In the election campaign last year, Joe Biden made an election pledge to end the HIV epidemic in the United States by 2025.
It 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 that goal?
Currently, an estimated 1.2 million people are living with HIV in the United States and approximately 40,000 people are diagnosed with HIV each year. That number has remained quite stable over the past half-dozen years.
Although antiretroviral medication has made HIV a long-term manageable disease, the war on HIV continues.
In 2014, the Joint United Nations Program on HIV / AIDS (UNAIDS) set a target for countries to reach 90-90-90 by 2020 in efforts to contain the virus: 90% of people diagnosed with HIV, 90% diagnosed in treatment and 90% of those undergoing viral suppression.
Some countries have achieved this, such as the United Kingdom and other parts of Western Europe, prompting UNAIDS to update its target to 95-95-95 by 2030.
However, the United States continues to lag behind.
It is estimated that only 86% of people with HIV in the U.S. have been diagnosed, and of those, only 65% have been suppressed by viruses or undetectable, according to 2018 data.
Despite this, there is one thing that most experts agree with: the United States has the tools at its disposal to end the epidemic.
ACT NOW: END AIDS is a community action group founded by more than 20 HIV organizations, including the AIDS Alabama and San Francisco AIDS Foundation, among others. Last year, it published a roadmap of how the United States can end the HIV epidemic.
As the 90-90-90 goals suggest, the key is to get people with HIV diagnosed and then get treatment and viral suppression. Once this happens, they cannot transmit the virus to other people, effectively interrupting the transmission on their way.
Encouraging at-risk groups to test regularly, follow safer sex practices, or take PrEP is another part of the toolkit. There have also been encouraging advances in recent months in the development of long-term treatments for HIV and PrEP, which can help even more.
Educating people that U = U (undetectable = non-transferable) and fighting stigma is also vital.
Related: FDA says injectable PrEP is a “revolutionary” therapy as it awaits approval
However, this roadmap – which has more than 130 pages – also explains some of the specific challenges that the United States faces. Many of them stem from inequality in access to health care. He highlights how HIV affects black and Latin communities more than others, and how southern states are being disproportionately affected.
A 2018 report estimated that 50% of black gay men will become HIV positive during their lifetime. That same year, black Americans accounted for more than 40% of all new HIV diagnoses, despite representing only 13% of the US population. Trans communities are also more affected than others.
To end HIV, the reasons behind it need to be addressed.
ACT NOW: END AIDS asked presidential candidates last summer about their plans to fight HIV. Biden’s campaign gave long and exhaustive responses that touched on many of the main points of the script already outlined.
It lasted several pages, but in short, it promised:
- Update the Obama-Biden Administration’s comprehensive National HIV / AIDS Strategy and “fully fund the Ryan White HIV / AIDS Program”.
- “Plan on the basis of the Affordable Care Act, giving Americans more options, lowering health care costs and making our health care system less complex … allowing Americans who are uninsured or who don’t like their coverage to buy for an audience like Medicare option. “
- Allow Medicare to negotiate lower prices with pharmaceutical companies, allow consumers to buy drugs from other countries, and improve the supply of quality generics.
- Face the opioid crisis, which is leading to HIV transmission through dirty needles.
- Ensure that federal health plans provide coverage for PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis).
- Tackle systemic racism that leads to health inequalities and the crippling impact of poverty and homelessness. And to combat HIV stigma.
All of these are big goals … But finding someone to register and say with confidence that the HIV epidemic would be defeated in the next four years proves to be a more difficult task.
Since his inauguration in January, advocates have been encouraged by some of those appointed by President Biden, including respected HIV / AIDS researcher Rochelle Walensky of Harvard Medical School and Massachusetts General Hospital, to head the Centers for Disease Control and Prevention. However, when taking office, the other key in progress was the Covid-19 pandemic.
In fact, a request to the White House to comment on this article has not been answered, while a spokesman for NIAID (National Institute of Allergy and Infectious Diseases) said that all of its experts were currently too busy with Covid-19 to make a statement. declaration.
Related: 10 incredible health clinics helping us to end the HIV epidemic
Edric Figueroa, coordinator of ACT NOW: END AIDS Coalition, told Queerty that he was “hopeful that the Biden-Harris team and CDC nominees such as Rochelle Walensky and Demetre Daskalakis (both coalition allies) can receive guidance from HIV leaders when updating the federal EHE (Ending HIV Epidemic) plan to make the 2025 goals achievable in all communities. “
He stressed that there would be “there would be no end to any epidemic in the United States without removing structural barriers to health care and adopting a human rights approach that would focus communities most affected by HIV in planning and implementing public health interventions,” adding, “Efforts to expand health coverage for the most vulnerable Americans are critical. “
“A biomedical approach alone will not end HIV in communities marginalized by structural inequities.”
