Report on Findings

HealthHIV’s Sixth Annual State of HIV Care™ National Survey identifies barriers that HIV care providers face in delivering care, captures their perspectives on existing resources, and highlights their experiences with achieving patient outcomes in 2024. These survey insights create vital education and training for the HIV care workforce and inform advocacy and research priorities for the coming year. The survey questions were developed using the HIV Care Continuum, a status-neutral framework that outlines the stages of HIV care. By framing the survey around this continuum, the survey ensures a comprehensive understanding of the interconnected nature of prevention and care in addressing HIV.

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Key Findings Workforce Care &
Treatment Prevention Behavioral Health Sexual Health Anti-LGBTQ Policies Implications Survey Data References

Overview

The U.S. has set ambitious targets through the Ending the HIV Epidemic in the U.S. (EHE) initiative, aiming to reduce new HIV infections by 75% by 2025 and 90% by 2030, increase PrEP coverage to 50% by 2025, and ensure that 95% of newly diagnosed individuals are linked to medical care by 2025.¹ Despite these goals, progress has been slow, with significant barriers hindering achievement.² Although improvements in insurance coverage have been made over the past decade, largely due to Medicaid expansion under the Affordable Care Act (ACA), over 40% of working-age Americans remained underinsured in 2022.^3, Complex insurance practices continue to create significant gaps in care, disproportionately impacting younger, Latinx/Hispanic, economically disadvantaged individuals, and those residing in the South—populations that also face increased vulnerability to HIV.^3, ⁴ These overlapping social and health challenges underscore the critical role of HIV care in addressing broader syndemics, where interconnected social and medical issues compound the burden of disease and make comprehensive, equitable care even more essential. In 2023, nearly one-third of Americans lived in primary care Health Professional Shortage Areas, further exacerbating the national workforce shortages and burnout crises, which strain healthcare systems and hinder engagement in HIV prevention and treatment services.⁵

Previous State of HIV Care National Surveys have consistently identified similar challenges, such as workforce burnout, behavioral health concerns, HIV criminalization, and the social and political determinants of health. The recurrence of these issues emphasizes their persistent nature, especially with regard to funding constraints and insurance barriers. However, new findings from 2024 highlight some important developments. There has been a marked shift toward treatment innovation, with widespread adoption of long-acting injectables reflecting the growing enthusiasm among providers for novel strategies in HIV care. Despite this, there is heightened concern among participants about policies that reinforce stigma and increase barriers to care, particularly for populations disproportionately impacted by HIV. These policies exacerbate the inequities within the healthcare system, making it even more difficult to achieve the EHE goals.

This report, based on insights from frontline healthcare providers, offers a critical look at the current state of HIV care in the context of EHE objectives. Understanding the systemic gaps and challenges faced by healthcare professionals is crucial for informing strategies that will improve HIV prevention and treatment, ensuring progress toward the 2025 and 2030 targets for ending the HIV epidemic in the U.S.

The State of HIV Care

In asking respondents to capture the State of HIV Care in one word, “improving” emerged prominently at the center, symbolizing the significant advancements in treatment and support; encircling it are “evolving”, “progressing,” “lacking,” and “hopeful,” which together convey a nuanced picture of ongoing challenges, potential for growth, and a collective optimism for the future.

What is the State of HIV Care in one word?

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Data from the HealthHIV State of HIV Care™ Sixth Annual National Survey
HealthHIV.org/stateof/hivcare

Key Findings

Workforce Shortages, Inadequate Compensation, and Burnout Create a Challenge to Quality HIV Care
Providers report that workforce shortages, inadequate compensation, and burnout are the primary barriers to quality care, underscoring an urgent need for increased funding and staffing support.
Providers Request Training on New Treatments and Health Equity
Clinicians and service providers emphasize the need for training in innovative HIV treatments, such as long-acting injectables, as well as guidance on addressing health disparities and navigating funding challenges. These areas are vital for improving care delivery and addressing systemic inequities.
Lack of Essential Behavioral Health Services Driving Gaps and Undermining Care for People with HIV
Many organizations are missing essential services, particularly in behavioral health and social services, resulting in the exclusion of social determinants of health from necessary care. Fewer than 30% of respondents offer services like childcare, inpatient detox, and crisis support, highlighting a national shortage of behavioral health care providers. This deficiency poses a barrier to meeting the broader health needs of people with HIV (PWH) and those at risk.
Ongoing Stigma Hindering Retention in HIV Care for Priority Populations
Stigma significantly complicates retention in HIV care, as many organizations struggle to provide sufficient behavioral health support. Fear of judgment and distrust in healthcare systems hinder access to care, especially for priority populations, including those experiencing homelessness and individuals who use substances.
Insurance Barriers Slowing Access to PrEP and HIV Care, Highlighting Need for Reform
Insurance barriers, such as formulary restrictions, high co-pays, and prior authorizations, delay access to ART and PrEP, disproportionately impacting priority groups. Providers face limitations in delivering care, and many lack familiarity with zero-cost-sharing guidelines for PrEP, emphasizing the need for policy reforms and targeted training to improve access and outcomes.

These findings reflect systemic challenges that the HIV care workforce faces, including the need for more comprehensive service offerings, expanded workforce training, and policy reform to reduce stigma and legal barriers in care provision.

About the Report

This report is structured to present a clear overview of the main findings and inferences from the HealthHIV Sixth National State of HIV Care™ survey, supported by relevant graphics that illustrate key trends and insights. The addendum contains all survey questions and detailed data to provide transparency and allow for deeper analysis, ensuring that those interested can review the underlying information that supports the report’s conclusions.

Participant Background

Total Respondents

966 professionals who provide HIV-related services across the care continuum.

Geographic Reach

Responses came from providers in 46 states, Puerto Rico, and the District of Columbia.

Healthcare Settings Represented

Community-Based Organizations (CBOs)
Community Health Centers
Ryan White HIV/AIDS Program Clinics
Health Department Clinics

Priority Populations Served

The majority of providers offer services to all listed priority groups, with particular emphasis on:

People experiencing homelessness or who are unhoused
Individuals with substance use disorders
Non-English-speaking individuals
Organizations located in urban areas

Survey Findings

State of the HIV Care Workforce

Workforce Crisis Deepens

Survey findings highlight a dire need for increased funding and staffing across the entire HIV care continuum. Providers from diverse professional backgrounds overwhelmingly report that staff shortages and inadequate compensation are the most pressing challenges facing the workforce. This marks the third consecutive State of HIV Care Survey where workforce shortages have been identified as one of the greatest barriers to effective HIV care, revealing a persistent crisis that threatens the future of care delivery.

Critical Service Gaps Exposed

There are clear gaps in essential services across HIV, HCV care, sexual and behavioral health, and social determinants of health. Providers are least able to offer critical resources like childcare, inpatient detox services, Intensive Outpatient Services, syringe exchange programs, and crisis support—underscoring a nationwide shortage of behavioral health professionals and social services that leaves priority populations at risk.⁶

Respondents were least likely to report offering the following services:

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HIV Care and Treatment

Evolving Priorities in HIV Care

Aging with HIV, Stigma and Discrimination, and Behavioral Health are the three most important HIV care topics. Notably, aging with HIV has surged from second to first place, while behavioral health has dropped from the top spot to third. These shifts reflect the changing landscape of HIV care, with providers increasingly focused on the unique needs of an aging HIV-positive population, while still grappling with the persistent challenges of stigma and mental health.

Most timely and important HIV Care topics:

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Retention in care is identified as the highest priority step in the HIV care continuum for the second year in a row. Increased retention and re-engagement in care will be necessary to meet EHE goals.

Providers believe these components need the most attention in the HIV Care continuum:

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Significant engagement with long-acting injectables for HIV treatment suggests provider interest in novel approaches to care that might help their patients remain adherent to medication.⁷ However, it also suggests the need for training on and funding for other ways to support adherence, including virtual appointments, case management, and mobile services.

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Among participants who are familiar with their organization’s health data…

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Urgent Need for Provider Training

A growing demand among HIV care providers for training on treatment innovations and best practices is evident. This reflects the mounting pressures faced by the workforce to keep pace with rapid advancements in HIV care, as providers strive to meet the evolving needs of their patients in an increasingly complex healthcare landscape.

