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GETTING TO ZERO ILLINOIS PLAN

Welcome to the Getting to Zero Illinois Online Interactive Plan. Below you will find the goals and strategies that make up GTZ-IL. To the right is a tag navigation bar; clicking on one of the tags will allow you to see specifically where the topic appears in the plan.

Want to view the plan offline?
Click the following links to download a PDF in English or Spanish.

workforce

The HIV health care and public health workforce is the backbone of our HIV service delivery system, providing needed services to individuals living with or vulnerable to HIV. As scientific and practical knowledge changes, our workforce must learn new approaches and adapt to the evolving needs of people living with or vulnerable to HIV.

Goal 1 – Improve educational institutions

Academic institutions that train health care professionals will provide appropriate education and training on HIV, STIs and viral hepatitis.

Strategy 1 – Create opportunities for mentorship and hands-on rotations through STI and HIV clinics, and ensure professional training programs incorporate and/or expand training on HIV/STIs (including post-exposure prophylaxis (PEP) and PrEP) by linking HIV, STI and viral hepatitis providers, including health department programs, with academic institutions, students, and residents in allied health professions (at all practice levels, including nurses and physician assistants).

Strategy 2 – Partner with state professional societies to establish continuing education requirements for lesbian, gay, bisexual, transgender and queer (LGBTQ) cultural awareness and affirmation; LGBTQ-affirming health care; anti-HIV stigma and anti-racism practices; and HIV, STI and viral hepatitis standards of care and best practices.

Goal 2 – Increase training opportunities

Increase opportunities for ongoing, practical training that builds knowledge about HIV, STI and viral hepatitis care, including science-based education such as PrEP and U=U, for all members of the HIV workforce.

Strategy 3 – Increase opportunities for Ryan White, STI, PrEP and viral hepatitis clinical providers to partner with the Midwest HIV/AIDS Education and Training Center (MATEC) to offer preceptorship experiences to novice providers.

Strategy 4 – Decrease interruptions in high-quality services that are due to implicit bias and other oppressive dynamics by developing a training curriculum for and delivering it to members of the HIV workforce who are not health care providers. The curriculum should emphasize the latest HIV science and include elements such as the life experiences of people living with or vulnerable to HIV, payment options for medications, a philosophy of good customer service, trauma-informed and strength-based care.

Strategy 5 – Increase the understanding and capacity of all types of HIV service providers to effectively support the unique and diverse behavioral health care needs of people living with or vulnerable to HIV.

Goal 3 – Strengthen representation

Increase opportunities for people living with or vulnerable to HIV to receive services from providers who are of the same race, ethnicity, gender, sexual orientation, gender identity and/or lived experience.

Strategy 6 – Address institutional barriers that prohibit hiring and advancement of peers and increase the number of peers who work for a living wage at all levels of organizations in the health care, public health and community-based HIV sectors. Efforts must focus on elevating Black and Latino/Latinx gay, bisexual, and other MSM; cisgender Black heterosexual women; people of transgender experience; and older adults to leadership positions.

Strategy 7 – Create sustainable employment for people living with or vulnerable to HIV.

health care

People must know that HIV services are available to them and can bring value to their lives. Regardless of HIV status or where a person receives services, people screened for HIV must be linked to high-quality health care services that support use of ARV medications for HIV treatment or PrEP, as well as other services necessary to achieve health and wellness. After connecting to health care, people must receive needed support to stay connected and to use ARV medications consistently and correctly.

Goal 4 – Expand outreach, education and marketing efforts

Increase the number of people living with or vulnerable to HIV who know about and are motivated to use help that is free, available and can bring value to their lives.

Strategy 8 – Increase knowledge and raise awareness of HIV and STI services by investing in at least two coordinated, statewide and community-informed marketing and media campaigns annually, beginning in 2020. Campaign focus areas include HIV/STI screening, PrEP, non-occupational PEP, HIV care and treatment, and other services that support successful health outcomes.

Strategy 9 – Provide tailored support for at least 5,000 people seeking HIV services annually via a widely publicized statewide resource hub that provides real-time information, referrals and linkage to care.

Goal 5 – Expand HIV screening

Increase the number of people living with HIV who know their HIV status from 86% to 93% by 2030.

Strategy 10 – Expand health care-based, routine HIV screening tests by 25%.

Strategy 11 – Expand highly targeted, community-based HIV screening tests by 25%.

