As part of his State of the Union address Tuesday night, President Trump announced a ten-year plan to end HIV as an epidemic in the U.S. by 2030. The Act Now: End AIDS Coalition agrees with the President that we now have the tools to end the U.S. epidemic, even short of a cure or a vaccine, and that this will require prioritizing people and communities who are most affected by HIV infection and who experience poorer HIV-related health outcomes. But to date this administration has targeted these same communities in ways that worsen the U.S. epidemic by proposing drastic budget cuts to HIV research, prevention and treatment programs domestically and globally; undermining healthcare access through the Affordable Care Act; and attacking sexual and reproductive rights and the human rights, safety, and health of transgender people, communities of color, undocumented immigrants, and other communities disproportionately impacted by HIV.
The federal plan proposed by the President, which we understand remains in development, reflects how far the science of preventing new HIV infections has advanced in the last decade. We now know that antiretroviral medications, taken as HIV treatment or prevention, can sustain optimal health for people living with HIV and stop transmission of HIV to others. Indeed, over 250 community-led organizations partnered to draft a detailed plan that was released on December 1st – World AIDS Day – of last year, setting out concrete steps to end the U.S. epidemic even sooner, by 2025. The plan, a collaborative document released by the Act Now: End AIDS coalition and AIDS United, specifically opposes several current Trump Administration policies, citing them as major obstacles to getting essential HIV prevention and treatment tools into the hands of the people who need them.
“The president spoke about the national HIV epidemic, so I’m glad that so many Americans heard that we can bring HIV below epidemic levels using existing tools. But to succeed, we must expand the ACA and access to healthcare, ensure comprehensive sexual health education and services, and increase access to pre-exposure prophylaxis (PrEP). This president has shown little regard for LGBTQ youth, people of color, women, immigrants, and other key communities that must be at the heart of any strategy to end the epidemic. We are days away from National Black HIV/AIDS Awareness Day, a reminder that without a firm commitment to human rights, our efforts will fail,” said Dazon Dixon Diallo, executive director of Sister Love.
Science confirms that people living with HIV who achieve an undetectable level of virus in their blood through effective treatment cannot pass the virus to others sexually. Likewise, pre-exposure prophylaxis (PrEP)– with one pill taken daily– can reduce the risk of an HIV-negative person acquiring HIV sexually by up to 99%. The community plan, “Ending the HIV Epidemic in the U.S.: A Roadmap for Federal Action (http://bit.ly/EndHIV2025),” asserts that dramatically scaling up HIV testing and treatment as well as access to PrEP by 2025 would avert approximately 353,000 new HIV infections between 2019 and 2030, saving the U.S. healthcare system billions of dollars. Conversely, if we do not scale up the U.S. HIV response now, we can expect 950,000 new HIV infections by 2030, bringing the number of persons living with HIV in the United States to nearly 1,589,000 persons and resulting in enormous personal and economic costs. Scaling up cost-effective programs like syringe services programs can dramatically reduce HIV and viral hepatitis transmission among those who inject drugs. In an era of opioid overuse, this is a key affordable tool in our toolbox. Moreover, additional services, including HIV treatment for women living with HIV could entirely eliminate perinatal HIV transmission.
The community roadmap makes clear that none of this will be possible without increased access to healthcare, including Medicaid expansion in all 50 states and U.S. territories, and a recommitment to protect the human rights of vulnerable communities. “We cannot end this epidemic so long as we continue to criminalize marginalized communities and people living with HIV. No matter how good the science is, people cannot effectively get tested, stay on treatment, or use PrEP when they’re being affected by racism, homophobia, transphobia, mass incarceration and deportation. Sexual and gender minorities cannot take care of their health when our political leaders aren’t actively working to protect their basic human rights and physical safety,” said Naina Khanna, Executive Director at the Positive Women’s Network-USA.
Act Now End AIDS has committed to monitor the development of the Trump Administration’s plan, pushing for the inclusion of community recommendations and a 2025 target for ending the epidemic. Charles King, CEO of Housing Works, added, “Extensive community expertise has already been captured in the existing roadmap; we need to make it clear that this new federal plan cannot just pick and choose the recommendations that are most convenient to this current administration. If we want to end this epidemic for every community in America, every single community recommendation contained in this document must be addressed.”
- Kaiser Daily Global Health Policy Report: Trump announces plan to end AIDS in ‘United States and beyond’ in SOTU speech; Experts say goal achievable while some remain skeptical about administration’s record (coverage of the State of the Union announcement)