Among respondents who personally provide HIV care…

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Hurdles in HIV Treatment Access

Providers often face patient refusals when attempting to link individuals to HIV treatment following diagnosis. Even when patients are willing, the struggle to secure timely appointments persists. These barriers underscore the urgent need for an expanded workforce and the adoption of alternative care models, such as pharmacist-led or mobile device-based treatment, to better serve diverse populations and improve access to care.^8, ⁹

Linkage to Care

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Starting ART

Once patients are linked to treatment, insurance barriers often disrupt smooth ART initiation, a process that may be further complicated by patient concern about medication side effects. Even more, social barriers like transportation instability and stigma prevent many from staying in care once treatment has been initiated.

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Retention in Care

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Insurance Barriers

Insurance issues can create significant barriers to timely care. Providers are often prevented from offering crucial services due to payer restrictions including prior authorization requirements, large co-pays, and limited formularies.

Providers report private employer-sponsored insurance generally requires the most time to complete and receive a determination for ART.
29% of respondents report being unable to provide HIV services due to payer/insurance restrictions sometimes, often, or all the time.

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HIV Prevention

Gaps in Prevention Efforts

PrEP providers stress that outreach and promotion require more attention than other steps along the continuum of preventive care. Many organizations are not effectively reaching high-risk groups such as individuals experiencing homelessness, youth, and people who use substances. This gap highlights the urgent need for targeted outreach to ensure PrEP access to those disproportionately impacted by HIV.

Providers believe these components need the most attention in the PrEP Care continuum:

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Providers report their organizations could be better at reaching these populations with HIV prevention services:

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The majority of participants familiar with their organization’s health data report testing and PrEP usage rates have increased over the last year. However, increased funding and workforce preparation are needed to maintain upward trends.

Top needs to improve PrEP services:

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Among participants who are familiar with their organization’s health data…

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Training and Knowledge Gaps in PrEP Care

PrEP providers are seeking more training on emerging prevention innovations, such as on-demand PrEP and injectables, as well as on how to provide PrEP to priority populations. Additionally, less than half of respondents are familiar with the Department of Health and Human Services guidelines on zero-cost sharing and co-pays for PrEP, indicating a significant gap in provider knowledge that needs to be addressed.

Just over half of providers are familiar with HHS guidelines on zero-cost sharing and co-pays for PrEP:

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Critical Barriers to Prevention Exposed

Patient refusal, fueled by stigma or a false sense of invulnerability to HIV, stands as a major barrier to both HIV testing and PrEP linkage. Providers also cite workforce shortages and discomfort discussing PrEP as significant obstacles. Even once patients are linked to care, insurance restrictions emerge as the greatest hurdle to prescribing PrEP, underscoring the complex challenges in delivering effective prevention.

Testing

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Linking to PrEP

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Health insurance plans that require the most time to complete and receive a determination for PrEP, as reported by providers:

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Prescribing PrEP

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Most common reasons clients/patients discontinue PrEP:

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Behavioral Health

Behavioral Health Gaps in HIV Care

There is a dire shortage of behavioral health providers in the HIV field, with the majority of respondents stating that their organizations cannot meet the growing demand for services. This aligns with the broader mental health challenge—over 50% of adults with mental illness received no treatment in 2023.¹⁰ The problem is particularly acute in Southern states, such as Alabama, Arkansas, and Mississippi, which are also critical areas for the CDC’s Ending the HIV Epidemic initiative, highlighting a pressing need for expanded mental health care in these regions.¹¹

Most respondents believe there are not enough behavioral health providers to meet the demand for services:

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Barriers to Behavioral Health Care for People with HIV

Fear of stigma or discrimination, along with a lack of trust in health systems and professionals, are major challenges to accessing mental health services for people with HIV (PWH). Providers report that retaining patients in mental and behavioral healthcare is particularly difficult for populations such as those experiencing homelessness, people who use substances, and individuals who are underinsured or uninsured. These barriers highlight critical gaps in care for priority populations.

Top challenges to accessing mental health services from the patient/client perspective:

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Populations that are most difficult to keep in mental/behavioral healthcare:

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Sexual and Reproductive Health

Critical Gaps in Sexual and Reproductive Health Care

A troubling disconnect in sexual healthcare remains: while most providers offer site-specific STI testing, only 61% provide Doxy-PEP and just 55% offer Expedited Partner Therapy.^12, ^13, ¹⁴ Even though routine STI testing is common, less than half of providers conduct testing at every visit. While nearly all providers are comfortable taking sexual histories, far fewer complete a comprehensive history that includes all recommended components, highlighting significant gaps in care and engagement with vital prevention and treatment innovations.

Best Practices for Sexual Healthcare

Among those respondents who personally provide sexual healthcare services…

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Anti-LGBTQ Policies

Anti-LGBTQ Policies Are Undermining HIV Care and Widening Health Disparities

Anti-LGBTQ healthcare policies present significant obstacles for HIV providers working to deliver equitable and effective care. These policies foster stigma and mistrust, discouraging LGBTQ individuals from engaging with prevention, testing, and treatment services.¹⁵ Marginalized groups, such as Black and Hispanic LGBTQ individuals, often experience compounded discrimination, further deepening health disparities and inequities.^16, ¹⁷

Providers widely recognize the harmful impact of anti-LGBTQ policies on public health outcomes. In addition to creating hostile healthcare environments, some state-level interventions intended to address public health challenges inadvertently reinforce harm. For example, statutes empowering public health officials with broad authority can alienate LGBTQ communities and hinder progress in fostering culturally affirming care.

To effectively advance health equity, HIV providers must navigate these systemic barriers while working to dismantle anti-LGBTQ policies that perpetuate discrimination and undermine trust. Prioritizing an intersectional approach that addresses these policies’ far-reaching consequences is essential for improving outcomes and ensuring all individuals have access to affirming, high-quality HIV care.

The majority of providers believe HIV criminalization policies impact the health of their clients:

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The majority of providers believe that HIV criminalization policies have a negative impact on public health efforts to prevent HIV transmission:

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Most providers have never counseled a patient on legal risks related to HIV criminalization:

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Almost all providers believe anti-LGBTQ healthcare policies impact the health of their clients/patients:

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Half of providers believe the recent escalation of anti-trans healthcare legislation across the country has negatively impacted the mental health of their transgender and/or gender non-conforming clients/patients:

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Almost all providers think harm reduction criminalization policies or laws impact the health of their clients/patients:

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Implications and Opportunities

The survey findings highlight the complex disconnect between barriers and opportunities to optimize HIV care and end the epidemic.

Barrier

The current HIV workforce is facing significant challenges, with experienced providers reporting burnout, poor compensation, and an approaching wave of retirements.¹⁸ While the gap between available, trained HIV providers and PWH grows, we have entered the next phase in HIV treatment development that has the opportunity to end the epidemic. In order to capitalize on new therapy development and true HIV care innovation, an expanded and experienced workforce is needed.

Opportunity

Expanding training opportunities for the next generation of HIV care providers, including primary care and general medicine professionals, can help alleviate workforce shortages and burnout. The survey demonstrated providers’ interest in training on treatment innovations and health disparities. Over two-thirds of providers already offer long-acting injectable treatments for HIV, indicating a willingness to adopt innovative approaches. There is an opportunity to provide more medical education that is responsive to current workforce needs, fostering expansion and innovation in HIV care.

Barrier

Despite treatment innovations, viral suppression among PWH remains at 65% due to ongoing gaps in social and behavioral health services, such as housing insecurity, mental illness, and the opioid epidemic. Despite treatment innovations, viral suppression among PWH remains at 65% due to ongoing gaps in social and behavioral health services, such as housing insecurity, mental illness, and the opioid epidemic.

Opportunity

Expanding behavioral health and social services is essential to addressing these gaps and helping priority populations maintain HIV care while managing co-occurring conditions like mental health issues and substance use. By tackling these intertwined challenges, we can improve long-term health outcomes and support viral suppression.

Barrier

Patients continue to face barriers to treatment access. Providers report that insurance and payor barriers keep patients from accessing regular HIV care and new therapies and directly affects the health outcomes of their clients.

