down where people live.
            • CDC have authority to collect data for public health surveillance with communicable disease.
            • Untended consequences with molecular surveillance and human rights around consent which should be in consideration.

            Respond Recommendations

            • Declare a moratorium on molecular HIV surveillance and partner with people living with HIV networks to develop standards for obtaining informed consent; privacy protections; and security, sharing, and storage protocols.
            • Community interventions (CAB, Community spaces, and wrap around care to address barriers) need to further invest into further effect on retention in care, normalization of viral suppression, de-stigmatization of HIV and incentives that allow for more community centered harm reduction.
            • Have the CAB be thoughtfully expanded and given strong direction.
            • Key activities: change host bi-annual community forums as a platform to analyze gaps and identify best practices to address the gaps to “Host bi-annual community forums as a platform to RAISE awareness about what Molecular Surveillance is and how it is used, and how to analyze gaps and identify best practices to address the gaps.”
            • Include funding to support a strategic response to new cases of HIV based on HIV data collection practices to address the root causes of HIV.
            • Provide update to the community on the results or outcomes of previous cluster detection activities that have been completed by the health department.

            Thematic Analysis of Pillar Discussions: Sampling of EHE Committee Recommendations

              Diagnose Pillar

              DIAGNOSE PILLAR

              Sampling of EHE Committee Recommendations

              Workforce

              • Prioritize hiring and select staff that look like the persons and people they trust (confidentiality) to administer/ promote testing in a welcoming environment (Outreach & Community Engagement Committee)
              • Have support available for first time testers with an emphasis on staff presence and consistency (Outreach & Community Engagement Committee)

              Organizational Capacity Building

              • Endorse programs/environments that show training and linkage/ connection to EHE (Meeting I)
              • Increase staff capacity (Policy and Social Determinants Committee)
              • Expand follow-up services (Status Neutral Systems Committee)
              • Build up field outreach and build rapport (Outreach & Community Engagement Committee)

              Education & Awareness

              • Provide opt-out education, deal with misinformation, evolution of HIV, and awareness
              • (Outreach & Community Engagement Committee)
              • Connect with formal and informal community leaders (e.g., gatekeepers and influencers) (Education & Awareness Committee)

              Resource Availability & Accessibility

              • Create an environment of accessibility (Status Neutral Systems Committee)
              • Bundle testing services for a comprehensive, wrap around service (one-stop-shop)
                • Bring back "Hip Hop for HIV" events with artists that appeal to different audiences and offer bundle of clinics or do a festival over a few days (Education and Awareness Committee)
                • Implement components of COVID-19 testing (drive by testing)/ bundle testing and vaccine administration (Outreach & Community Engagement Committee)
                • Look at providers who are conducting STI testing and ensure that they are also providing HIV tests (bundled testing) (Research and Data Evaluation Committee)
                • Bundle resources (HIV testing with other services, (e.g., PrEP, nPEP/PEP, COVID, service linkage, etc.) (Policy and Social Determinants Committee)
                • Provide routine testing on mobile unit with bundled services (Policy and Social Determinants Committee)
              • Adjust testing hours with consideration of intended audiences' activities (e.g., work schedules and leisure time windows) so people are available and present when testing occurs (Outreach & Community Engagement Committee)
              • Train providers to be trauma-informed (whole health) (Status Neutral Systems Committee)

              Quality Assurance

              • Train individuals, especially workforce on people first language, require refresher training, and provide evidence that they are using it to add a level of accountability
                • Evaluate evidence and provide a non-funded endorsement (e.g., sticker of approval) for cultural competency to improve consumer and provider accountability (Policy and Social Determinants Committee)
              • Routinely review materials regularly to address changes in terminology (Status Neutral Systems Committee)
              • Use CBO data for testing data and their positivity rate. Create systems to collect data at other unfunded CBOs. (Research Data and Evaluation Committee)
                • Provide test kits to require data reporting
                • Establish a workgroup for providing outreach to providers
                • Utilize DIS to build on relationships

              Anti-Stigma

              • Use appropriate messaging to reduce stigma and ""normalize"" testing (whole health approach) (Status Neutral Systems Committee)
              • Reduce stigma and discrimination by requiring workforce and funded recipients to complete initial and ongoing training on stigma. (e.g., stigma around provider education on taking sexual health history)
                • Work with harm-reduction coalition. Use cultural humility principles to improve cultural competency. (Policy and Social Determinants Committee)

