- During his second State of the Union address, President Donald Trump mentioned a plan to “eliminate” HIV in the US by 2030.
- The idea isn’t that the disease would get completely eliminated, but that people with HIV would have access to life-saving medication, and that prophylactic drugs could prevent the virus’ spread.
- Experts say this plan is totally possible, but Trump and Congress will first need to agree on a 2020 budget.
When the first HIV cases were reported in the US in 1981, the virus – which attacks the way the human immune system functions – was considered a death sentence.
Today, however, HIV is a livable condition, not a leading cause of death. Prescription medications can prevent its spread and ease symptoms.
Still, the epidemic rages on in some communities around the US. More than 38,000 Americans were infected last year, and in 2016 (the latest year for which federal data is available) 6,160 US deaths were directly attributed to HIV. Health officials are convinced that with the drugs we have today, the US can bring those numbers down.
“In recent years, we have made remarkable progress in the fight against HIV and AIDS,” President Donald Trump said Tuesday during his State of the Union address. “My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”
Public health experts from the Centres for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS) say that if new HIV funding gets approved, they have a plan to prevent 75% of new HIV infections by 2025 and 90% by 2030.
So it’s perhaps not accurate to say we’ll eliminate HIV in the US. But the hope is that if nearly everyone with HIV gets diagnosed and treated, health officials can prevent the spread of HIV enough for the risk of infection to drop close to zero. Meanwhile, those who have HIV would get the necessary drugs to keep them alive.
It’s a two-pronged effort that involves two kinds of drugs.
HIV is treatable and preventable
First, there are the drugs that treat people who are HIV-positive and help prevent them from spreading the virus to others. Then there are the drugs known as “pre-exposure prophylaxis,” or PrEP for short. These are daily pills that prevent infections in people who don’t already have HIV but who may come in contact with blood or bodily fluids like semen from someone who does. PrEP is about 97% effective, which is about as good as some of the best vaccines.
This combination of medications for people with HIV and medication for at-risk populations is the heart of the plan.
“If you get everyone who’s infected on anti-retroviral and decrease the viral load to below detectable level, and give those who need PrEP PrEP, you can theoretically end the epidemic as we know it,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters on Wednesday.
But the plan will only work if HIV-positive individuals know they have the illness and seek treatment.
“Ninety per cent of new infections are transmitted by people who have been undiagnosed and are not in effective care,” HHS assistant secretary for health Brett Giroir said. “We have very effective antiretroviral therapy, and when people are on retroviral therapy and achieve an undetectable viral level, they cannot transmit the disease. “
Where cases of HIV are clustered in the US
The plan isn’t going to be rolled out everywhere in the country. To decide where more HIV detection and prevention is needed, leaders at the CDC did a county-by-county analysis to pinpoint places with the most HIV infections. They noticed a troubling trend: Half of the nation’s new HIV cases are confined to less than 1.6% of US counties, along with Washington DC and San Juan, Puerto Rico.
“I was shocked that it was only 48 counties out of over 3,000 counties in the United States,” CDC director Robert Redfield said.
Health officials plan to focus their efforts on those counties, along with seven states that have dispersed, rural populations dealing with HIV: Oklahoma, Missouri, Kentucky, Arkansas, Alabama, South Carolina, and Mississippi.
Beyond geography, the HIV epidemic also tends to cluster in specific communities, many of them marginalized, like gay and bisexual men, transgender people, women of colour, and certain segments of the Native American community.
“While new HIV infection rates have stabilised overall in Indian country, American Indian and Alaskan native communities have seen a 63% increase in new infections among our young native men who have sex with men,” Michael Weahkee, principal deputy director of the Indian Health Service, said.
Additionally, about 10% of HIV cases are associated with intravenous drug use, including opioids.
These are communities where it’s important to do outreach in order to build trust.
“Trust is a crucial weapon in our fight to eradicate HIV, and it’s necessary to encourage people from marginalized groups to get tested,” Dr. Albert Wu, an HIV researcher at Johns Hopkins University, told the Associated Press.
Will Trump actually do it?
Not everyone is convinced that President Trump is committed to ending the HIV epidemic. That’s mainly because his administration has shut down some research into a cure for HIV, particularly when that research involves fetal tissue.
“[Secretary Azar] says he supports tackling HIV/AIDS in the United States, but HHS is dismantling research for cures,” Mary Alice Carter, executive director of Equity Forward, a watchdog group that calls out anti-abortion and anti-birth control lobbying efforts, said in a statement.
Benjamin Corb, director of public affairs for the American Society for Biochemistry and Molecular Biology, echoed that concern.
“In his first two years in office, we have not seen a president committed to supporting the nation’s research community,” Corb said, noting the Trump administration’s attempt to cut funding at the National Institutes of Health and other federal science organisations. (Congress ignored those attempts in last year’s budget.)
Despite those doubts about Trump’s follow-through, ending HIV has been a goal of many groups for a long time, and there seems to be a wealth of support for the plan from all ends of the political spectrum.
“While we might have policy differences with the president and his administration, this initiative, if properly implemented and resourced, can go down in history as one of the most significant achievements of his presidency,” AIDS Institute executive director Michael Ruppal said in a statement.