Elizabeth Hertel, director of MDHHS, emphasized the importance of dismantling stigma as a critical piece of the solution. “Stopping new HIV infections and ensuring people living with HIV have access to the best possible care is attainable with the right resources, increased diagnoses, and proven treatment strategies,” Hertel stated. “We must also work to reduce HIV-related stigma, which continues to create barriers to receiving support. Everyone deserves the opportunity to live a healthy life, free from shame and with access to the care they need.”
Stigma isn’t just a social issue; it’s a barrier to life-saving care. Michigan reported 696 new HIV diagnoses in 2023, bringing the total number of residents living with HIV to 18,437 by the end of that year. Behind these numbers are real people—mothers, fathers, siblings, and friends—facing systemic challenges in accessing equitable healthcare. The disproportionate impact on African Americans, who are eight times more likely to contract HIV, and Latinos, who are four times more likely, underscores the need for targeted interventions. These disparities demand more than statistics; they demand action.
The state’s plan to combat this public health crisis rests on three pillars: increasing testing, expanding access to pre-exposure prophylaxis (PrEP), and improving retention for individuals receiving ongoing treatment. PrEP, a preventive medicine designed to reduce the risk of contracting HIV through sex or injection drug use, is a cornerstone of prevention efforts. Expanding PrEP access to eligible individuals requires a culturally competent approach that meets people where they are—physically, emotionally, and socially.
Dr. Natasha Bagdasarian, Michigan’s chief medical executive, stressed the collaborative nature of this plan. “It was critically important to take a collaborative approach to develop this plan and ensure the voices of those affected by HIV were at the heart of our strategy,” she said. Her statement reflects the necessity of centering community voices, especially those from groups most impacted by the epidemic. “We also sought the expertise of public health leaders to inform how we go about ending new HIV infections and improving care.”
The plan sets measurable goals, including increasing the number of state-funded HIV tests from 29,668 in 2022 to 32,800 by 2027. Testing is foundational because it is often the first step in connecting individuals to care. However, testing alone is not enough. For individuals who test negative but remain at high risk, referrals to PrEP are critical. Michigan aims to increase the percentage of eligible individuals referred for PrEP from 46% in 2022 to 65% by 2027. These numbers aren’t just benchmarks; they represent lives that can be safeguarded against a preventable disease.
Education is another vital component. The Centers for Disease Control and Prevention (CDC) reported a 12% drop in new HIV infections nationally between 2018 and 2022, but progress remains uneven. The CDC estimated 31,800 new infections in 2022, with a goal of reducing that number to 9,300 by 2025 and 3,000 by 2030. Reaching these targets requires educating those at highest risk—individuals with multiple sexual partners, inconsistent condom use, or injection drug use. Education must be accessible, relevant, and culturally specific, addressing the unique needs of Black and Brown communities.
Reducing new infections also requires retaining individuals in ongoing treatment. HIV is no longer a death sentence, but without consistent care, the virus can progress to AIDS. Retention in care ensures individuals can lead healthy lives while also reducing the likelihood of transmission. However, retention is not simply a matter of prescribing medication. It involves addressing the social determinants of health—housing instability, lack of transportation, and insufficient healthcare access—that disproportionately affect marginalized populations.
Stigma looms large in all of these efforts. Fear of judgment or discrimination can prevent individuals from seeking testing or treatment, even when services are available. Breaking down stigma requires intentionality, not just in healthcare settings but across society. It means creating spaces where people feel safe to disclose their status and seek support without fear of rejection or reprisal.
Responding swiftly to potential HIV outbreaks is another component of the state’s plan. Outbreak response requires robust public health infrastructure and community trust. When outbreaks occur, timely intervention can prevent further spread and connect affected individuals to care. These efforts must prioritize the voices of those directly impacted, ensuring that responses are not just reactive but proactive in addressing root causes.
The fight against HIV demands collective accountability. It is not enough for health departments or medical providers to shoulder the responsibility. Faith-based organizations, schools, community centers, and local governments must all play a role in dismantling stigma, promoting education, and expanding access to care. This is especially critical in Black communities, where trust in healthcare systems has been eroded by historical and ongoing injustices.
Community involvement is essential because HIV does not exist in isolation. It intersects with issues like poverty, incarceration, and systemic racism. Addressing HIV means addressing these broader inequities. It requires acknowledging the historical and structural factors that have placed Black and Brown communities at higher risk and committing to dismantling those systems.
The MDHHS plan is a step in the right direction, but steps must turn into strides. Achieving a 90% reduction in new HIV infections by 2030 is ambitious, but ambition is what this moment demands. The lives of nearly 20,000 Michiganders living with HIV—and countless others at risk—depend on it.
The journey to ending the HIV epidemic in Michigan will not be easy, but it is necessary. It calls for all of us to lean into the discomfort of these conversations and the urgency of this work. HIV is preventable, but prevention requires action. Treatment is available, but access must be equitable. Stigma can be dismantled, but it takes all of us to break the silence.
The MDHHS plan offers a roadmap, but the road ahead is ours to travel together.
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