              Mental/ Behavioral & Substance Use

              • Address freedom from domestic violence and coercive behavior related to HIV prevention, testing and treatment. (Policy and Social Determinants Committee)
              • Utilize a whole health approach (Status Neutral Systems Committee)
                • Each encounter represents an opportunity to engage and meet the people where they are
                • Ex. Wellness exam, annual, mental health care- Focus on the entire body

              Policy/Advocacy

              • Stop criminalization of people living with HIV (Policy and Social Determinants Committee)
              • Implement policies that protect the marginalized communities, especially transgender communities (Policy and Social Determinants Committee)
              • Advocate hard for syringe exchange programs [i.e., create access to clean syringes, disposal of “dirty” syringes, washing (risk reduction)] Bring a task force together (harm reduction), lobbyists support- intergovernmental affairs
                • Pharmacists provide up to 4 syringes plus disposal sites (Policy and Social Determinants Committee)

              Cultural Awareness & Competency

              • Be culturally specific and do more to demonstrate [understanding] (Outreach & Community Engagement Committee)
                • Use local antenna t.v. channels that serve multiple languages to reach nonEnglish speaking populations (Education and Awareness Committee)
                • Multilingual education and resources with at-home testing (Policy and Social Determinants Committee)
              • Funding recipients [should] be required to complete cultural humility and sensitivity training to reach cultural competency (Policy and Social Determinants Committee)

              Building and Maintaining Partnerships

              • Create new and/or refresh collaborations/partnerships (get out of silos) (Status Neutral Systems Committee)
              • ETE Coordinator partner with community representation from the ETE development cohort(s) to provide quarterly updates, presentations [with opportunities for public comment], and reports to City Council and Commissioners Court on [new] developments and progress (Policy and Social Determinants Committee)
              • Create a community review commission for additional accountability (Meeting I)

              Housing

              • Address shelter/transitional housing issues (Policy and Social Determinants Committee)
                • Protection for people of trans experience when accessing shelters and transitional housing
                • Opt- out HIV screening in shelters
              Treat Pillar

              TREAT PILLAR

              Sampling of EHE Committee Recommendations

              Workforce

              • Train new and existing staff to improve customer service, competency levels, follow-upfollow through around HIV treatment (Outreach & Community Engagement Committee)
                • Measure level/training through competency checklist on a routine basis (e.g., 3,6, 9 month or ongoing). Review with supervisor.
              • Important for Linkage Worker/Navigators to be able to engage with partners (Status Neutral Systems Committee)
                • For example, an HIV negative partner or someone living with HIV. Having a staff member who can do both regardless of funding would ensure both partner’s needs are met. One stop shopping module! Keeping partners together creates supportive environment for retention.
              • Train case managers, linkage workers or navigators on helping people find a good fit for them on receive services. (Status Neutral Systems Committee)

              Organizational Capacity Building

              • Simplify the linkage process—focus on necessary requirements and reduce turnaround time from diagnosis to care (Outreach & Community Engagement Committee)
                • Develop a clear next step for linkage to care
              • Commit to recruiting and training community members to join the expanded HIV workforce. (Outreach & Community Engagement Committee)
                • PLHIV are the subject matter experts on programs that support PLHIV and are expert navigators.
                • Encourage a creative approach to valuing lived experience as qualification for these positions beyond formal education requirements.
                • Increase representation of people living with HIV to the HIV workforce at all levels of leadership
              • Fund one navigator for Status Neutral to help with all, PrEP, or HIV services. Break away from navigators that can only help with people living with HIV because of Ryan White funding restrictions. (Status Neutral Systems Committee)

              Resource Availability and Accessibility

              • Adopt everyday language instead of vague terminology to use in promotions Update messaging based on what’s current (Education & Awareness Committee)
              • Embed outreach workers and case managers within clinics
                • In-house clinic relationships can reduce treatment barriers (Outreach & Community Engagement Committee)
              • Rollout telehealth options for clients with challenges with transportation that includes mailing HIV treatment meds in discrete ways. (Policy & SD Committee)
              • Implement a local U=U campaign (Research Data &evaluation Committee)
              • Remove barrier of paperwork by instilling patient portal to upload their own paperwork – clinics can have people scan photo in via phone for sex workers
                • Pilot program for sex workers in clinics with hours from 6pm-6am. (Status Neutral Systems Committee)
                • Discontinue the practice of record owning facilities. State DSHS is about to embark on patient portal system. Seek guidance from them.

