New Paper Available on Breast/Chestfeeding for Birthing People Living with HIV (Co-Authored by Monica Hahn, MPH, MS, MD)

Tilting the Scale: Current Provider Perspectives and Practices on Breastfeeding with HIV in the United States

Tilting the Scale: Current Provider Perspectives and Practices on Breastfeeding with HIV in the United StatesA new paper worked on by Pacific AETC’s own Co-Principal Investigator,  Monica Hahn, MPH, MS, MD, on breast/chestfeeding for birthing people living with HIV is now available! Published on February 13th, 2023.


The risk of vertical transmission from breastfeeding with HIV (BFHIV) has been found to be very low in optimal scenarios with sustained maternal viral suppression during pregnancy and postpartum. Medical providers must account for the risk of this serious adverse event alongside parental autonomy, breastfeeding benefits, and patient values. To assess provider practices, comfort, and challenges with BFHIV, an online mixed-method survey was sent to breastfeeding and HIV provider listservs from June to July 2021. The target population was US medical professionals from diverse practice settings with experience in clinical issues associated with BFHIV, including physicians, advanced practice providers, nurses, and lactation consultants. Data analysis utilized nonparametric hypothesis testing, ordinal regression, and reflexive thematic analysis. Most providers reported counseling pregnant people with HIV on infant feeding choices, but fewer specifically endorsed counseling about breastfeeding. Of 84 unique institutions identified by 100 included respondents, 10% had an institutional protocol supporting BFHIV. Institutional protocols were associated with higher degrees of provider comfort with BFHIV in optimal scenario clinical vignettes. Providers perceived that White patients faced fewer BFHIV barriers than patients with other racial identities. Discomfort balancing the goals to protect infants from infection risk and support the parent’s role in infant feeding decisions was a key theme in free text responses; this manifested in a spectrum of management styles ranging from patient’s informed choice to paternalism. This study highlights the tension providers navigate regarding BFHIV discussions, calling for patient care guidelines and protocols grounded in risk reduction and respect of patient autonomy.

New: HRSA HIV/AIDS Bureau Special Bulletin: HRSA Commemorates National Black HIV/AIDS Awareness Day

HRSA HIV/AIDS Bureau Update: Special Bulletin Header

HRSA HIV/AIDS Bureau Update: Special Bulletin

Dear Ryan White HIV/AIDS Program Colleagues:

Today, HRSA’s HIV/AIDS Bureau (HAB) recognizes National Black HIV/AIDS Awareness Day (NBHAAD). This day is an opportunity to increase awareness about HIV care, treatment, and support services for Black/African American people in the United States.

Black people continue to face social and structural barriers, including racism, discrimination, homophobia, HIV stigma, medical mistrust, and limited access to high-quality health care, which prevent them from seeking care and treatment. I am proud that HRSA’s Ryan White HIV/AIDS Program (RWHAP) is working to address these barriers and encourage the development of safe and supportive health services for people with HIV.

HRSA is also dedicated to recruiting and retaining a diversified workforce, especially one that is inclusive of people with lived experience in the fields they serve. As part of our NBHAAD activities, we are hosting a special webinar (available in both English and Spanish) on Wednesday, February 8, from 3:00-4:00 PM ET to provide guidance on how to apply for federal job opportunities. We hope you can join us for this event.

Maintaining a diverse workforce and continuing our strong relationships with RWHAP providers, communities, and partners has been key to the success of the RWHAP, especially for improving outcomes for racial and ethnic minorities.

Nearly half of the more than 576,000 RWHAP clients we serve are Black/African American. In 2021, a record-breaking 87.2% of our Black/African American RWHAP clients receiving medical care were virally suppressed, which means we continue to close the disparity gap from 63.3% virally suppressed in 2010.

While we are pleased with our progress, we know there is still more we can do. Several of our RWHAP Part F Special Projects of National Significance initiatives are focusing on developing and disseminating tools and strategies to help improve outcomes for Black people with HIV. These include the Black Women First Initiative and E2i initiatives for Black MSM. Our RWHAP Best Practices Compilation also highlights other strategies that help improve HIV care.

Finally, I’d like to acknowledge all those working to support Black people with HIV, including peer navigators, social workers, case managers, nurses, physicians, and many more who are helping to make a difference for those you serve.

Thank you for your ongoing efforts and dedication to stopping HIV stigma and providing equitable access to HIV care and treatment to more than half a million people with HIV across the country.


Laura W. Cheever

Laura Cheever, MD, ScM

Associate Administrator

Recognizing National Black HIV/AIDS Awareness Day #NBHAAD (February 7, 2023)

Tuesday, February 7th is National Black HIV/AIDS Awareness Day 2023. Pacific-AETC recognizes National Black HIV/AIDS Awareness Day and continue efforts to expand anti-racist and equitable HIV prevention, care, and treatment in Black communities. Racism, discrimination, and mistrust in the health care system affect whether Black people seek or receive HIV prevention, treatment, and care. We must work to stop HIV stigma and overcome structural barriers to HIV testing, prevention, and treatment to help reduce health inequities in Black communities.