Opportunity

Healthcare organizations and systems need sustained funding to provide support services, as well as expanded insurance coverage and reforms to ensure clients have continuous access to HIV care.

Breaking Barriers and Building Opportunities to End the HIV Epidemic

Addressing the ongoing disconnect between opportunities and barriers in HIV care requires a multi-faceted, forward-thinking approach. While the development of innovative HIV treatments opens doors to ending the epidemic, significant gaps in workforce capacity, social services, and policy support continue to hinder progress. Expanding the HIV care workforce, enhancing training for both seasoned and new providers, and improving access to behavioral and social services are all critical steps in achieving long-term health outcomes for people with HIV. Advocacy efforts must prioritize sustainable funding, equitable insurance reforms, and the dismantling of discriminatory policies, particularly those targeting LGBTQ individuals and people with HIV. By championing these priorities, healthcare providers and policymakers can drive a more inclusive and impactful response to the HIV epidemic, moving us closer to the goal of ending it by 2030.

Implications for HIV-Related Advocacy

The survey findings highlight the urgent need for advocacy against HIV criminalization laws and anti-LGBTQ policies to protect patient well-being and public health. Survey respondents identified the role of providers in advocating for policy reform as essential—not only to safeguard patient rights but also to create a care environment where patients feel safe and supported. By working toward policy changes, providers can help reduce barriers to HIV prevention, treatment, and support, ultimately improving health outcomes for patients facing discrimination and legal stigmatization.

Advocating Against HIV Criminalization and Anti-LGBTQ Policies to Safeguard Patient Well-Being

HIV criminalization laws and anti-LGBTQ policies pose profound risks to patient well-being and public health. Providers are positioned to play a key role in advocating against these policies, both to protect patient rights and to foster an environment where patients feel safe accessing care. By supporting policy reform efforts, providers help reduce barriers to HIV prevention, treatment, and support, improving overall health outcomes for patients facing discrimination and legal stigmatization.

To effectively address the pressing concerns surrounding HIV, advocacy priorities must be flexible and cross-disciplinary, incorporating adaptable strategies that integrate diverse fields and perspectives.

Key Advocacy Priorities from Survey Findings

By focusing on these areas, advocates can work towards a more equitable and effective approach to HIV care.

Long-Term Funding

Prioritize workforce growth at local, state, and federal levels.
Significant expansion of the HIV care workforce is essential to meet the U.S. goal of Ending the HIV Epidemic by 2030.

Sustainable Change

Even with increased funding and new staff, lasting improvements depend on addressing entrenched inequities in policy.

Policy Advocacy

Fight for Medicaid expansion in the remaining ten states.
Advocate for greater oversight of private insurance practices.
Confront harmful policies, such as gender-affirming care bans that have been enacted in 26 states.¹⁹ Nearly all respondents believe that these harmful policies directly affect the health of their clients and patients.

HealthHIV Research and Evaluation conducts regular national surveys to better inform ongoing advocacy, education, research, and training activities. These “State Of” surveys provide unique insight into patient and provider issues in order to optimize primary and support services for diverse communities. The regular reports offer the ability to study multi-year trend analyses illustrating changes, challenges, and opportunities to address the needs of providers and patients. HealthHIV, HealthHCV and the National Coalition for LGBTQ Health conduct State of surveys addressing HIV care, HCV care, LGBTQ healthcare, and aging with HIV.

HealthHIV.org/StateOf

Appendix: State of HIV Care Survey Data

Organization Background

Response	Percentage
Academic Hospital/Clinic	7.67%
Addiction Center	.57%
Advocacy Organization	1.28%
AIDS Service Organization (ASO)	6.39%
Community Based Organization (CBO)	18.4%
Community Center	1.85%
Community Pharmacy	.85%
Emergency Room/Urgent Care	.28%
Federally Qualified Health Center (FQHC)	16.05%
Government Entity (Local, State, Federal)	6.96%
Health Department (Non-Clinic)	2.70%
Health Department (Clinic/Public Health Clinic)	11.22%
LGBTQ Health Center	2.13%
Other	4.97%
Private Hospital/Clinic	2.13%
Private Practice	2.13%
Ryan White HIV/AIDS Program Clinic	11.65%
Specialty Pharmacy	.71%
Substance Use Treatment Facility	.71%
University/College	1.28%
Veterans Affairs Medical Center	.43%

Response	Percentage	Count
Alabama	1.29%	9
Alaska	.86%	6
Arizona	2.00%	14
Arkansas	.86%	6
California	6.71%	47
Colorado	.86%	6
Connecticut	1.86%	13
Delaware	.86%	6
District of Columbia	2.71%	19
Florida	10.00%	70
Georgia	2.86%	20
Hawaii	.14%	1
I do not live/work in the U.S.	1.71%	12
Idaho	.29%	2
Illinois	3.71%	26
Indiana	1.57%	11
Iowa	.14%	1
Kansas	.57%	4
Kentucky	1.29%	9
Louisiana	2.29%	16
Maine	.14%	1
Massachusetts	2.57%	18
Michigan	4.43%	31
Mississippi	1.00%	7
Missouri	1.71%	12
Montana	.43%	3
Nebraska	.14%	1
Nevada	.71%	5
New Hampshire	.29%	2
New Jersey	2.57%	18
New Mexico	.29%	2
New York	8.57%	60
North Carolina	2.71%	19
Ohio	2.14%	15
Oklahoma	.43%	3
Oregon	.57%	4
Pennsylvania	3.57%	25
Puerto Rico	.86%	6
Rhode Island	.29%	2
South Carolina	3.00%	21
Tennessee	.57%	4
Texas	4.00%	28
Utah	.29%	2
Virginia	2.86%	20
Washington	2.14%	15
West Virginia	1.29%	9
Wisconsin	.86%	6
Wyoming	.71%	5

Setting (Select all that apply)	Count
Urban	488
Rural	203
Suburban	175
Tribal	13

Response	Percentage
No	53.12%
Yes	46.88%

Response	Percentage	Count
Medicaid	56.11%	542
Medicare	52.07%	503
Other Public Insurance	43.69%	422
Employer-Sponsored Insurance	43.17%	417
Other Private Insurance	45.86%	443
Income Dependent/Sliding Scale	39.75%	384
Other	15.32%	148

Services Offered

Response	Percentage	Count
Preventative Health Screening	48.76%	471
Immunizations and Vaccinations	46.69%	451
Medication Management/Prescriptions	43.06%	416
Management of Chronic Conditions	41.72%	403
Annual Exams or Physical Exams	40.58%	392
Medicare Wellness Visits	28.88%	279
Minor In-Office Surgical Procedures	15.84%	153
None of the Above	11.39%	110
Other	8.59%	83

Response	Percentage
No	29.39%
Yes	70.61%

Response	Percentage
No	31.92%
Yes	68.08%

Response	Percentage
No	40.35%
Yes	59.65%

Response	Percentage
No	21.82%
Yes	78.18%

Response	Percentage	Count
HIV Prevention Education	58.70%	567
HIV Testing	57.87%	559
Linkage to Care/Treatment	57.04%	551
Condom Distribution	56.31%	544
Provision of PrEP	50.52%	488
Behavioral Risk Reduction Interventions	48.14%	465
Partner Services	40.68%	393
Provision of nPEP	38.61%	373
Other	4.14%	1

Response	Percentage	Count
STI Screening and Testing	57.56%	556
HPV Screening or Vaccinations	43.06%	416
Viral Hepatitis (A, B) Services (including vaccination)	42.34%	409
Family Planning Services	30.54%
Gender Affirming Services	25.26%	244
Expedited Partner Therapy (EPT)	22.36%	216
None of the Above	10.04%	97
Other	3.52%	34

Response	Percentage	Count
Case Management	52.07%	503
Transportation Services (bus passes, ride share, etc.)	47.31%	457
Health Care Insurance Navigation (ACA plans, SSDI/SSI, etc.)	38.61%	373
Food/Nutrition Services (food pantry, food stamps, etc.)	36.85%	356
Housing Services	28.67%	277
None of the Above	7.45%	72
Child Care	3.52%	34
Other	3.52%	34