Goal 6 – Increase linkage to care

By 2023, increase the number of people who are linked to appropriate services based on their HIV status, with an emphasis on HIV care and treatment and PrEP for prevention.

Strategy 12 – Increase the percentage of people newly diagnosed with HIV who are linked to HIV medical care within 30 days of diagnosis from 82% to 90%.

Strategy 13– Increase the percentage of people vulnerable to HIV who are linked to a PrEP prescriber from approximately 21% (~6,500 people) to 50% (~15,000 people).

Goal 7 – Increase engagement in care

By 2023, increase the number of people who are engaged in health care based on their HIV status, with an emphasis on HIV care and treatment and PrEP.

Strategy 14 – Increase the percentage of people living with HIV who are engaged HIV-related medical care from 63% to 80% (~32,000 people).

Strategy 15 – Increase the percentage of people vulnerable to HIV who access PrEP-related medical care from 21% (~6,500 people) to 50% (~15,000 people).

Goal 8 – Increase HIV medication use

By 2023, increase the number of people living with or vulnerable to HIV who use ARV medications for HIV treatment and PrEP.

Strategy 16 – Ensure that 80% (~26,000) of people living with HIV who are accessing HIV-related medical care are prescribed ARV medications.

Strategy 17 – Ensure that 80% (~12,000) of people vulnerable to HIV who are accessing PrEP-related medical care are prescribed PrEP.

Goal 9 – Increase access to housing and supportive services

Increase housing and supportive services opportunities for people living with or vulnerable to HIV who are experiencing homelessness or housing instability to remove barriers to ARV use for HIV treatment and PrEP.

Strategy 18 – Increase by 50% the number of dedicated HIV-housing units for homeless populations who are living with or vulnerable to HIV.

Strategy 19 – Increase by 50% the quantity of housing support services, such as case management and tenancy support, for homeless populations who are living with or vulnerable to HIV.

Strategy 20 – Match HIV surveillance data to Department of Housing and Urban Development Housing Management Information Systems (HMIS) data for at least eight HMIS jurisdictions in Illinois to determine the number of homeless individuals living with HIV.

Goal 10 – Reduce structural and institutional barriers to health care

Dismantle or eliminate structural and institutional barriers that negatively impact ARV use for HIV treatment and PrEP among persons living with or vulnerable to HIV.

Strategy 21 – Improve equitable transportation options and the ability to access services for people living with or vulnerable to HIV.

Strategy 22 – Improve equitable food and nutrition options and accessibility for people living with or vulnerable to HIV.

Strategy 23 – Improve equitable dental care options and accessibility for people living with or vulnerable to HIV.

Strategy 24 – Improve equitable legal options and accessibility for people living with or vulnerable to HIV.

Strategy 25 – Improve equitable emergency funding options and accessibility for people living with or vulnerable to HIV.

HIV cases declined in Chicago in 2019, but health inequities persist

On World AIDS Day, the Chicago Department of Public Health announced yet another decline in HIV cases. The report stated that 652 Chicagoans had reported new cases of HIV in 2019, which was a 14% decrease from the year before, and the lowest number of new cases since 1988. This reported decrease is the result of the hard work of our partners that have made efforts to end new HIV cases and provide better care for those living with HIV and AIDS.

As we continue to commemorate National Black HIV/AIDS Awareness Day, recognized on Feb. 7 each year, we cannot ignore that of those 652 new cases, Black Chicagoans accounted for 56% of new HIV cases and 57% of new AIDS cases despite only accounting for 30% of the city’s population. Unfortunately, these numbers are not surprising, but instead reflect a pattern of the HIV epidemic disproportionately impacting Black communities.

Although the same data is not yet available for the entire state, as of 2018, the CDC reported that 46.6% of people living with HIV in Illinois were Black, and that Black Illinoisans accounted for 50.1% of new HIV cases that same year. This was followed by Latinx Illinoisans, who made up 19.5% of HIV cases across the state and 23% of new HIV cases. These numbers show that similar inequities exist statewide.

At Getting to Zero Illinois (GTZ-IL), we recognize these disparities and have committed ourselves to dismantling racism—one of our five driving principles—with the understanding that systemic racism has created barriers and established social determinants of health that affect a person’s wellbeing and access to care outside of their individual control. For example, due to systemic racism, Black communities in Illinois, and across the U.S., are more likely to experience disinvestment in their neighborhoods, which results in less funding for transportation, education, and housing services, the implications of which affect residents’ overall health and wellbeing.

GTZ-IL is addressing these social determinants of health holistically, meaning that we not only work to provide and improve equitable services in HIV testing and treatment, but also in housing, transportation, food and nutrition, dental care, legal services, and emergency funding. We know that access to these resources are systemically kept out of reach for many Black residents. Improving disparities in the HIV epidemic, therefore, means establishing health equity in every arena.

“HIV disparities are a symptom of racial injustice,” said Dr. Keith Green, a 2020 GTZ-IL Implementation Council member, at the virtual panel “Building Black Power in the Age of COVID-19.” “It is but a symptom, which means that we’re also talking about queer injustice. We’re also talking about injustice against women. Thinking about it as a racial justice issue allows us to build alliances across issues that are also racial justice issues. It means that we’re not in this fight alone.”

Dr. Green’s call for community action echoed among other Black community leaders who emphasized the importance of open communication, strong support systems, and removing barriers from accessing HIV testing and treatment during the panel, commemorating National Black HIV/AIDS Awareness Day.

“We must recognize that ending the HIV epidemic is a collective effort and everyone can help reduce HIV stigma and promote access to HIV testing, prevention, and treatment services in Black communities,” said Coleman Goode, GTZ-IL Equity Workgroup co-chair.

While we celebrate the decrease in HIV transmission that we saw last year, we must push to continue to not only see a decline in new HIV cases, but a decline in the health inequities among Black Illinoisans. We can do this by learning from our Black-led community partners, including information they provide such as the Chicago Black Gay Men’s Caucus’ Prosperity Project Report, and by working to ensure all residents have access to the resources they need. It is through a collective effort and holistic approach rooted in eliminating systemic racism that we will not only end the HIV epidemic in Illinois, but also establish health equity across the state.

equity

The data are clear: grave disparities exist in the HIV epidemic. These disparities map to race, ethnicity, sexual orientation, gender identity, age and a person’s other lived experiences. We must use data to define which communities face the greatest disparities and in what context. With this information, we can set tangible and aggressive targets. The first set of goals and strategies in this section define the population-based metrics that will guide investments in our effort to build health equity. Baselines for statewide new HIV diagnoses, viral suppression, sustained viral suppression and PrEP prescriptions, as well as projected targets for 2023, will be established by GTZ-IL’s RED Committee by the end of 2019 to consistently measure progress over time and report back actual advancement toward goals. All goals and strategies have a target completion date of 2023, unless otherwise noted.

Goal 11 – Reduce new HIV diagnoses

Reduce disparities among communities with disproportionately high burden of HIV incidence.

Strategy 26 –Reduce the rate of new HIV diagnoses among Black gay, bisexual and other MSM.

Strategy 27 – Reduce the rate of new HIV diagnoses among Latino/x gay, bisexual and other MSM.

Strategy 28 – Reduce the rate of new HIV diagnoses among cisgender Black heterosexual women.

Strategy 29 – Reduce the rate of new HIV diagnoses among transgender women of color.

Strategy 30 – Reduce the rate of newly diagnosed people who are concurrently diagnosed with HIV and AIDS.

Goal 12 – Increase viral suppression

Increase the percentage of HIV-diagnosed people who are virally suppressed among communities experiencing disparities.

Viral Suppression: Indicated by the most recent viral load test in which results equal fewer than 200 copies of HIV RNA/mL

Strategy 31 – Increase viral suppression among Black gay, bisexual and other MSM.

Strategy 32 – Increase viral suppression among Latino/x gay, bisexual and other MSM.

Strategy 33 – Increase viral suppression among cisgender Black heterosexual women.

Strategy 34 – Increase viral suppression among transgender women of color.

Strategy 35 – Increase viral suppression among people living with HIV and AIDS over the age of 50.

Goal 13 – Sustain viral suppression

Increase the percentage of HIV-diagnosed people who have sustained viral suppression among communities experiencing disparities.

Sustained Viral Suppression: Indicated by two or more viral load tests where all results equal fewer than 200 copies of HIV RNA/mL in a 12-month period

Strategy 36 – Increase sustained viral suppression among Black gay, bisexual and other MSM.

Strategy 37 – Increase sustained viral suppression among Latino/x gay, bisexual and other MSM.

