America has the tools and knowledge to end the HIV epidemic by 2025, according to a new policy paper released by a coalition of leading HIV/AIDS organizations. All that’s needed now is the political will.
The paper, entitled “Ending the HIV Epidemic in the United States: A Roadmap for Federal Action,” was released to coincide with World AIDS Day on December 1st and is signed by over 250 organizations, including AIDS United, the National Alliance of State and Territorial AIDS Directors, NMAC (formerly the National Minority AIDS Council), the National Coalition of STD Directors, and The AIDS Institute.
In the report, six achievable pillars are identified for ending the epidemic for good: committing to ending the epidemic; ensuring access to care; preventing transmission of the virus; addressing social and structural barriers to care; ongoing research; and supporting the involvement of people living with HIV. Within each pillar, the report lays out specific recommendations, such as upgrading prevention programs in Puerto Rico; eliminating the waiting period for Medicare; urging every American to get tested at least once; and decriminalizing sex work.
Analysts consulted by the coalition of nonprofits estimated that a quick ramp-up of these recommendations would save the country $57 billion over the next decade.
These types of measures have been proven effective in addressing the epidemic at the local level, said William McColl, AIDS United’s Director of Health Policy. On a conference call unveiling the roadmap, he cited the work of AIDS Free Pittsburgh, a community coalition that oversaw a decrease of new HIV cases by 30 percent from 2015 to 2017. In New York City, McColl added, similar efforts resulted in a record low in new diagnoses in 2017 — just over two thousand cases, a record low since tracking began.
The roadmap calls for a “95/95/95” framework. That means 95 percent of people living with HIV are aware of their HIV status, 95 percent of diagnosed individuals are retained in care, and 95 percent of individuals on antiretroviral therapy are virally suppressed.
“When we talk about ending the epidemic, we mean bringing new infections down so low they drop beneath the number of deaths each year while the numbers of HIV related deaths also drops,” AIDS United’s Senior Policy Manager Alex Smith told INTO. The goal is to make HIV-related deaths as rare as deaths from diseases like measles, mumps, or tuberculosis, for example.
The plan begins with a national commitment to the goal of 95/95/95 by 2025, which includes increasing PrEP uptake to 40 percent of people vulnerable to HIV. PrEP is a suite of interventions that include regular testing, counseling, and a daily dose of antiviral medication that helps block the HIV virus from taking hold in the body. The Centers for Disease Control estimates that in 2016 only about 80,000 people were using PrEP, representing just six percent of the 1.2 million vulnerable people in the United States.
Without a rapid scale-up, the paper warns, “the U.S. HIV epidemic will continue to outrun the response.”
To meet that target, America will have to improve HIV monitoring nationwide and also upgrade access in overseas territories like Puerto Rico and the US Virgin Island.
Care programs will also need to implement specific protections to guarantee care for LGBTQ patients. Health care discrimination remains a widespread problem in the United States, with the Trump administration working to undo provisions that bar discrimination.
The roadmap also recommends equitable access to care, particularly for Medicaid and Medicare patients. Medicaid covers over 40 percent of people with HIV in care, with Medicare covering about 20 percent. But more could be done to cover those with HIV, such as eliminating the 29-month waiting period that Social Security Disability recipients must endure before they can use Medicare. In addition, the report says, it’s urgent that the Affordable Care Act be maintained, especially nondiscrimination protections and a stable insurance marketplace. Congressional Republicans have been trying to dismantle ACA since it was passed.
To prevent new HIV transmissions, the document recommends implementing routine HIV screenings for everyone over the age of 15, as well as broad access to PrEP and harm reduction services like syringe access.
Southern states are identified as needing particular focus, accounting for over 50 percent of the estimated new cases despite representing only 37 percent of the US population. In Indiana, for example, Governor (now Vice President) Mike Pence oversaw a catastrophic spike in HIV transmissions after the closure of testing facilities and the restricting of needle exchanges.
At a ceremony this week marking World AIDS Day, Pence delivered the same speech, word for word, as last year, and failed to make any mention of LGBTQ people. Previously, Pence expressed support for “ex-gay” conversion practices instead of funding the Ryan White Care Act. This year, he tweeted that the Trump administration will funnel $100 million to faith-based organizations.
HIV experts were diplomatic in responding to Pence’s announcement.
“I think there’s a space for faith based communities in implementing this roadmap,” Smith told INTO, “especially in addressing stigma in the South.”
Effectively ending the epidemic will require addressing numerous social and structural barriers to care, according to the roadmap. That includes overturning laws that criminalize HIV and consensual sex work, and also an end to disproportionate incarceration of people of color and transgender people. In addition, more needs to be done to extend care to immigrant populations; and Congress must repeal SESTA and FOSTA, two Trump-signed bills that restrict speech around sex work online and have prevented basic protections for sex workers.
The roadmap places particular emphasis on meeting the needs of people of color, transgender and gender-nonconforming people, undocumented immigrants, people in prison, and more. Many of those groups are frequent targets of Republican policy; but the coalition hopes to educate incoming lawmakers about the urgency of their plan, as well as its achievability.
“We need to avoid creating the impression that this is a simple and easy fix that can occur without resources,” McColl told INTO. “We need to create a real sense of urgency about this. We’re going to make sure that every single member of Congress, including new members, have an opportunity to understand the fact that we now have the tools to end the epidemic in the United States.”
In the meantime, everyone else can lend a hand by contacting elected officials and attending public events. AIDS United issues regular alerts about opportunities to get involved.
“This is an ambitious goal, but one we believe is achievable,” said Jesse Milan, President and CEO of AIDS United, on the conference call announcing the plan.
That was met with agreement by Jeanne White-Ginder, whose son Ryan was a poster child for combating HIV stigma in the 1980s.
“We have to insist that AIDS is a priority,” White-Ginder said on the call. “We must all demand that Congress and this administration pursue it with the same urgency that we called for at the height of the crisis. It can be done.”
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