Response	Percentage	Count
Individual Psychotherapy/Counseling	39.65%	383
Peer-Led Support Groups	26.81%	259
Outpatient Medicine Management	26.60%	257
Group Psychotherapy/Counseling	21.84%	211
Medication Assisted Treatment (MAT)	21.12%	204
None of the Above	13.56%	131
Crisis Support/Hotlines	12.84%	124
Syringe Exchange Services	11.80%	114
Inpatient Treatment	9.73%	94
Intensive Outpatient Services (IOP)	7.76%	75
Inpatient Detox Services	3.93%	38
Other	2.90%	28

Populations Served

Response	Percentage	Count
Adults (25-49)	65.94%	637
Older Adults (50+)	62.84%	607
Youth (18-24)	60.35%	583
Children and Adolescents (Under 17)	33.13%	320

Response	Percentage	Count
Gay Men/Men Who Have Sex With Men (MSM)	66.46%	642
People Who Identify as Bisexual	65.32%	631
People Who Identify as Transgender	63.77%	616
Lesbians/Women Who Have Sex With Women (WSW)	62.84%	607
People Who Identify as Queer	62.84%	607
People Who Identify as Non-Binary	61.59%	595
None	2.17%	21

Response	Percentage	Count
People Experiencing Homelessness/Unhoused	62.53%	604
People with Substance Use Disorders	62.01%	599
Non-English-Speaking Individuals	60.04%	580
Women of Childbearing Age	58.07%	561
People Who Are Incarcerated or Formerly Incarcerated	56.83%	549
Immigrants/Refugees	54.87%	530
Undocumented Persons	54.35%	525
Pregnant Women	50.72%	490
None of the Above	1.55%	15

Participant Professional Background

Response	Percentage
Clinical	39.09%
Non-Clinical	60.91%

Response	Percentage
Dentist	1.87%
Dietician/Nutritionist	.37%
Endocrinologist	.37%
Licensed Clinical Social Worker	3.75%
Licensed Practical Nurse	5.62%
Medical Assistant	3.37%
Mental Health Case Manager	1.12%
Mental Health Professional	5.24%
Nurse Manager	4.12%
Nurse Practitioner	18.35%
Occupational Therapist	.37%
Other Provider/Clinical Professional	7.12%
Pharmacist	7.12%
Physician (MD/DO)	18.35%
Physician Associate	3.75%
Registered Nurse	19.10%

Response	Percentage	Count
Addiction Medicine/Substance Use	3.00%	29
Cardiology	.21%	2
Correctional Medicine	.31%	3
Diabetology	.21%	2
Emergency Medicine	.41%	4
Endocrinology	.21%	2
Family Medicine	5.69%	55
Gastroenterology	.10%	1
Hematology	.21%	2
Hepatology	.72%	7
HIV Medicine	10.56%	102
Infectious Disease	8.70%	84
Internal Medicine	3.31%	32
Managed Care	.52%	5
OBGYN/Women’s Health	1.66%	16
Oncology	.41%	4
Pediatrics	1.97%	19
Pharmacy	1.14%	11
Primary Care	3.93%	38
Psychiatry/Behavioral Health	2.69%	26
Pulmonology	.21%	2
Rheumatology	.10%	1
Other	2.38%	23
None of the Above	1.76%	17

Response	Percentage
No	55.81%
Yes	44.19%

Response	Percentage
Administrator	22.36%
Advocate	4.81%
Case Manager/Medical Case Manager	17.07%
Clergy/Faith-Based Professional	.24%
Community Health Worker	12.02%
Disease Intervention Specialist	3.13%
Harm Reductionist/Risk Reductionist	2.40%
Health Education Specialist	5.77%
Health Navigator	4.09%
Medical Billing	.72%
Mental Health Professional	.72%
Non-Clinical Professional	12.26%
Outreach Worker	5.77%
Researcher	3.13%
Student	.24%
Substance Use Counselor/Professional	.72%

Response	Percentage
Less Than 2 Years	19.50%
11-20 Years	20.53%
2-4 Years	21.99%
21+ Years	17.89%
5-10 Years	20.09%

Participant Demographics

Response	Percentage
Female/Woman	65.38%
Genderqueer/Gender Non-Conforming/Non-Binary	3.57%
Male/Man	27.19%
Prefer Not to Respond	1.93%
Prefer to Self-Describe	.59%
Transgender Man	.89%
Transgender Woman	.45%

Response	Percentage
Asian and/or Asian American	1.79%
Black or African American	31.49%
Multiracial	7.16%
Native American or Alaska Native	.60%
Native Hawaiian or Pacific Islander	.15%
Prefer Not to Respond	5.97%
Prefer to Self-Describe	2.69%
White or Caucasian	50.15%

Response	Percentage
No	79.20%
Prefer Not to Respond	3.86%
Yes	16.94%

Response	Percentage
18–24	1.49%
25–34	11.89%
35–44	21.84%
45–54	24.67%
55–64	25.71%
65+	11.29%
Prefer Not to Respond	3.12%

Workforce Burnout

Response	Percentage
A Few Times a Month	23.86%
A Few Times a Week	15.32%
A Few Times a Year or Less	24.45%
Every Day	6.92%
Never	7.51%
Once a Month or Less	13.11%
Once a Week	8.84%

Response	Percentage
No	55.60%
Yes	44.40%

Response	Percentage
A Few Times a Month	21.18%
A Few Times a Week	26.18%
A Few Times a Year or Less	6.03%
Every Day	30.44%
Never	.74%
Once a Month or Less	7.79%
Once a Week	7.65%

Response	Percentage
Agree	41.79%
Disagree	.90%
Neutral	8.51%
Strongly Agree	46.42%
Strongly Disagree	2.39%

Response	Percentage
Agree	44.25%
Disagree	3.14%
Neutral	13.75%
Strongly Agree	36.32%
Strongly Disagree	2.54%

Response	Percentage
Agree	41.77%
Disagree	5.39%
Neutral	17.07%
Strongly Agree	30.99%
Strongly Disagree	4.79%

Response	Count
Workforce Shortage	155
Poor and/or Stagnant Compensation	149
Burnout	70
Inflexible Work Shifts/Scheduling	17
Lack of Training	23
Inadequate Benefits Package	21
Inadequate Paid Time Off/Vacation	18
Increased Workload	93

Response	Percentage
Incorporating More Mental/Behavioral Health Services for Staff	17.08%
Allowing More Flexible Schedules	23.50%
Creating a Crisis Hotline	2.90%
Ensuring Adequate Staffing	19.46%
Supporting Manageable Workloads	22.77%
Promoting Social Experiences Among Staff	19.67%
Working to Improve Bureaucratic Processes	14.08%
Other	3.62%
None of the Above	17.08%

Education and Training

Response	Percentage
Online Conferences/Meetings	5.07%
Webinars	51.35%
In-Person Conferences/Meetings	48.03%
Self-Paced Courses (online)	46.48%
Internal Organizational Training (in-person)	34.47%
Self-Paced Educational Videos	31.88%
Self-Paced Microlearning	11.18%
Social Media	10.35%
Self-Paced Simulations	6.31%
Other	2.80%
None of the Above	.10%

Response	Percentage
In-Person Conferences/Meetings	48.96%
Online Conferences/Meetings	37.16%
Webinars	36.96%
Self-Paced Courses (online)	36.96%
Internal Organizational Training (in-person)	25.05%
Self-Paced Educational Videos	20.60%
Self-Paced Microlearning	9.73%
Self-Paced Simulations	9.94%
Social Media	5.69%
Other	1.35%
None of the Above	0%

Response	Count
Monitoring Health Disparities/Addressing Health Equity	122
Fiscal Health (Ryan White, 340B, PrEP)	56
Preventing Stigma and Discrimination	55
Addressing Mental/Behavioral Health	48
Providing Trauma Informed Care	40
Discussing Sexual Health with Clients/Patients	34
Addressing Structural Racism	33
Providing Culturally Competent Care	29
Preventing Provider Burnout/Health Care Workforce Shortages	27
Building Coalitions/Patient Access Advocacy	21
Providing Affirmative Care for Transgender/Non-Binary Clients	17
Discussing Substance Use with Clients/Patients	15
Conducting Motivational Interviewing	13
Caring for Undocumented Individuals	11
Expanding/Implementing Telehealth	11
Conducting Risk Assessments	10
Immunizations/Vaccinations	10
Other	10
Increasing Workforce Diversity	7

