Responding to the emerging needs of COVID-19 within communities of color & working to End the HIV Epidemic by 2030 and address Viral Hepatitis and STI in communities of color

Organizations that have been providing long-standing and proven-effective HIV/STI/HCV services to communities of color are now struggling to provide vital services while also addressing our newest pandemic, COVID-19. This challenge has been exacerbated within our communities of color which have suffered the long-term impact of health inequalities and of being at ground zero for both pandemics.

When organizations, such as these, are under acute stress, they are more likely and, in many cases, need to operate in survival mode, which means that attention is more narrowly focused on the immediate, the here and now. As such, these organizations may struggle to implement their strategic plans; leadership may have difficulty providing adequate staff support; and organizations may not be prepared to make informed, and sometimes difficult, programmatic and funding decisions.

The Black AIDS Institute, San Francisco Community Health Center, and Latino Commission on AIDS, three organizations which have worked collaboratively over many years and are led by and serve people of color, joined forces to create the Stronger Together Partnership (STP) in April 2020. The STP seeks to proactively support organizations in achieving the 2030 goals for Ending the HIV Epidemic and plans for the elimination of Hepatitis, while simultaneously responding to the impact of COVID-19 on communities of color and the organizations serving them. The first critical efforts of STP included a COVID-19 National Rapid Assessment and a Virtual Strategic Think Tank. 

Working with over 57 other organizations, STP is assessing the institutional challenges posed by the Novel Coronavirus (COVID-19) to the provision of HIV/STI/HCV services to communities of color in the U.S., Puerto Rico, U.S. Virgin Islands, and the Associated Pacific Island Jurisdictions. A preliminary report of the COVID-19 National Rapid Assessment can be downloaded at https://ilhe.org/stronger-together-partnership-c19-national-rapid-assessment-preliminary-report/. 

In addition to the assessment, the STP convened a COVID-19 Virtual Strategic Think Tank (VSTT) on October 14^th, 2020, 3pm – 6pm EST, with community leaders of color, management leaders at organization serving communities of color, researchers, public health leaders, and funders  to (a) discuss the preliminary findings of the national rapid assessment; (b) develop strategies to achieve the goals of “Ending the HIV Epidemic: A Plan for America by 2030”; and (c) map out future strategies to strengthening our community-based organizations nationwide as we address the COVID-19 health-related needs of people of color beyond 2021. 

Driven by and for people of color leaders, the chief goal of the VSTT was to generate a set of research, policy, funding, and practice recommendations from which develop a detailed and thorough health agenda to enhance the health and quality of life of communities of color across the U.S. within a health equity, civil rights, and human rights framework. The VSTT took into consideration ongoing health disparities among communities of color exacerbated by COVID-19, the critical 2020 Presidential election, the results and subsequent implementation of Census 2020, and the challenges of the U.S. economy. This report on the COVID-19 Virtual Strategic Think Tank held on October 14^th, 2020, highlights key aspects of the planning and implementation process and ten core recommendations arising from the discussions.

Top Ten Action Steps to Enhance the Health and Quality of Life of Communities of Color across the U.S., Puerto Rico, U.S. Virgin Islands, and Affiliated Pacific Island Jurisdictions

The following set of recommendations are based on notes from notetakers during break-out groups, comments in the chat boxes for the break-out groups and general discussion, comments in the Padlets for the break-out groups, and transcripts of the discussions during the break-out groups and the general discussion. These recommendations seek to provide a blueprint from which develop a detailed and thorough health agenda to enhance the health and quality of life of communities of color across the U.S.  

1. Adoption of a Federal strategy to respond to COVID-19, HIV, and other epidemics within a health equity framework. This framework will ensure meaningful representation of people of color on all NIH-sponsored vaccine and therapeutics biomedical research and engagement of communities of color during policy and resource allocation planning for COVID-19 care and treatment, community education, and vaccine development and distribution. 
2. Craft a national agreement to bring relief to all States and U.S. Territories. Relief must include interdepartmental coordination to address the COVID-19 impact on people of color, particularly in low-income, rural, immigrant, and border communities. Relief must be comprehensive and holistic and preserve HIV resources needed to end the HIV epidemic particularly for smaller community-based and health organizations in underserved areas.
3. Immediate Federal resources for critical institutional infrastructure enhancement of our health care system.  Pressing infrastructure enhancements include staff development, technology upgrade, and PPE as well as long-term needs such as emergency preparedness planning, financial planning, multi-agency collaboration, inter-agency data sharing, program innovation, and practice transformation. 
4. Elevate mental illness, substance abuse, mass incarceration, and homelessness as national emergencies. This entails specific resources to foster practice innovations by and for our communities of color that focus on client preference, individual and community empowerment, intersectionality, inclusiveness, and cultural relevance and appropriateness.
5. Federal investment in capacity development of our professional force in health, academic, and research careers. Education and training initiative must focus on the most underrepresented populations such as LGBTQIA+ individuals, people living with HIV, younger adults, people of color, and low-income individuals.
6. Protect and expand the Affordable Care Act.  Expansion of Medicaid and protection of programs such as the 340B drug program and Federally Qualified Health Centers are essential to improve health quality among our uninsured/underinsured populations.
7. Federal commitment to launch a Federal program to address the systemic and structural racism, classism, homophobia, transphobia, HIV stigma, and xenophobia embedded in our institutions and laws. Federal programs should embrace language justice, diversity, equity, and inclusion within a health equity, civil rights, and human rights framework.
8. Review Federal strategic plans and priorities to reflect demographic changes. Post Census 2020, Federal government initiatives must understand better and take into consideration the particular and specific needs of different communities of color and population changes occurring across different geographic areas of our nation.
9. Establish a Federal plan to increase technology equity in our nation. Technology equity is essential for our organizations and communities to implement and utilize telehealth, electronic medical records, and virtual services, particularly in low-income communities and rural areas.
10. Declaration of commitment to develop a multiyear (10 years) Federal public health enhancement plan in 2021 and a multi-disciplinary and multi-sectorial taskforce to guide its implementation. Essential to this plan is to establish steps to address fundamental causes of health disparities, including ongoing food insecurity, housing instability, lack of transportation, financial instability, underinsurance, science and medical mistrust, multi-morbidity, and technology inequity among the most underserved communities.