At the campaign last year, Joe Biden made an election promise to end the 2025 HIV epidemic in the United States.
This is a five-year improvement on former President Donald Trump’s goal of ending the epidemic by 2030. Now that Biden is in the White House, how realistic is the goal?
Currently, about 1.2 million people live with HIV in the US, and about 40,000 people are diagnosed HIV-positive each year. The figure has remained fairly stable over the past half-dozen.
Although anti-retroviral medication has made HIV a long-term manageable disease, the war on HIV continues.
In 2014, the United Nations Program on HIV / Aids (UNAIDS) set a target for countries that had to hit 90-90-90 by 2020 in efforts to combat the virus: 90% of people diagnosed with HIV is, 90% of those diagnosed during treatment, and 90% of those treated to be virally suppressed.
Some countries have achieved this, such as the United Kingdom and other parts of Western Europe, which has led to UNAIDS now upgrading its target to 95-95-95 by 2030.
However, the US is still lagging behind.
Only 86% of those with HIV in the U.S. have been diagnosed, and only 65% of them are virally suppressed or undetectable, according to 2018 data.
Despite this, there is one thing most experts agree on: the United States has the tools to end the epidemic.
ACT NOW: END AIDS is a community action group founded by more than 20 HIV organizations, including AIDS Alabama and the San Francisco AIDS Foundation. Last year, it published a roadmap on how the US can put an end to the HIV epidemic.
As these 90-90-90 targets suggest, it is important to get those diagnosed with HIV, and then after treatment and viral suppression. Once that happens, they cannot transmit the virus to others, effectively stopping the transmission in its tracks.
Encouraging risk groups to get tested regularly, follow safer sex practices or take PrEP is another part of the toolkit. In recent months, there have also been encouraging breakthroughs in the development of long-term HIV and PrEP treatments, which may help further.
To educate people that U = U (undetectable = non-transferable), and to fight stigma, is also essential.
Related: FDA says injectable PrEP is a ‘breakthrough’ therapy, as it has been approved
However, the road map, which covers more than 130 pages, also explains some of the particular challenges facing the United States. Many of these stem from inequalities in access to care. It highlights how HIV affects black and Latin communities worse than others, and how the southern states become excessively affected.
According to a 2018 report, 50% of black, gay men will become HIV-positive in their lifetime. In the same year, black Americans represented more than 40 percent of all new HIV diagnoses, but only 13 percent of the U.S. population. Trans communities are also hit harder than others.
To end HIV, the reasons for it must be addressed.
ACT NOW: END AIDS asked the presidential candidates last summer about their plans to tackle HIV. The Biden campaign provided long, far-reaching answers that touched on many of the key roadmap points.
It lasted several pages, but briefly promises to:
- Update the comprehensive national HIV / Aids strategy of the Obama-Biden administration and fully fund the Ryan White HIV / Aids program.
- ‘Plan to build on the Affordable Care Act by giving Americans more choice, lowering healthcare costs and making our healthcare system less complicated … so that Americans who are uninsured or dislike their coverage, in a Medicare-like audience can purchase. option. “
- Allow Medicare to negotiate lower prices with pharmaceutical companies, and allow consumers to buy prescription drugs in other countries, and improve the supply of generic products.
- Deal with the opioid crisis, which leads to transmission of HIV through dirty needles.
- Ensure that federal health plans provide coverage for PrEP (prophylaxis before exposure) and PEP (prophylaxis after exposure).
- Address the systemic racism that leads to inequalities in health, and the crippling impact of poverty and homelessness. And to tackle HIV stigma.
This is all a big goal … But it’s a harder task to find someone who will set a record and say with confidence that the HIV epidemic will be defeated in the next four years.
Since his inauguration in January, advocates have been encouraged by some of President Biden’s nominees, including the respected HIV / Aids researcher Rochelle Walensky of Harvard Medical School and Massachusetts General Hospital to lead the Centers for Disease Control and Prevention. The official was the Covid-19 pandemic.
Indeed, a request to the White House for comment on this piece remained unanswered, while a spokesman for the NIAID (National Institute of Allergy and Infectious Diseases) said that all their experts are currently too busy with Covid-19 to get a to make a statement.