Response	Count
New HIV Treatments Including Injectable Treatment	113
Integration of STIs, Viral Hepatitis, and HIV Services	41
Current HIV Treatment Guidelines	40
Reducing Administrative Burdens Related to Treatment Prior Authorizations	37
Integrating HIV Treatment into Primary Care	35
Monitoring Clients/Patients with HIV Not on Treatment	32
Addressing Treatment Resistance Among Clients/Patients with HIV	31
Discussing Management of HIV Treatment Side Effects	23
Ordering and Interpreting Baseline HIV Labs	14
Managing HCV Coinfection with HIV	11
Managing HBV Coinfection with HIV	6
Other	2

Response	Count
Providing On-Demand PrEP/PrEP 211	75
Providing PrEP for Hard to Reach Populations	56
Providing Injectable PrEP	35
Applying a “Whole Person” Approach to PrEP Programs	30
Promoting PrEP Programs in the Community	29
Funding PrEP Programs	27
Helping Clients/Patients Cover the Costs of PrEP	18
Providing TelePrEP Services	14
Providing Event-Based PrEP	13
Linking Clients from PEP to PrEP	12
Providing PrEP in the Pharmacy Setting	11
Providing PrEP Navigation Services	11
Linking Clients from PrEP to Doxy PEP	9
Assessing Behavioral Risk/Taking a Sexual History	6
Navigating Reimbursement for PrEP Services	6
Other	2

Primary Care

Response	Percentage
No	78.03%
Yes	21.97%

Response	Percentage
Cardiovascular Disease (e.g., Hypertension, Cholesterol)	83.18%
Diabetes Screening (e.g., Fasting Glucose, A1C)	83.18%
Frailty Screening (e.g. Bone Density Scan)	60.75%
None of the Above	14.02%

Response	Percentage
I Perform This Screening	36.79%
I Refer My Clients/Patients to Another Provider for This Screening	46.23%
This Screening is Not Part of My Standard of Care	16.98%

Response	Percentage
I Perform This Screening	29.52%
I Refer My Clients/Patients to Another Provider for This Screening	53.33%
This Screening is Not Part of My Standard of Care	17.14%

Response	Percentage
I Perform This Screening	63.21%
I Refer My Clients/Patients to Another Provider for This Screening	27.36%
This Screening is Not Part of My Standard of Care	9.43%

Response	Percentage
I Perform This Screening	49.06%
I Refer My Clients/Patients to Another Provider for This Screening	30.19%
This Screening is Not Part of My Standard of Care	20.75%

Response	Percentage
I Perform This Screening	61.68%
I Refer My Clients/Patients to Another Provider for This Screening	20.56%
This Screening is Not Part of My Standard of Care	17.76%

Response	Percentage
I Perform This Screening	33.02%
I Refer My Clients/Patients to Another Provider for This Screening	43.40%
This Screening is Not Part of My Standard of Care	23.58%

Response	Percentage
Depression	82.24%
Substance Use	75.70%
Anxiety	74.77%
Self Harm/Suicide Risk	70.09%
Gender Dysphoria	36.45%
Body Dysmorphia	19.63%
None of the Above	12.15%

Mpox

Response	Percentage
No	55.61%
Yes	44.39%

Response	Percentage
No	15.47%
Unsure	19.62%
Yes	64.91%

Response	Percentage
Concerns About Vaccine Pain/Scarring	1.51%
Concerns About Vaccine Safety	10.94%
Cultural/Religious Reasons	.75%
Lack of Knowledge About mpox Transmission and/or Vaccine	37.74%
Low Assumption of Infection Risk	29.43%
Medical Mistrust	10.57%
None of the Above	4.91%
Other	4.15%

Response	Percentage
No	16.73%
Unsure	26.24%
Yes	57.03%

Response	Percentage
No	49.43%
Yes	50.57%

Behavioral Health Care

Response	Percentage
No	80.84%
Yes	19.16%

Response	Percentage
Depression, Anxiety, Suicidal Ideation	7.25%
Alcohol Use	6.21%
Substance Misuse (Non-Opioid)	5.28%
Post Traumatic Stress Disorder/Trauma	4.45%
Opioid Misuse	4.35%
Smoking/Vaping/Tobacco Use/Cessation	4.35%
Gender Dysphoria	3.52%
Interpersonal Violence	3.52%
Eating Disorders	2.38%
Body Dysmorphia	1.97%
Other	1.04%
None of the Above	.31%

Sexual and Reproductive Health Care

Response	Percentage
No	62.90%
Yes	37.10%

Response	Percentage
No	7.49%
Yes	92.51%

Response	Percentage
Annually	8.09%
At Each Visit	48.55%
Every Three Months	28.90%
Every Six Months	2.89%
Other	11.56%

Response	Percentage
No	10.16%
Unsure	9.09%
Yes	80.75%

Response	Percentage
Pregnancy Testing	79.68%
Birth Control Management	61.50%
Pregnancy Counseling	54.01%
None of the Above	13.90%
Genetic Counseling and Testing	11.23%
Infertility Services	10.70%
Male and Female Sterilization	9.09%
Other	5.35%

Response	Percentage
No	28.88%
Unsure	10.16%
Yes	60.69%

Response	Percentage
No	25.13%
Unsure	19.79%
Yes	55.08%

Response	Percentage
Not Very Comfortable	1.07%
Somewhat Comfortable	19.25%
Very Comfortable	77.54%
Very Uncomfortable	2.14%

Response	Percentage
All of the Above	68.45%
STI Protection	28.89%
Sexual Partners	27.81%
Sexual Practices	25.67%
Past History of STIs	25.67%
Pregnancy Intentions/Birth Control	17.11%
Screen for Sexual Violence/Interpersonal Violence	13.90%
Other	1.07%
None of the Above	0%

HIV Continuum

Response	Percentage
No	44.37%
Yes	55.63%

Response	Percentage
Onsite at My Organization’s Location	21.74%
Community Health Fairs/Events	15.84%
Community Based Organizations (CBOs)	9.94%
At Home Testing	6.42%
Health Department Clinics	5.28%
Substance Use Treatment Centers	5.18%
Correctional Facilities	4.66%
Primary Care Office	4.55%
AIDS Service Organizations (ASOs)	3.11%
Family Planning Clinics	2.80%
Emergency Room/Urgent Care	1.45%
Other	1.97%

Response	Count
Refusal to Get Tested	74
Limited Staff/Workforce Shortage	47
Limited Testing Resources	41
Limited Time During Appointments	25
Limited Testing Guidelines or Organizational Policies (e.g., patient does not meet criteria for testing)	12
Inadequate Preparation of Testing Providers	9
Other	8

Response	Count
Fear of Stigma or Discrimination	107
Assumption of Low HIV Risk	44
Lack of Knowledge About Available Care	19
Distrust in Health Care System	16
Fear of Confidentiality Breach	13
Mental Health Issues	8
Substance Use	8
Insufficient Counseling	7
Cost or Insurance Issues	5
Interpersonal Violence Concerns	2
Other	2
Lack of Transportation to Testing	1

Response	Percentages
No	51.87%
Yes	48.13%

Response	Percentages
Less than 50	9.48%
1,000–1,999	14.66%
2,000+	21.55%
501–999	20.69%
51–500	33.62%

Response	Percentages
Decreased	9.57%
Increased	69.57%
No Change	11.30%
Unsure	9.57%

Response	Percentages
No	52.89%
Yes	47.11%

Response	Percentages
Few than 50	80.70%
1,000–1,999	1.75%
2,000+	3.51%
51–500	14.04%

Response	Percentages
Decreased	12.39%
Increased	32.74%
No Change	37.17%
Unsure	17.70%

Response	Percentages
No	45.52%
Yes	54.48%

Response	Count
Patient Refusal	64
Limited Appointment Times	44
Insurance Coverage Concerns	30
Indirect Costs of Getting an Appointment	25
Limited Options for HIV Care in Region	19
Limited Staff/Workforce Shortage	17
Patient Refusal	12
Other	7

Response	Count
Fear of Stigma or Discrimination	107
Lack of Knowledge About Available Care	21
Cost or Insurance Issues	14
Distrust in Health Care System	12
Substance Use	11
Fear of Confidentiality Breach	9
Mental Health Issues	9
Lack of Transportation to Care	8
Housing Instability	7
Long Waiting Times for an Appointment	6
Employment Issues (e.g., shift scheduling)	5
Lack of Available Care	5
Insufficient Counseling	4
Inconvenient Appointment Times	3
Childcare Issues	2
Other	1

Response	Percentages
No	62.50%
Yes	37.50%

Response	Percentages
Fewer than 50	66.67%
1,000–1,999	1.15%
2,000+	1.15%
501–999	3.45%
51–500	27.59%

Response	Percentages
Decreased	2.30%
Increased	47.13%
No Change	43.68%
Unsure	6.90%

Response	Percentages
No	56.22%
Yes	43.78%

Response	Count
Insurance Barriers (formulary restrictions)	54
Concerns About ART Side Effects	48
Administrative Time Involved in Processing Prior Authorizations or Patient Assistance Applications	24
Concerns About Adherence to ART	23
Other	8
Concerns About ART Interactions with Current Medications/Comorbidities	7

Response	Count
Fear of Stigma or Discrimination	47
Concerns About ART Side Effects	41
Insurance Barriers/Co-Pays	39
Mental Health Issues	12
Fear of Confidentiality Breach	9
Distrust in Health Care System	6
Concerns About ART Interactions with Current Medications	4
Other	4
Insufficient Counseling	1

Response	Percentage
No	22.87%
Unsure	7.45%
Yes	69.68%

Response	Percentage
No	40.74%
Yes	59.26%

Response	Percentage
Fewer than 50	13.39%
1,000–1,999	13.39%
2,000+	7.14%
501–999	12.50%
51–500	53.57%

Response	Percentage
Decreased	7.21%
Increased	50.45%
No Change	29.73%
Unsure	12.61%

Response	Percentage
Fewer than 49%	22.87%
50–59%	12.23%
60–69%	4.79%
70–79%	10.64%
80–89%	14.36%
90–99%	14.36%
None/Not Applicable	6.91%
Unsure	13.83%

Response	Percentage
Medicaid	16.04%
Medicare	2.14%
Other	.53%
Other Public Insurance	4.81%
Private Insurance (ACA Plan)	6.95%
Private Insurance (Employer)	21.93%
Ryan White/ADAP	10.16%
There Is No Difference	12.83%
Unsure	24.60%

Response	Percentage
No	55.32%
Yes	44.68%

Response	Count
Lack of Transportation to Care	44
Fear of Stigma or Discrimination	33
Mental Health Issues	27
Housing Instability	19
Cost or Insurance Issues	13
Substance Use	11
Employment Issues (e.g., shift scheduling)	11
Fear of Confidentiality Breach	9
Inconvenient Appointment Times	6
Long Waiting Times For an Appointment	4
Reluctance to Follow Provider’s Advice	4
Other	4
Childcare Issues	3
Incarceration or Legal Detention	1
Too Sick to Travel to Clinic	1

Response	Percentage
Routinely Contacts Patients Prior to Their Appointment as a Reminder (e.g. phone, email, text)	18.22%
Routinely Follows Up With Patients Who Miss Their Appointments (e.g. phone, email, text)	17.70%
Routinely Reinforces the Value of Follow Up Visits	16.46%
Provides Patient Navigation or Case Management Services (e.g. accompanying to appointments as needed)	15.42%
Systematically Monitors Retention in Care of All HIV Patients (e.g. monitoring visit adherence, gaps in care, visits per interval or time)	13.98%
Provides Telehealth Services	13.87%
Provides Bridge Counseling and/or Re-Engagement Services	9.83%
Offers Flexible Scheduling (walk-in hours) or Extended Clinic Hours (e.g. evenings, weekends)	9.42%
Other	.31%
None	.21%

Response	Percentage
Dissatisfied	8.47%
Neutral	21.69%
Satisfied	44.97%
Very Dissatisfied	1.06%
Very Satisfied	23.81%

Response	Percentage
No	78.53%
Yes	21.47%

Response	Percentage
Decreased	26.83%
Increased	12.20%
No Change	53.66%
Unsure	7.32%

Response	Percentage
No	55.24%
Yes	4.76%

Response	Count
Mental Health Issues	50
Fear of Stigma or Discrimination	39
Housing Instability	27
Substance Use	18
Pharmacy Issues (e.g. late refills)	27
Incorrect Medication Administration (e.g. missing doses)	14
Other	7
Reluctance to Follow Provider’s Advice	6
Fear of Confidentiality Breach	4
Employment Issues (e.g. shift scheduling)	4
Incarceration or Legal Detention	1

Response	Percentage
No	1.57%
Unsure	1.57%
Yes	96.86%

Response	Percentage
No	53.65%
Yes	46.35%

Response	Percentage
Decreased	7.95%
Increased	37.50%
No Change	43.18%
Unsure	11.36%

Response	Percentage
Initial Receipt of Care/Starting ART	6.54%
Linkage to Care	13.55%
None of the Above	11.92%
Retention in Care	42.99%
Testing and Diagnosis	19.16%
Viral Suppression	5.84%

Response	Percentage
Access to HIV Related Data	1.17%
Dedicated Insurance or Health Navigation Specialists	4.91%
Fiscal Health/Funding to Support HIV Services	30.14%
Increased Insurance Coverage for HIV Specific Services	4.67%
Increased Reimbursement Rates or Considerations	3.97%
Marketing Resources to Educate the Public About HIV Care	9.11%
More HIV-Focused Training for Providers	6.07%
More Providers Trained in HIV Care	17.52%
None of the Above	5.61%
Other	3.50%
Support Staff to Provide Wraparound Services to HIV Clients/Patients	13.32%

Response	Percentage
Resistance Testing
All of the Time	12.72%
Most of the Time	5.26%
None of the Time	53.07%
Some of the Time	10.53%
Unsure	18.42%
Choosing an Atypical ART Regimen in the Setting of Medication Class Resistance
All of the Time	14.98%
Most of the Time	3.52%
None of the Time	50.66%
Some of the Time	14.54%
Unsure	16.30%
Treating Opportunistic Infections (e.g. toxoplasmosis, tuberculosis, Kaposi’s Sarcoma)
All of the Time	16.81%
Most of the Time	6.19%
None of the Time	39.82%
Some of the Time	21.68%
Unsure	15.49%
Treating HIV/HCV Co-Infection
All of the Time	18.61%
Most of the Time	4.33%
None of the Time	44.16%
Some of the Time	18.18%
Unsure	14.72%
HIV Treatment in Pregnancy
All of the Time	26.11%
Most of the Time	7.52%
None of the Time	38.94%
Some of the Time	12.83%
Unsure	14.60%

Response	Percentage
Aging with HIV	26.50%
Stigma and Discrimination	24.12%
Behavioral Health	24.02%
Whole Person Care	22.05%
HIV and Comorbidities	21.12%
Support Services	18.43%
Transgender Health	18.32%
Harm Reduction	17.60%
Systemic Racism	17.29%
Insurance Costs/Issues	16.87%
Trauma Informed Care	15.84%
Multipurpose Prevention Technologies	10.56%
Treatment Resistance	9.42%
Other	1.35%
None	.10%

Response	Percentage
I am Aware of Whole Person Care But Have Not Implemented it Into My Practice	12.18%
I am Not Aware of Whole Person Care	21.78%
I Have Fully Integrated Whole Person Care Into My Practice	37.94%
I Have Partially Integrated Whole Person Care Into My Practice	28.10%

Response	Percentage
Large Co-Pays	19.44%
Limited Medication Formularies/Prior Authorizations for Medications	22.95%
Limited or No Coverage for Specialist Care	15.46%
None of the Above	23.89%
Other	4.68%
Prior Authorizations for Tests/Procedures	13.58%

PrEP Continuum

Response	Percentage
No	50.41%
Yes	49.59%

Response	Count
Promoting Interest in PrEP	52
Developing Community Trust	46
Promoting Awareness of HIV Risk	38
Preventing Stigma and/or Discrimination	27
Providing Sufficient Counseling	8
Other	3