Kelsey Louie, CEO of the world’s oldest HIV and AIDS prevention service, GMHC, takes a slightly more optimistic tone, saying that the new administration and Congress “renewed my hope that we can end HIV in the United States before the end of this decade.
“President Biden recognized that the end of the HIV epidemic will require a comprehensive approach that includes addressing the health inequities that continue to fuel new infections in black and Latin communities and among LGBTQ + people, particularly transsexuals and non-conforming black women .
He also applauds Biden’s commitment to increasing access to health care, PrEP and PEP, and hopes, “the president will continue to take further steps to end the anti-LGBTQ + discrimination that contributes to the HIV epidemic, how to defend the approval of the federal government Law of Equality. “
Related: Five questions for Kelsey Louie from GMHC
Understanding the difference between the biomedical approach (PrEP, medications, regular HIV testing) and access to health care is a point that comes up repeatedly when talking to those who work in the field.
Ruston Taylor is Senior Director of Clinical Pharmacy Services and Community Health Extension Legacy in Houston, Texas. He tells Queerty about the importance of the Ryan White program and why it should be financed properly.
“I think that a very important thing for me as a pharmacist is to know that the patient has a home to go to. I cannot take medication to someone who has nowhere to live. “
Dr. Natalie Vanek is chairman of the Texas HIV Medicines Advisory Committee (the local AIDS Medicines Assistance Program / ADAP) and a physician at Legacy Community Health’s main clinic in the Montrose district of Houston. She told Queerty that Biden’s goal of ending the HIV epidemic by 2025 is a “high” goal.
“I think it is possible. We have the tools available. However … I don’t think it’s necessarily reachable. It is a doable thing, but it will require a Herculean effort, in my opinion.
“We need to have a much more robust funding to not leave any person or community behind.
“We have to face the inequalities that come with this epidemic.”
Vanek says that more needs to be done to reach those who are not entitled to the healthcare system or who have trust issues around healthcare professionals. This includes recent immigrants and other minority groups.
“This is a difficult thing to do. Sometimes, there is not much trust between the communities and the health care provider ”.
Vanek says one way to improve this is to actively involve community groups in planning and delivering health care and education, but she also says Covid-19 has made things more difficult.
“Somehow, [Covid] it really highlighted health disparities because it really showed how marginalized black people really suffered more, just as they did 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 many people joined the program because they lost their jobs, due to the Covid epidemic.
“Fortunately, there is the Texas HIV Medicines Program to provide medicines for them, but at the same time, we have to find funding to try to cover this increase in costs. I know that we are not the only ADAP going through this. “
Mark S. King is an HIV activist, longtime survivor and blogger.
Like Vanek, he tells Queerty that Biden’s 2025 deadline is a “high, aspirational goal, but we already have things that are slowing that down.”
King also highlights the Covid-19 pandemic.
“I am an advocate of ‘killing the crocodile closest to the boat’,” he says. “And now, that crocodile is Covid. We were retarded. The huge price that we will have to pay financially, socially and economically to Covid because of our criminal lack of attention to it in the last year, we will feel it for a long time and it will define us back as a country. “
Like everyone with whom Queerty spoke, King highlights the fact that more must be done to reach the most vulnerable so that there is any hope of ending the HIV epidemic. He is already excited that the Biden government has set aside money to promote the Affordable Care Act.
“Trump made sure that no dollar was spent on a single damn commercial or Internet ad that said, ‘Hey, the health care system is available if you go to Health.gov.’ There was none of that. Biden has already set aside money specifically for the promotion of our own healthcare market. This is amazing. In fact, we are promoting the fact that we have this. “
King is also hopeful that having a black vice president can help.
“I am convinced that Kamala Harris will be looking over Joe’s shoulder every moment for the next four years, saying, ‘Don’t forget about blacks and browns. Don’t forget about social justice. Don’t forget what brought us here. ‘”
“Once you address racial justice, which includes access to health care, access to affordable housing, equitable payment … all of these things have a direct effect on HIV.
“Can we deal with racism in the United States in the next five years and have it all sorted out in an organized way? Of course not, ”says King, suggesting such a naive notion. However, he says the next four years can help to repair “the damage of the Trump administration” and work for equitable health for all: “because that is the only way to control the HIV epidemic. “