NBHAAD PromoMore progress is needed to reduce the disproportionate impact of HIV on Black communities. AIDSVu reports that in 2020, Black people represented 42% of new HIV diagnosesdespite making up only 14% of the U.S. population. The disparity is clear in HIV prevalence as well—in 2020, 40% of all people living with HIV in the U.S. were Black.

The below trainings from Pacific AETC and other capacity-building organizations are valuable opportunities to better understand health inequities and structural racism, strengthen our anti-racist framework, and best inform our work.

Access PAETC On-Demand Trainings below:

HIV Learning Network – Challenging Structural Racism in HIV Care

This presentation was given on July 8, 2022 by Monica Hahn, MD, MPH, AAHIVS, Clinical Director, Pacific AETC, Associate Medical Director, HIVE Clinic, and Associate Professor, Family and Community Medicine, UCSF.

Description: Dr. Monica Hahn, MD, MPH, AAHIVS, will provide an overview of structural racism in the context of the HIV and COVID-19 pandemic, review what lessons we have learned from HIV and COVID-19 that can inform our work, and help us move toward providing services with an anti-racist framework.

The Intersection of Misogynoir: Obstetric Racism & HIV, a 3-part series

The Intersection of Misogynoir: Obstetric Racism & HIV, a three-part series flyer

Speaker: Dr. Karen A. Scott, MD, MPH, FACOG.

Session #1: From Slavery to Sovereignty: Reclaiming Our Time, Narratives, Bodies, Lives, Families, and Futures

Session #2: Reimagining STI/HIV Risk and Sexual Behavior and Health among Black Women & Girls: Theoretical Approaches in Problem Analysis and Solution Building

Session #3: Black Mothers Living with HIV Navigating Health Care Systems: Problem Analysis and Solution Building Using Narrative Inquiry & Applications of the PREM-OB Scale™ Suite.

The Intersection of Structural Racism, HIV and COVID-19; Strategies to dismantle systems that perpetuate Health Inequities

The Intersection of Structural Racism, HIV and COVID-19; Strategies to dismantle systems that perpetuate Health Inequities LogoThis webinar was presented on August 6, 2020.

Description: This webinar will examine the intersection of structural racism, HIV, and COVID-19 while hearing experts on opportunities to make paradigm shifts for healthcare and social justice systems. We will discuss lessons learned from the HIV epidemic that apply to COVID-19, structural racism, and health inequities

Upcoming #NBHAAD 2023 Webinars:

The power of PrEP event promo

“The Power Of PrEP”:a webinar addressing the disparities in the utilization of PrEP for HIV prevention in the Black community on February 7 at 2pm ET.

National Black HIV/AIDS Awareness Day Town Hall with Leisha McKinley-Beach on Feb 7 at 3pm ET

The next Office of Infectious Disease and HIV/AIDS Policy (OIDP) Live with Leadership is February 7 at 2:30 ET, commemorating National Black HIV/AIDS Awareness Day

The next Office of Infectious Disease and HIV/AIDS Policy (OIDP) Live with Leadership is February 7 at 2:30 ET, commemorating National Black HIV/AIDS Awareness Day

Black Women and PrEP Toolkit

BLACK WOMEN AND PREP TOOLKIT PROMOEnding the HIV epidemic in Black communities will take multi-faceted, innovative, and intentional approaches. Launched in time for the 2018 National Women and Girls HIV/AIDS Awareness Day (March 10), the Black Women and PrEP Toolkit is a product of those conversations—created for Black women by Black women.

This initiative was launched, in part, with Gilead Sciences.

This toolkit contains:

  1. Branded posters that can be co-branded for your organization
  2. Brochures and presentations for community education
  3. Resources created by other organizations doing great work around PrEP for Black women.
  4. Information about how the Black AIDS Institute can provide your organization or health department training and capacity building services to increase PrEP awareness and utilization

Take a deeper look with AIDSVu Infographics:

Check out the National Black HIV/AIDS Awareness Day webpages from CDC and for more information and resources.

National Black HIV/AIDS Awareness Day Promo ImageHIV/AIDS-Related Research and African Americans

NIH Strategic Plan for HIV and HIV-Related Research (FY 2021-2025), from the National Institutes of Health (NIH) Office of AIDS Research (OAR). The Plan describes NIH research priorities to prevent, treat, and eventually cure HIV/AIDS. An overarching focus of NIH HIV research is to better understand health disparities, including disparities that may be linked to race and ethnicity.

Research Related to HIV/AIDS and African Americans:

Additional Information and Resources

Why Black AIDS History Matters

Literature review: Older African Americans and the HIV Care Continuum

Dimensions of HIV prevention and treatment for Black women

We the people report by Black AIDS Institute

From the CDC:

From the U.S. Department of Health and Human Services Office of Minority Health:

From the Office of AIDS Research: