Ending the HIV Epidemic: What Will Happen to the HIV Testing Workforce?

What will happen to the HIV testers when we get to zero? Most of the testers will be unemployed with no translatable skills. Simultaneously, federal and state health departments, and subsequently AIDS service organizations, have suffered significant cuts in funding.¹ From a recent survey by Southside Health Advocacy Resource Partnership (SHARP) in Chicago, we understand that most of these individuals are underemployed, queer Black people. The COVID-19 pandemic has highlighted that “Getting to Zero” will cause unemployment as AIDS service organizations (ASOs) terminate or repurpose staff for the pandemic response.² To avoid this, Getting to Zero efforts must prioritize a workforce investment strategy that ensures HIV testers have translatable employment now.

Starting as the theme for the 2011 World AIDS Campaign from the United Nations,³ “Getting to Zero” has become the colloquial moniker for US Ending the HIV Epidemic plans. However, these plans are not prioritizing the welfare of the HIV workforce. Aside from declining incidence of HIV transmission,⁴ an outcome of HIV prevention and treatment is the steady decline of funding for HIV services. Since 2012, HIV prevention services funding that enables ASOs to offer HIV tester occupations has decreased and remained stagnant over the last few years.⁵ Predominantly, these occupations employ the populations most vulnerable to—and sometimes living with—HIV/AIDS. As the funding decreases, Getting to Zero will cause unemployment for people most vulnerable to, and living with, HIV. During the COVID-19 pandemic, some organizations reduced their number of HIV tester positions. The staff reduction indicates how ASOs are not investing in the long-term careers of their shrinking, underpaid workforce.

With HIV-tester certifications that mean nothing outside of HIV prevention and treatment, jobs that do not pay a living wage, and decreasing HIV funding, frontline staff will be unemployed when we achieve an end to the HIV epidemic. HIV tester certifications do not translate to any employment opportunities outside of HIV prevention and treatment. During a 2018 community survey (n = 20) by SHARP, we discovered that most of the HIV prevention and treatment workforce in the southside of Chicago were Black men who have sex with men, along with Black transidentified and gender nonconforming persons. These individuals are compensated $29 000 to $36 000 per year. According to the median income chart released by the Chicago Planning & Development Department, this is 50% to 60% of the area median income, and their standard of living is very low to low income.⁶ This population has expressed concerns about their employment status.⁷

Getting to Zero efforts must start prioritizing investment in translatable employment strategies for HIV testers, now. ASOs must embrace a commitment to what I call “translatable employment”: an occupation or professional certification that is useful in one field and translates to a useful credential in another. For instance, HIV testers should be licensed by their employers in phlebotomy, so that they have prospects for other employment in public health and other fields. From my experience, issues are not prioritized in HIV prevention and treatment unless funders (e.g., the Centers for Disease Control and Prevention, foundations) make them a priority. Because of the cause-and-effect relationship between funders and ASOs, workforce investment must be prioritized by funders for ASOs to make translatable employment a priority. Otherwise, the workforce that has made Getting to Zero possible will be left with zero jobs.