Strategy 38 – Increase sustained viral suppression among cisgender Black heterosexual women.

Strategy 39 – Increase sustained viral suppression among transgender women of color.

Strategy 40 – Increase sustained viral suppression among people living with HIV and AIDS over the age of 50.

Goal 14 – Increase PrEP usage

Increase PrEP prescriptions among PrEP-eligible people in communities experiencing disparities.

Strategy 41 – Increase PrEP prescriptions among Black gay, bisexual and other MSM.

Strategy 42 – Increase PrEP prescriptions among Latino/x gay, bisexual and other MSM.

Strategy 43 – Increase PrEP prescriptions among cisgender Black heterosexual women.

Strategy 44 –Increase PrEP prescriptions among transgender women of color.

Goal 15 – Eliminate barriers to care

Remove structural and institutional barriers that adversely affect communities experiencing disparities to ensure all people are provided high-quality, equitable care.

Strategy 45 – Ensure priority communities have access to culturally, linguistically and medically appropriate care and supportive services by creating and integrating standards of equity into existing organizational policies and practices.

Strategy 46 – Provide capacity building services and establish funder expectations to ensure that HIV service organizations reflect the communities they serve and work diligently to dismantle or transform institutional policies and practices that compromise the wellbeing of their own workforce. Revised policies may include:

Encouraging employment of people with criminal records,
Not requiring professional degrees unless absolutely necessary,
Providing time off and flexible scheduling,
Providing opportunities for upward mobility, and
Providing a living wage.

Strategy 47 – Ensure that the development and implementation of behavioral and clinical interventions for communities experiencing disparities are aligned with root cause analysis findings and are evidence-based.

Strategy 48 – Ensure priority populations have access to trauma-informed services that work to mitigate the violence being experienced by communities at the individual, community and institutional level, including intimate-partner violence within different-gender and same-gender relationships.

Strategy 49 – Improve public and private health insurance coverage for all individuals experiencing disparities.

Goal 16 – Support people with lived experiences

Reduce or eliminate challenges associated with the unique lived experiences of individuals and communities experiencing health disparities.

Strategy 50 – Promote sexual/reproductive justice and bodily autonomy for transgender and cisgender women.

Strategy 51 – Ensure all babies in Illinois are born HIV-negative by enhancing HIV testing for women whose status is unknown in the first and third trimesters of pregnancy, and supporting intensive case management programs for pregnant women living with HIV.

Strategy 52 – Ensure statewide availability of health promotion and harm reduction programs, including HIV/HCV/STI screening and treatment, syringe exchange, overdose prevention and medication-assisted treatment (MAT) for people who use drugs.

Strategy 53 – Maintain and expand resources for programs that provide HIV/HCV screening and linkage, medical care, behavioral health care, and supportive services for people who are justice involved, including those living in jails and prisons and those recently released from these facilities.

Strategy 54 – Ensure all public schools across Illinois provide comprehensive, evidence-based sexual health education and services, including appropriate discussion of all sexual and gender identities and behaviors.

Strategy 55 – Ensure that health care providers know that Illinois law allows minors 12 years of age or older to access sexual health services, including PrEP, without a parent’s consent.

Strategy 56 – Decriminalize sex work in Illinois and ensure that sex workers receive adequate systemic support.

Strategy 57 – Reduce HIV-related stigma and the negative impact of HIV criminalization by examining state legislation that currently criminalizes HIV exposure and transmission.

Strategy 58 – Normalize HIV services within places where older adults receive services, including the provision of cultural humility training to employees and residents.

Strategy 59 – Decrease loneliness and isolation among priority communities, especially among people living with HIV who are aging and long-term survivors.

Strategy 60 – Normalize HIV services for populations experiencing disparities by training the HIV workforce on the unique health care and supportive services needs of these communities

HIV cases declined in Chicago in 2019, but health inequities persist

efficiency

State and local governmental public health departments play a key role in organizing, funding, monitoring and improving quality programs and services for individuals living with or vulnerable to HIV. When these institutions intentionally and effectively coordinate with each other, the overall HIV service system is more efficient, expansive and effective.

Goal 17 – Coordinate across public health entities

IDPH closely coordinates HIV services planning and funding activities with CDPH and other local health departments across Illinois.

Strategy 61 – Increase alignment of CDPH and IDPH HIV, STI and viral hepatitis programs by 2020, and include other local health departments as appropriate.