              Education and Awareness

              • Increase education and awareness around the concept of U=U (Education & Awareness Committee)
                • Enter the Pop culture (like PrEP) with simple messaging for U=U so that it gives a sense of consistency
              • Emphasize the benefits of HIV medications (e.g., more time to live) and reduce fear around having sex (Education & Awareness Committee)
              • Provide internal reach and cross-knowledge efforts across departments/programs (Outreach & Community Engagement Committee)
              • Provide education and awareness on what it means to be out of care (Outreach & Community Engagement Committee)
              • Increase education for undocumented communities (Policy & SD Committee)
              • Include HIV education with COVID canvassing. (Policy & SD Committee)
              • Create Trauma informed and Cultural Humility Principles training series and ongoing refresher courses so that it’s more than a one and done training. Require providers from funded entities to participate. (Status Neutral Systems Committee)

              Anti-Stigma

              • U=U can help reduce stigma about living with HIV (Education & Awareness Committee)
              • Viral suppression can lift the burden of fear around HIV transmission (Education & Awareness Committee)
              • Get public’s input (e.g., poll to young generations and/or Project Leap students) on language to use and how to promote U=U (Education & Awareness Committee)
                • Give more power to patients — persistence over adherence
              • Promote inclusivity across television, social media, and radio platforms (Outreach & Community Engagement Committee)
              • Promote primary care for all health needs i.e., wholistic health (Outreach & Community Engagement Committee)
              • Virtual tele-PrEP services is more desirable. It is easier and helps to combat stigma, transportation, etc. Similar with HIV, easier access to go to them if in person or virtual. (Status Neutral Systems Committee)

              Mental/Behavioral Health & Substance Use

              • Make mental and behavioral health a part of HIV treatment (Outreach & Community Engagement)
                • Provide additional support for mental and behavioral health with HIV treatment
                • Build and implement a mental health model for HIV treatment and care. Embed personnel in provision of services
                • Recognize emotional triggers attached to HIV
                • Offer mental health services on a wider scale. Take mental health services to people affected by HIV
              • Provide mental health check-in for people starting medication whether PrEP or HIV Rapid Start. Train case managers, linkage workers or navigators to treat people more sensitively and more than a number. The overall needs to be overhauled! More userfriendly services. (Status Neutral Systems Committee)
              • Increase access to mental health services and substance abuse treatment. (Policy & SD Committee)
              • Promote persistence of patients taking their medication (Education & Awareness Committee)
              • Provide universal screenings (Education & Awareness Committee)

              Cultural Awareness & Competency

              • Identify trusted partners/gatekeepers to guide people with HIV through treatment o Consider cultural differences e.g., undocumented immigrants may go to a pharmacy before a doctor’s office (Outreach & Community Engagement Committee)
              • Promote inclusivity with HIV data on populations at-risk (Outreach & Community Engagement Committee)
                • Address behavior of HIV without strong emphasis on race
              • All staff [complete] cultural competency trainings center focusing on the LGBTQIA+ community, particularly the transgender community. (Policy & SD Committee)

              Policy/Advocacy

              • Propose dual 50/50 funding for HIV prevention and care programs (Outreach & Community Engagement Committee)
              • Improve internal organizational systems on rapid start reflecting a one-stop shop for treatment (Outreach & Community Engagement Committee)
              • Assess and address root causes of why people fall out of HIV care (Outreach & Community Engagement Committee)

              Quality Assurance and Evaluation

              • Provide data and outcomes for provider detailing on RW system and available resources. (Research Data & Evaluation Committee)
                • A follow-up assessment done at 3- and 6-month mark to check knowledge retention.
                • Learning Collaborative - AETC to train providers and do follow-up
                • Doctor detailing should be based on prevalence and incidence.
                • [Follow up with those neighborhoods to see what the impact was on viral load and PrEP uptake]. Utilize more Needs Assessment information.
              • Measure from detailing - new PCPs who start treating HIV and/or PrEP and increase number of patients. Measure referrals to integrated health (mental health, dietician, case management, dental and vision). (Research Data & Evaluation Committee)
              • Publish complete and accurate data for transgender people (this has been requested for YEARS) and those recently released from incarceration. (Policy & SD Committee)
              • Improve workforce accountability through quality assurance (Outreach & Community Engagement Committee)

