Why It Matters

HIV is preventable. People continue to acquire it. We must do more to grow awareness of and access to effective HIV prevention strategies.

 

Meanwhile, 14% of people living with HIV in Iowa are unaware of their status. Diagnosing people living with HIV is key to improving health outcomes for those individuals. It is also an important part of interrupting the chain of HIV transmission in Iowa.

 

Where We Stand Today 

There are a variety of tools available that interrupt the transmission of HIV, however more progress needs to be made. 

  • Up to 14% of Iowans living with HIV don’t know their HIV status. 
     

  • Early diagnosis and rapid access to treatment improves health outcomes for people living with HIV. 
     

  • The CDC estimates about 40% of HIV transmissions occur from people who have not yet been diagnosed. 
     

  • Pre-exposure prophylaxis (PrEP) is a medication that can prevent HIV acquisition. Not everyone who could benefit from PrEP knows about it, has access to it, or is currently taking it. 
     

  • Diagnosing individuals living with HIV is the first step to accessing HIV care and reducing transmission by people who do not know they are living with HIV.

HIV prevention toolkit

HIV prevention toolkit. Source: Eisinger et al.26 Published by Oxford University Press for the Infectious Diseases Society of America 2019. This work is written by (a) U.S. Government employee(s) and is in the public domain in the U.S.  Edited by Iowa Department of Public Health.

What We're Doing Now

There are a variety of tools available that interrupt the transmission of HIV. These tools guide our work, and we are taking multiple approaches in each area.

 

Marketing
 

Robust marketing aimed at increasing awareness of HIV, the importance of testing, the availability of pre-exposure prophylaxis (PrEP), and other prevention strategies. These activities are being implemented in multiple media markets, using multiple modes, attempting to engage both providers and the general public with a special focus on prioritized populations. 

 

Increasing Provider Awareness
 

Beyond marketing, the IDPH supports the Regional Health Specialist (RHS) initiative which seeks to engage medical and other community based service providers and gain buy-in for the importance of routine screening, prevention service provision, sexual health assessments, etc.

 

Serving At-Risk Youth
 

Through the Personal Responsibility Education Program (PREP) and Community Adolescent Pregnancy Prevention (CAPP) programs, the state of Iowa funds a small number of organizations to provide educational and behavior modification interventions to at-risk youth in Iowa.

 

Distributing Condoms
 

Through partnerships with contractors and community organizations, IDPH supports broad condom distribution efforts that have increased dramatically since 2018. 

 

Distributing Harm Reduction Supplies

In partnership with the Bureau of Substance Abuse, increasing the availability of harm reduction supplies, wound care kits, syringe disposal units, etc.—everything legally allowable in the absence of approval for Syringe Service Programs (SSPs) in Iowa. 

 

Increasing Access to PrEP and nPEP
 

Provider education, directory maintenance, navigation services, and safety net service provision (TelePrEP). Information about all of these resources is available via the PrEP Iowa website

 

Expanding Access to Testing
 

Integrated Testing Services (ITS) sites provide services through a regional service delivery model, partnering with Federally Qualified Health Centers (FQHCs) and community based pharmacies, experimenting with rural testing administered by case managers, and working with the State Hygienic Laboratory to develop and implement home testing technologies - among many other strategies.

 

Rapidly Linking to Care and Treatment

​Disease Intervention Specialists (DIS) provide linkage and partner services to all Iowans newly diagnosed with HIV. DIS link people living with HIV (PLWH) to medical care and support services, such as medication assistance.

Gaps, Barriers, & Challenges

Gaps
  • Sexual health education is not taught uniformly in all Iowa schools.   

  • Awareness of and access to biomedical prevention tools (PrEP and nPEP) remains limited for many individuals/populations.

  • Routine and opt-out testing are not widely practiced in primary care and other healthcare settings.

 

Barriers
  • Sexual health education can be highly politicized and difficult to influence. 

  • Syringe services programs (SSPs) remain unallowable within the state of Iowa. There are also other restrictions under the drug paraphernalia rules. 

  • Gaps in pharmacists’ understanding of legality for non-prescription syringe sales. 

  • Federal funding rules around PrEP are highly restrictive.

 

Challenges
  • Gaining buy-in from private providers and health systems on the importance of sexual health histories, routine screening, and prescribing/managing PrEP. 

  • Developing and supporting the growth of infrastructure for nPEP access. 

  • Increasing awareness and acceptability of PrEP among cisgender women. 

  • Increasing awareness and acceptability of PrEP among men who have sex with men who don’t identify as gay or bisexual.

 
 
 
A group of students walking outdoors together_edited.jpg
 

To stop HIV in Iowa by 2030, this focus area must:

  • Engage with and learn from disproportionately impacted and other prioritized communities to inform our larger direction and strategies. 
     

  • Expand upon marketing and communications strategies to ensure that reliable, medically accurate, and age appropriate information is being delivered in accessible ways.
     

  • Continue engaging with providers and systems, both medical and social, to integrate HIV education and testing into as many entry points as possible.
     

  • Increase awareness of and access to all forms of PrEP and nPEP for Iowans who may benefit from biomedical interventions. 
     

  • Expand the availability of equitable services and resources to PWID.
     

  • Deliver all services with a status neutral approach.

Process for Community Engagement 

Engagement Focus

This focus area will work with partners across the state to understand barriers related to diagnosing HIV, identify best practices and define potential improvement opportunities.

 

This focus area committee will concentrate on three broad areas impacting diagnosis of people living with HIV in Iowa:

PrEP and condom
Primary Prevention

Individual-level access to HIV prevention tools (sexual health education, condoms, pre- and/or post-exposure prophylaxis)

Systems-level integration of primary prevention strategies (sexual health education, condom distribution, nPEP and PrEP provision)

Finger prick
Testing

Individual level awareness of, access to, and engagement in HIV testing services.

Systems level adoption of routine and opt-out HIV screening practices, including appropriate reporting. 

Chain icon
Linkage

 Systems-level readiness to identify and rapidly link individuals to services utilizing a status-neutral approach (linking individuals newly diagnosed with HIV into the systems of medical care and support services and linking individuals not diagnosed with HIV into appropriate prevention services)

Gathering Feedback

Focus Groups & Key Informant Interviews
  • Representatives from priority populations, especially:

    • Men who have sex with men,

    • People who use drugs

  • Representatives from populations disproportionately impacted by HIV, especially:

    • African American community members

    • Latinx community members

  • Medical providers (primary care and emergency department)

  • Staff at HIV/STD testing sites

  • Disease Intervention Specialists 

  • Newly-diagnosed people living with HIV

Surveys

Statewide survey of representatives from prioritized populations, with the following goals:

  • Assess knowledge, attitudes, and use of nPEP and PrEP

  • Assess testing engagement

  • Identify opportunities for better marketing, awareness building, and recruitment strategies