Strategy 62 – Ensureservice planning, delivery and evaluation across city, county and jurisdictional boundaries is rooted in data by increasing the public health sector’s capacity to collect, analyze and integrate HIV, STI and viral hepatitis surveillance data.

Goal 18 – Invest in services for people living with HIV

State agencies collaborate and coordinate efforts to increase long-term investments in services that are aligned with GTZ-IL.

Strategy 63 – Integrate GTZ-IL goals, strategies and action steps into the priorities of state programs outside IDPH (such as Illinois Medicaid) that specifically support people living with or vulnerable to HIV as well as state programs that are not HIV-specific (such as Department of Aging).

linked conditions

People living with or vulnerable to HIV often need of services beyond those that address HIV alone. Many need comprehensive behavioral health care (including mental health and substance use treatment), screening and treatment for sexually transmitted infections (STIs), and vaccination against sexually transmittable or communicable diseases such as viral hepatitis and meningitis. Appropriate, timely and seamless care for these and other conditions helps individuals maximize HIV services and achieve positive health outcomes.

Goal 19 – Expand behavioral health care

Behavioral health care is readily available to people living with or vulnerable to HIV, decreasing stigma and removing barriers associated with mental health and substance use disorders.

Strategy 64 – Ensure behavioral health screenings are performed at all initial and routine medical visits for clients served through the Ryan White HIV/AIDS Program system of care. Promote a similar standard of HIV and PrEP care for non-Ryan-White-funded federally qualified health centers (FQHCs).

Strategy 65 – Expand the availability of culturally-relevant and linguistically-appropriate behavioral health services by increasing by 20 percentage points the number of behavioral health providers at Ryan White sites and community health centers who are certified to bill Medicaid and private health insurance plans.

Goal 20 – Reduce STIs and viral hepatitis

Reduce the burden of sexually transmitted infections (STIs) and Viral Hepatitis, among people living with or vulnerable to HIV.

Strategy 66 – Cure 50% of hepatitis C cases among people living with HIV.

Strategy 67 – Ensure people vulnerable to HIV, with an emphasis on gay, bisexual and other MSM and transgender women of color, are screened for HIV, syphilis, chlamydia and gonorrhea.

Strategy 68 – Ensure all people living with HIV are screened for syphilis, chlamydia and gonorrhea.

Strategy 69 – Ensure all people living with or vulnerable to HIV who are diagnosed with STIs are treated according to the CDC STD Treatment Guidelines and are provided Expedited Partner Therapy when appropriate.

Strategy 70 – Ensure all people vulnerable to HIV who are diagnosed with syphilis and/or rectal gonorrhea are linked to PrEP and counseled about the availability of PEP.

Strategy 71 – Ensure all persons living with and vulnerable to HIV are provided recommended vaccinations, including human papillomavirus (HPV), hepatitis A, hepatitis B and viral meningitis.

Strategy 72 – Ensure access to condoms, including internal condoms, to those living with and vulnerable to HIV.

surveillance

Our success relies on our ability to define, measure and evaluate key goals and strategies. Where available, outcomes data will be essential to measuring progress. When competing data systems exist, they should communicate and offer seamless integration to avoid duplication of efforts. Collecting meaningful and timely data at state, city and community levels will be essential to tracking GTZ-IL’s progress and ensuring the 20+20 Target is achieved.

Goal 21 – Improve data systems

Improve and expand data systems to enhance services and care.

Strategy 73 – Ensure GTZ-IL strategies are fully integrated into all state and local health department HIV community planning processes, resulting in aligned and complimentary strategies.

Strategy 74 – Improve data systems and Electronic Case Reporting to advance health-care sector data reporting on HIV, STI and viral hepatitis.

Strategy 75 – Allow providers to more easily determine if individuals are in care or out of care by expanding timely access to surveillance data maintained by CDPH and IDPH.

Goal 22 – Track and share GTZ-IL progress

Monitor and share publicly GTZ-IL plan implementation progress.

Strategy 76 – Assess progress of GTZ-IL’s goals by developing a system to allow for monitoring and dissemination of indicators.

Strategy 77 – Develop models that project annual HIV incidence in Illinois through 2030 to inform investments of resources in ARV and PrEP scale-up strategies and structural interventions.

Strategy 78 – Ensure that the HIV sector is using consistent language when collecting and reporting data, when possible, to allow for future data integration.