              Building and Maintaining Partnerships

              • Collaborate with Texas DCFAR Dr. Giordano and other institutions to plan research projects in partnership with community for this measure (Initial and follow-up survey). (Research Data & Evaluation Committee)
              • Develop a process to solicit input from, engage and consult with local networks of people living with HIV, etc. Positive Women's Network, Texans Living with HIV, etc. and include meaningful involvement of people living with HIV indicators in the final version of the EHE plan. (Outreach & Community Engagement Committee)
              • Create better partnerships to take lab services to community. This would complement the virtual provider visits. Reduces transportation barrier. (Status Neutral Committee)
              • When implementing ART benchmarks, include partnerships with all healthcare entities, such as FQHCs and private medical providers, who provide medical services to people living with HIV. (Policy & SD Committee)

              Housing

              • Housing is treatment and should reach out to New York about their program to offer housing regardless of HIV status. (Status Neutral Committee)
              • Create a pilot program that funds a one-stop shop housing program for people living with HIV (newly diagnosed) who are experiencing unstable housing or homelessness, the program funds a housing center that includes a primary HIV specialist or provider on staff to help treat the participants while providing them stable housing, incorporates job training/finding programs, and connects participants to additional resources (e.g. SNAP benefits, longer term housing, ADAP, etc.) for their first 6 months when newly diagnosed with HIV. (Policy & SD Committee)

              Employment

              • Use Peers to provide navigation services and hire them with respectable wage. They do not have to have a PhD. More powerful to hire peers. Representation of the people you serve is important. (Status Neutral Committee)
              Thematic Analysis of Prevent Pillar

              PREVENT PILLAR

              Sampling of EHE Committee Recommendations

              Workforce

              • Have a conversation with the patient in order to get information that the organization needs for the intake packet, not just hand them a long packet to fill out. (Status Neutral Systems Committee)
              • Should do a better job of explaining why the information being completed is important. (Status Neutral Systems Committee)
              • Have peer navigators for PrEP, individuals that are representative of community and taking PrEP themselves. Navigators similar to HIV case manager, should be for PrEP – checking on access to care, labs, meds, as well as support system to stay on PrEP. Also, to check in on other health issues, such as STIs. Check in on feelings around being on PrEP, are they experiencing negative impact or internalized stigma. Train navigators on trauma informed care. (Status Neutral Systems Committee)

              Organizational Capacity Building

              • Need to educate people, such as Doctors’ offices/OB/GYN or therapists, that have access to the people. Teaching those that have access to the people to provide PrEP information. (Status Neutral Systems Committee)

              Education & Awareness

              • Adopt [lay terminology] and people –first language instead of vague terminology to use in promotions (Education and Awareness Committee)
                • Update messaging based on what’s current
              • Increase education and awareness around the strategy treatment as prevention (TasP) and language gaps (Education and Awareness Committee)
                • Provide PrEP education to providers and encourage them to discuss PrEP with their patients (Outreach and Community Engagement Committee)
              • Passive Education moments via video. Use TV that are in the lobby of medical offices to put up PrEP education or ads. Put PrEP informercials in medical exam rooms and in rooms in non-profit. Also, use informercials in waiting room of other types of businesses within neighborhoods/community and in places like homeless shelters or food pantry. (Status Neutral Systems Committee)
              • Engage health care schools and programs to educate students (e.g., medical, nurse practitioner, nursing, and any other healthcare program) on PrEP and HIV prevention. (Policy and Social Determinants Committee)

              Resource Availability & Accessibility

              • People need a long-term preventative method that people don’t have to think about like a shot (Outreach and Community Engagement Committee)
              • Partner with local HIV organizations to provide same-day PrEP start with evening hours. (Policy and Social Determinants Committee)
              • PCP should be offering PrEP at wellness checks.
                • Provide support for PCP navigation to get PrEP to patients. (Policy and Social Determinants Committee)
              • Public health campaign to educate people on PrEP engagement opportunities (Policy and Social Determinants Committee)
                • Public campaign on Mistr and Sistr and Q Care on telehealth.
              • Investigate awareness and accessibility for PEP. Identify prescriptions for Truvada/Descovy and HIV test completed. Mobile PrEP clinic. Normalizing PrEP/PEP conversations within PCP visits. Explore feasibility of PrEP DAP. (Research and Data Evaluation Committee)
              • Have HHD/ Texas Department of Health partner with rural areas Doctor offices/ FQHC to provide PrEP/ HIV testing. (Policy and Social Determinants Committee)