Related: 10 wonderful health clinics that help us end the HIV epidemic
Edric Figueroa, the ACT NOW: END AIDS Coalition Coordinator, told Queerty that he was hopeful that the Biden-Harris team and CDC appointers such as Rochelle Walensky and Demetre Daskalakis (both coalition allies) could take the lead in HIV. leaders when updating the federal EHE (Ending HIV Epidemic) plan to make the 2025 targets achievable in all communities. ”
He stressed that there would be no end to a US epidemic without removing structural barriers to health care and taking a human rights approach that centers communities most affected by HIV in the planning and implementation of public health interventions. health care coverage for the most vulnerable Americans is critical. ”
” A biomedical approach alone will not end HIV in communities marginalized by structural inequalities. ”
Kelsey Louie, CEO of the world’s older HIV and Aids prevention service, GMHC, takes a slightly more optimistic tone, saying the new government and Congress: “renewed my hope that we can end HIV in the United States before the end of this decade.
“President Biden has acknowledged that ending the HIV epidemic will require a comprehensive approach that includes tackling health inequalities that continue to fuel new infections in Black and Latinx communities and among LGBTQ + people. , especially transgender and non-female colored women. “
He also welcomed Biden’s commitment to increasing access to health care, PrEP and PEP, and hoped: ‘the president will continue to take more steps to end discrimination against LGBTQ + contributing to the HIV epidemic, such as to plead for the passing of the federal Equality Act. ”
Related: Five questions for Kelsey Louie from GMHC
Understanding the difference between the biomedical approach (PrEP, medication, regular HIV testing) and access to healthcare is a point that comes up time and time again when talking to those working in the field.
Ruston Taylor is senior director of clinical services for pharmacies and outreach for legacy community health in Houston, Texas. He tells Queerty about the importance of the Ryan White program and why it should be adequately funded.
‘I think one thing that is very important to me as a pharmacist is just knowing that the patient has a home to go to. I can not get medicine for someone who is homeless. ”
Dr. Natalie Vanek is chair of the Advisory Committee on HIV Medicine in Texas (the local AIDS drug assistance program / ADAP) and a physician at the Legacy Community Health flagship clinic in the Montrose District of Houston. She tells Queerty that the Biden goal of ending the HIV epidemic by 2025 is a ‘high’ goal.
“I think it is possible. We do have the tools available. However, I do not think it is necessarily attainable. It’s a doable thing, but I think it’s going to take a Herculean effort.
‘We need to have much more robust financing so that we leave no person or community behind.
“We need to address the inequalities that this epidemic is causing.”
Vanek says more needs to be done to help those who are not entitled to the health care system or have trust issues around health workers. This includes recent immigrants and other minority groups.
“It’s hard to do. Sometimes there is not much trust between communities and healthcare providers. ”
Vanek says one way to improve this is to actively involve community groups in the planning and delivery of health care and education, but she also says that Covid-19 has made things harder.
“In a way, [Covid] really put a bright spotlight on the health differences because it showed how people with colorless rights really suffered the most, just like with HIV.
‘Currently, in Texas, our ADAP program (the Texas HIV Medication Program) has suffered a budget deficit of $ 52 million, which is devastating. Part of this is because so many people came to the program because they lost their jobs due to the Covid epidemic.
‘Fortunately, there is the HIV medication program in Texas that can provide medicine for that, but at the same time we need to get money to try to cover the increase in costs. I know we are not the only ADAP going through this. ”
Mark S. King is an HIV activist, long term survivor and blogger.
Like Vanek, he tells Queerty that Biden’s deadline for 2025 is a “high goal, a pursuit, but we already have things slowing it down.”
King also highlights the Covid-19 pandemic.
“I’m a proponent of ‘kill the crocodile closest to the boat,'” he says. “And at the moment, the crocodile is Covid. We’re slowing down. Covid will have to pay because of our criminal lack of attention to it over the past year, we will still feel it for a long time and it will set us back as a country. ‘
As with everyone Queerty spoke to, King stressed that more needs to be done to target the most vulnerable, as there is hope to end the HIV epidemic. He has already been encouraged that the government of Biden has earmarked money for the promotion of the Affordable Care Act.
“Trump has made sure no dollars are spent on a single ad or Internet ad that says, ‘Hey, health care is available if you go to health.gov.’ There was nothing of the sort. Biden has already earmarked money for the promotion of our own healthcare market. It’s amazing. We actually promote the fact that we have it. ”
King is also hopeful that a black vice president can help.
“I’m convinced that Kamala Harris is going to look over Joe’s shoulder every four years, ‘Do not forget black and brown people. Do not forget social justice. Do not forget what brought us here. ‘”
‘Once you address racial justice, which includes access to health care, access to affordable housing, fair payment, all of this has a direct impact on HIV.
‘Can we address racism in the United States in the next five years and deal with it all neatly? Of course not, ”says King, presenting such an idea as naive. However, he says the next four years could repair the damage to the Trump administration and work for fair health care for all: ‘because it’s the only way we can deal with the HIV epidemic. ”