Response	Percentage
Men Who Have Sex With Men (MSM)	16.98%
Youth (18–24)	15.94%
People Who Use Substances	15.32%
Older Adults (50+)	14.91%
Transgender People	14.80%
Heterosexual Women	13.66%
People Who Are Experiencing Homelessness/Are Unhoused	13.46%
Non-English-Speaking Individuals	13.04%
Undocumented Persons	12.42%
People Who Are Incarcerated or Formerly Incarcerated (jail or person)	11.49%
Other	.83%

Response	Count
People Who Are Experiencing Homelessness/Are Unhoused	41
Youth (18–24)	33
People Who Use Substances	25
Heterosexual Women	18
People Who Are Incarcerated or Formerly Incarcerated (jail or person)	11
Non-English-Speaking Individuals	11
Older Adults (50+)	7
Undocumented Persons	7
Men Who Have Sex With Men (MSM)	7
Transgender People	7
Other	5

Response	Percentage
No	38.67%
Yes	61.33%

Response	Percentage
Decreased	7.21%
Increased	81.98%
Unsure	10.81%

Response	Percentage
No	54.37%
Yes	45.63%

Response	Percentage
No	63.86%
Yes	36.14%

Response	Percentage
Fewer Than 50	45.00%
1,000 – 1,999	5.00%
2,000+	1.67%
501 – 999	3.33%
51 – 500	45.00%

Response	Percentage
Decreased	13.56%
Increased	57.63%
No Change	23.73%
Unsure	5.08%

Response	Count
Provider Discomfort Discussion PrEP	53
Refusal to be Linked to PrEP	33
Limited Staff/Workforce Shortage at PrEP Clinics	23
Limited PrEP Clinics/Services	21
Limited Appointment Times	13
Other	8
Limited Guidelines or Organizational Policies (e.g. patient does not meet criteria for PrEP services)	5

Response	Count
Provider Initiated Patient Discussions	74
Targeted Community Promotions (e.g. transit signage, billboards, public benches, etc.)	20
Peer to Peer Discussions	20
Dating Apps	16
Influencers/Community Representatives	8
Provider Presentations/Tabling at Community Social Gathering Events (e.g. Pride events, community center events, faith-based events, etc.)	7
TV Advertisements	6
Social Media Marketing	5
Other	2
Promotional Materials in Clinic Waiting Rooms	1

Response	Percentage
No	71.58%
Yes	28.42%

Response	Percentage
Insurance Issues	5.49%
Workflows for Integrating CAB Administration Into Your Practice	2.69%
Funding to Support a CAB Program	2.17%
Access to Adequate Support Staff (PrEP navigators, case managers, etc.)	1.66%
Physical Capacity (e.g. refrigeration units, syringes, etc.)	1.24%
Staff Training	.93%
Other	.21%
We Have Not Encountered Any Barriers Providing CAB	0%

Response	Percentage
TDF/FTC (Truvada)	10.46%
TAF/FTC (Descovy)	9.63%
CAB (Apretude)	6.73%

Response	Percentage
Private Insurance (employer)	44.23%
There Is No Difference	22.12%
Medicaid	8.65%
Other	4.81%
Medicare	4.81%
Other Public Insurance	3.85%
Ryan White/ADAP	1.92%

Response	Percentage
Very Confident	62.14%
Fairly Confident	22.33%
Somewhat Confident	11.65%
Slightly Confident	1.94%
Not Confident At All	1.94%

Response	Percentage
Routinely/At Every PrEP Visit	90.91%
Only When Symptoms Arise	9.09%

Response	Percentage
Unsure	24.04%
Less Than 49%	20.19%
50–59%	15.38%
60-69%	12.50%
80-89%	9.62%
70-79%	8.65%
90-99%	7.69%
None/Not Applicable	1.92%

Response	Percentage
Increased	62.86%
No Change	14.29%
Decreased	14.29%
Unsure	8.57%

Response	Count
Time Required to Complete Prior Authorizations	34
Preferred PrEP Modality Not Covered by Insurance	24
No Insurance	20
Concerns About Adherence to PrEP	10
Low or No Reimbursement for PrEP Office Visits	2
Concerns About Medication Interactions	2

Response	Count
Low Perceived HIV Risk	36
Fear of Stigma or Discrimination	19
Cost or Insurance Issues (e.g co-pays)	17
Insufficient Counseling	7
Concern About Medication Side Effects	6
Distrust in Health Care System	5
Lack of Transportation to Care	2
Long Waiting Times for an Appointment	2
Lack of Available Care	1
Housing Instability	1
Mental Health Issues	1
Substance Use	1

Response	Percentage
No	65.30%
Yes	34.70%

Response	Percentage
Satisfied	36.36%
Neutral	33.88%
Very Satisfied	18.18%
Dissatisfied	9.92%
Very Satisfied	1.65%

Response	Count
Difficulty Adhering to Medication	31
No Longer Perceive HIV Risk	21
Medication Cost/Lack of Insurance	19
Frequency of Required Appointments	18
Appointment Cost	11
Medication Side Effects	6
Fear of Stigma or Discrimination	5
Distance From Nearest Pharmacy	3
Difficulty Obtaining Refills From the Pharmacy	2
Other	2

Response	Percentage
Routinely Contacts Patients Prior to Appointment as a Reminder (e.g. phone, email, text)	11.18%
Routinely Follows Up With Patients Who Miss Appointments (e.g. phone, email, text)	10.04%
Provides PrEP Navigation or Case Management Services	9.73%
Routinely Reinforces Value of Followup Visits	9.63%
Systematically Monitors Retention in Care of All PrEP Patients (e.g. monitoring visit adherence, gaps in care, or visits per interval or time)	7.76%

Response	Percentage
Outreach/PrEP Promotion	39.34%
Retention in Care	21.58%
Linkage to PrEP	13.39%
Adherence to PrEP	9.56%
Prescribing PrEP	8.47%
PrEP Uptake	7.65%

Response	Percentage
No	74.79%
Yes	25.21%

Response	Percentage
No	47.40%
Yes	52.60%

Anti-LGBTQ Policies

Response	Percentage
No	54.27%
Yes	45.73%

Response	Percentage
No	33.64%
Yes	66.36%

Response	Percentage
No	47.20%
Yes	52.80%

Response	Percentage
Always	3.00%
Never	28.69%
Often	6.00%
Rarely	35.97%
Sometimes	26.34%

Response	Percentage
No	71.95%
Yes	28.05%

Response	Percentage
Always	13.74%
Often	15.27%
Rarely	38.39%
Sometimes	32.06%

Response	Percentage
No	29.34%
Yes	70.66%

Response	Percentage
Increasing public awareness and understanding of HIV and its impacts, and challenging myths and misconceptions about HIV transmission and criminalization.	35.09%
Educating lawmakers and law enforcement officials on HIV and its transmission.	33.95%
Replacing laws that criminalize HIV exposure, transmission, or non disclosure with public health approaches that prioritize prevention, testing, treatment, and support.	33.64%
Building coalitions and partnerships across sectors and communities to advance policies and practices that reduce HIV related stigma, discrimination, and criminalization.	31.68%
Increasing HIV testing rates by reducing stigma and discrimination against PLWH.	30.64%
Strengthening community based organizations and networks that advocate for the rights PLWH and provide legal and social support services.	30.43%

Response	Percentage
NEUTRAL: I do not have a strong opinion on the use of MHS for HIV. I would like to learn more about the technology, its benefits, and its limitations before making a decision.	37.26%
STRONGLY SUPPORT: I believe that MHS is an important tool for tracking the spread of HIV and monitoring the effectiveness of treatments.	25.05%
SOMEWHAT SUPPORT: I think that MHS for HIV has some potential benefits, but it also raises concerns about privacy, data security, and confidentiality.	23.77%
SOMEWHAT OPPOSE: I have some concerns about the potential impact of MHS on individual privacy and confidentiality for PLWH. I believe that any surveillance program should be designed with safeguards to protect the privacy and rights of individuals.	7.92%
STRONGLY OPPOSE: I believe that MHS for HIV is an invasion of privacy and a violation of human rights. Genetic testing should not be used to track the spread of HIV or monitor the effectiveness of treatments, as it can stigmatize and marginalize PLWH and undermine their autonomy and dignity.	6.00%