              Quality Assurance

              • Assess policies around the HIV positivity rate (Outreach and Community Engagement Committee)
                • Refrain from just seeing people as numbers
                • Celebrate negative tests
              • Provide best practices for same-day PrEP. Feasibility and workflows, tools to support implementation. (Research and Data Evaluation Committee)
              • Survey clients for preferred entry points. Measure utilization by priority population.
              • Explore feasibility fully implementation of telemedicine services. (Research and Data Evaluation Committee)

              Anti-Stigma

              • Make the messaging of programs and initiatives universal and inclusive with people first language. (Outreach and Community Engagement Committee)
                • Share the stigma
                • Consider early sexual debut
                • Prioritize other populations besides gay men

              Mental/ Behavioral & Substance Use

              • Support self-efficacy/resiliency to mitigate individual risk and improve sustainability (Outreach and Community Engagement Committee)
              • Have a safe location where people can use and have staff with a healthcare provider RN/NP. (Policy and Social Determinants Committee)
              • Provide ongoing counseling for behavior change/risk reduction (Outreach and Community Engagement Committee)

              Policy/Advocacy

              • Remove prescription requirements and have outreach workers on site when testing in nontraditional areas late at night. (Outreach and Community Engagement Committee)
              • End abstinence only programs in schools and teach healthy sex education!
                • Perhaps partner with local churches to teach sexual health to the youth. Of course, the scope of the education and participation will vary. (Policy and Social Determinants Committee)
              • (Advocate for syringe service programs (SSPs) and safe injection sites) Model SSP after various programs that include insulin and/or hormone therapy (Policy and Social Determinants Committee)
                • Austin program
              • PrEP being made available or able to be prescribed over the counter by pharmacistspass a law! (Policy and Social Determinants Committee)
                • Similar to programs located in Nevada, California, and North Carolina
                • Implement a state gap program or city program.
                • Drug assistance program like that in Washington State (start PrEP, labs, visits)
              • Advocate for health department services that are reimbursable through Medicaid/Medicare for status neutral, PrEP, and HIV treatment (Policy and Social Determinants Committee)

              Cultural Awareness & Competency

              • Explore feasibility of co-current delivery of gender affirming care and PrEP. (Research and Data Evaluation Committee)

              Building and Maintaining Partnerships

              • Host focus groups of community members in high-risk areas (e.g., Home Depot, adult bookstores, transwomen sex workers) and hear from those communities (Outreach and Community Engagement Committee)
              • People, providers, advisory boards- In terms of advisory boards, sometimes they are needed and other times they are not. Providers or whomever should tap into networks that already exist to get feedback when developing strategies including people living with HIV to make sure what’s being proposed will work. (Policy and Social Determinants Committee)

              Housing

              • Find resources, such as housing, transportation, food assistance, for people who are HIV negative and seek PrEP will help them maintain PrEP adherence. (Status Neutral Systems Committee)
              • Provide subrecipient/funded organizations with payment points for linking people to PrEP, as well as keeping appointments and then link people on PrEP to housing and supportive services. (Status Neutral Systems Committee)
              Prevent Pillar

              RESPOND PILLAR

              Sampling of EHE Committee Recommendations

              Workforce

              • Do more education with HIV workforce and community on the roles of partner services and stigma. Educate on how to explain the PS role to people getting an HIV test. Educate DIS on stigma. (Status Neutral Committee)

              Organizational Capacity Building

              • Level up- Look at what the providers and funders are doing in addition to community members and get them to make structural changes (Education & Awareness Committee)
              • Talk to HIV professionals/providers to encourage people to enter the field. (Status Neutral Committee)

              Education & Awareness

              • Educate community on MHS/CDR (Outreach and Community Engagement Committee)
                • Formally present to community at large about MHS/CDR and how clusters are identified and what is done with the information
                • Improve public and individual understanding of what information is available to the government
                • Discuss changes on MHS/CDR and surveillance with larger community
                • Provide a realistic picture of how the system works
                • Emphasize there is no way of knowing how people are a part of a cluster
              • If there is an HIV outbreak what ways can the City HHD reach out to a community to respond to that outbreak without stigmatizing that community? What would you do to notify a community of an HIV breakout? (Status Neutral Committee)
                • Billboards, social media, using local radio – make the broadcast general to avoid stigmatizing the neighborhood or community.
                • Create an alert via phone to say when there is a high outbreak area, and you may want to call a number for more information or where to get tested.
                • Offer in multiple languages.
                • Need more vast advertising with HIV like has happened with COVID.

              Resource Availability & Accessibility

              • Understand differences in support and duplicate the support provided for PLWH to also reflect support for those without HIV (Education & Awareness Committee)
              • Community interventions (CAB, Community spaces, and wrap around care to address barriers) need to further invest into further effect on retention in care, normalization of viral suppression, de-stigmatization of HIV and incentives that allow for more community centered harm reduction. (Policy and Social Determinants Committee)
              • Prioritize neighborhoods where people spend their leisure time instead of just where they live (Outreach & Community Engagement Committee)

              Quality Assurance and Evaluation

              • Develop community education events and measure participation and knowledge retention of response activities and education. (Research and Data Evaluation Committee)
              • Assess the make-up of the CAB and evaluate service provide. Compare composition of CAB with people impacted. (Research and Data Evaluation Committee)
              • Measure community participation. Develop survey to capture gaps or needs perceived by participants (Research and Data Evaluation Committee)

              Anti-Stigma

              • Reach outside the state to other sources (e.g., Gilead, AETC, NMAC) to address stigma through trainings like anti-bias/stigma training for providers/PLWH (Education & Awareness Committee)
              • Create environments where there is no stigma like Hip Hop for HIV (Education & Awareness Committee)
              • Explore the MHS/CDR and DIS efforts for anti-stigma, how to reduce stigma in their activities/workday (Status Neutral Committee)

              Mental/ Behavioral & Substance Use

              • Increase self-efficacy to change around HIV through education and risk-reduction opportunities (Outreach & Community Engagement Committee)
              • Cultivate a more routine health habit for a wellness reframing approach (Education & Awareness Committee)

              Policy/Advocacy

              • Look at other states’ laws on who face criminalization issues (e.g., Missouri, Oklahoma, Kansas) and states who have been more progressive with addressing HIV laws [Followup about what they are doing with it, action] (Education & Awareness Committee)
              • Explore moratorium on MHS activities to combat concern of HIV criminalization (Education & Awareness Committee)
              • Agencies should be more transparent to advocate for privacy/protection around MHS/CDR (Outreach & Community Engagement Committee)
              • Include funding to support a strategic response to new cases of HIV based on HIV data collection practices to address the root causes of HIV. (Policy and Social Determinants Committee)

              Cultural Awareness & Competency

              • Improve PrEP marketing to young people (Outreach and Community Engagement)
              • Young people think PrEP is only for gay individuals. Commercials depict flamboyant individuals—should be more about wellness and integrate images of being healthy. (Status Neutral Committee)
              • Representation in all avenues– see people like them in any demographic helps encourage peers to join the efforts. (Status Neutral Committee)

              Building and Maintaining Partnerships

              • Increase [first line] communication from DIS to CBOs. (Research and Evaluation Committee)
                • Outcomes from CBO’s feels like a true partnership
                • Discuss struggles, what they go through
                • Build relationships
                • Easier for CBO’s to do warm hand off
                • Made aware someone from the HD would be reaching out
              • Have the CAB be thoughtfully expanded and given strong direction. (Policy and Social Determinants Committee)
                • Key activities: change host bi-annual community forums as a platform to analyze gaps and identify best practices to address the gaps to “Host bi-annual community forums as a platform to RAISE awareness about what Molecular Surveillance is and how it is used, and how to analyze gaps and identify best practices to address the gaps.”
                • Partner with DIS to increase education in communities on their successes, challenges, outcomes, and other partnerships
              • Reach out to representation influencers that can reach out to younger population and incentivize them to get involved. (Status Neutral Committee)