Response	Percentage
I Am Not Aware of This Ruling	54.93%
No	43.10%
Yes	1.97%

Response	Percentage
No	52.96%
Yes	47.04%

Response	Percentage
No	63.35%
Yes	36.65%

Response	Percentage
No	6.52%
Yes	93.48%

Response	Percentage
No	10.12%
Unsure	40.08%
Yes	49.80%

Response	Percentage
No	94.05%
Yes	5.95%

Response	Percentage
No	72.97%
Yes	27.03%

Response	Percentage
No	4.55%
Yes	95.45%

Notes

Centers for Disease Control and Prevention. (2024, June 10). Ending the HIV Epidemic in the US Jurisdictions and Plans. Ending the HIV Epidemic in the US (EHE). https://www.cdc.gov/ehe/php/jurisdictions-plans/index.html
Centers for Disease Control and Prevention. (2024, May 14). About Ending the HIV Epidemic in the US. Ending the HIV Epidemic in the US (EHE). https://www.cdc.gov/ehe/php/about/index.html
Collins, S. R., Haynes, L. A., & Masitha, R. (2022, September 29). State of U.S. Health Insurance in 2022: Biennial Survey. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey
Centers for Disease Control and Prevention. (2024, July 1). Fast Facts: HIV in the United States. HIV. https://www.cdc.gov/hiv/data-research/facts-stats/index.html
National Center for Health Workforce Analysis. (2023). Behavioral Health Workforce, 2023. HRSA. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/Behavioral-Health-Workforce-Brief-2023.pdf
Bridging the Gap: The Urgent Need for Social Workers. (2023, September 29). Columbia School of Social Work Blog. https://socialwork.columbia.edu/news/bridging-gap-urgent-need-social-workers
Nachega, J. B., Scarsi, K. K., Gandhi, M., Scott, R. K., Mofenson, L. M., Archary, M., Nachman, S., Decloedt, E., Geng, E. H., Wilson, L., Rawat, A., & Mellors, J. W. (2023). “Long-acting antiretrovirals and HIV treatment adherence.” The Lancet HIV, 10(5), e332–e342.
Crawford, N. D., Lewis, C. F., Moore, R., Pietradoni, G., & Weidle, P. (2022). “Examining the Multilevel Barriers to Pharmacy-Based HIV Prevention and Treatment Services.” Sexually Transmitted Diseases, 49(11S), S22. https://doi.org/10.1097/OLQ.0000000000001643
Cooper, V., Clatworthy, J., Whetham, J., & Consortium, E. (2017). “mHealth Interventions To Support Self-Management In HIV: A Systematic Review.” The Open AIDS Journal, 11, 119–132. https://doi.org/10.2174/1874613601711010119
Reinert, M., Fritze, D., & Nguyen, T. (2022). “The State of Mental Health in America 2023.” Mental Health America.
Centers for Disease Control and Prevention. (2024, June 10). Ending the HIV Epidemic in the US Jurisdictions and Plans. Ending the HIV Epidemic in the US (EHE). https://www.cdc.gov/ehe/php/jurisdictions-plans/index.htm
Menza, T. W., Berry, S. A., Dombrowski, J., Cachay, E., Crane, H. M., Kitahata, M. M., & Mayer, K. H. (2022). “Anatomic Site–Specific Gonorrhea and Chlamydia Testing and Incidence Among People With HIV Engaged in Care at 4 US Clinical Centers, 2014–2018.” Open Forum Infectious Diseases, 9(7), ofac298. https://doi.org/10.1093/ofid/ofac298
Bachmann, L. H. (2024). “CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024.” MMWR. Recommendations and Reports, 73. https://doi.org/10.15585/mmwr.rr7302a1
Centers for Disease Control and Prevention. (2023, November 3). Expedited Partner Therapy. https://www.cdc.gov/std/ept/default.htm
Harsono, D., Galletly, C. L., O’Keefe, E., & Lazzarini, Z. (2017). “Criminalization of HIV exposure: a review of empirical studies in the United States.” AIDS and Behavior, 21, 27-50. https://link.springer.com/article/10.1007/s10461-016-1540-5
Hoppe, T. , McClelland, A. & Pass, K. (2022). “Beyond criminalization: reconsidering HIV criminalization in an era of reform.” Current Opinion in HIV and AIDS, 17 (2), 100-105. https://doi.org/10.1097/COH.0000000000000715
Keralis, J. M. (2023). “HIV Criminalization Laws and Enforcement: Assessing the Relationship Between HIV Criminalization at the State Level, Policing at the County Level, and County-level HIV Incidence Rates.” AIDS and Behavior, 27(11), 3713–3724. https://doi.org/10.1007/s10461-023-04087-z
https://pubmed.ncbi.nlm.nih.gov/32211784/
Human Rights Campaign. (2024). Map: Attacks on Gender Affirming Care by State. https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map

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120324B

Report on Findings

Table of Contents

Download this Report

Overview

The State of HIV Care

What is the State of HIV Care in one word?

Key Findings

About the Report

Participant Background

Total Respondents

Geographic Reach

Healthcare Settings Represented

Priority Populations Served

Survey Findings

State of the HIV Care Workforce

Workforce Crisis Deepens

Top three needs to improve HIV services:

Top three needs to improve PrEP services:

Top three workforce issues currently facing providers:

Top three health care topics for training:

Critical Service Gaps Exposed

Respondents were least likely to report offering the following services:

HIV Care and Treatment

Evolving Priorities in HIV Care

Most timely and important HIV Care topics:

Providers believe these components need the most attention in the HIV Care continuum:

Among participants who are familiar with their organization’s health data…

Urgent Need for Provider Training

Top three HIV Care and Treatment topics for training:

Among respondents who personally provide HIV care…

Hurdles in HIV Treatment Access

Linkage to Care

Starting ART

Retention in Care

Insurance Barriers

HIV Prevention

Gaps in Prevention Efforts

Providers believe these components need the most attention in the PrEP Care continuum:

Providers report their organizations could be better at reaching these populations with HIV prevention services:

Top needs to improve PrEP services:

Among participants who are familiar with their organization’s health data…

Training and Knowledge Gaps in PrEP Care

Top three PrEP topics for training:

Just over half of providers are familiar with HHS guidelines on zero-cost sharing and co-pays for PrEP:

Critical Barriers to Prevention Exposed

Testing

Linking to PrEP

Health insurance plans that require the most time to complete and receive a determination for PrEP, as reported by providers:

Prescribing PrEP

Most common reasons clients/patients discontinue PrEP:

Behavioral Health

Behavioral Health Gaps in HIV Care

Most respondents believe there are not enough behavioral health providers to meet the demand for services:

Barriers to Behavioral Health Care for People with HIV

Top challenges to accessing mental health services from the patient/client perspective:

Populations that are most difficult to keep in mental/behavioral healthcare:

Sexual and Reproductive Health

Critical Gaps in Sexual and Reproductive Health Care

Best Practices for Sexual Healthcare

Among those respondents who personally provide sexual healthcare services…

Anti-LGBTQ Policies

Anti-LGBTQ Policies Are Undermining HIV Care and Widening Health Disparities

The majority of providers believe HIV criminalization policies impact the health of their clients:

The majority of providers believe that HIV criminalization policies have a negative impact on public health efforts to prevent HIV transmission:

Most providers have never counseled a patient on legal risks related to HIV criminalization:

Almost all providers believe anti-LGBTQ healthcare policies impact the health of their clients/patients:

Half of providers believe the recent escalation of anti-trans healthcare legislation across the country has negatively impacted the mental health of their transgender and/or gender non-conforming clients/patients:

Almost all providers think harm reduction criminalization policies or laws impact the health of their clients/patients:

Implications and Opportunities

Barrier

Opportunity

Barrier

Opportunity

Barrier

Opportunity

Breaking Barriers and Building Opportunities to End the HIV Epidemic

Implications for HIV-Related Advocacy

Advocating Against HIV Criminalization and Anti-LGBTQ Policies to Safeguard Patient Well-Being

Key Advocacy Priorities from Survey Findings

Long-Term Funding