It is customary for Congress to shrug off the president’s budget proposal, but there is one ask from President Trump that has drawn bipartisan praise: The request for $291 million toward ending HIV transmission in a decade.
The initiative focuses on working with community organizations to boost the number of people taking medication to treat and prevent HIV. At this time, progress in the U.S. has stalled, and 40,000 people are still infected by HIV every year.
To get a closer look at the plan, the Washington Examiner sat down with Dr. Brett Giroir, assistant health secretary at the Department of Health and Human Services. The interview has been edited for length and clarity.
Washington Examiner: Medication to treat HIV has transformed its prognosis from a death sentence to a chronic ailment. Given that, how do you stress the importance of prevention?
Brett Giroir: If you take the medications and you are on lifelong care, it’s possible to live a near-normal lifespan, but it’s also possible not to. One in 5 people who present with HIV infection present with full-blown AIDS.
So this really is a serious disease. Yes, it can be turned into a chronic disease, but if you have a choice of having a chronic disease that could kill you at any moment, that could be spread if you’re off [medication], that involves lifelong trips to the doctor, hundreds of thousands of dollars in care costs, versus not having that disease at all, I think any rational person would understand it’s best to avoid that disease if you can.
[Related: Most HIV infections spread by people who aren’t diagnosed or aren’t getting treatment]
WE: What can we expect future budget requests to look like?
BG: The first year really is a ramp-up year. I’m not ready to share any dollar amount because that hasn’t been worked out in the budget.
We have about 120,000 people with HIV who don’t know they have it. We also have many tens of thousands who have been lost to care. So if we are successful, the number of diagnoses we have in the first couple of years will go up significantly. Not that they’re new cases, but they’re new diagnoses.
When you put those into the system, there’s an initial influx of money that you need to do to get them cared for. But over a period of time you save tremendous amounts of money to the system.
WE: Can you respond to critics who say that the president’s budget request to couple the HIV initiative with an overhaul of Medicaid is counter-productive?
BG: This plan does not require any miracles to happen. We don’t need a new HIV vaccine. We don’t need a new treatment. Antiretroviral therapy is highly effective, and if you’re on it and you’re virally suppressed, you cannot transmit the virus.
We did not assume any Medicaid expansion or any changes in coverage. For the people in the gap who would have no resources, we built resources into the program over five years so they would all be taken care of at community health centers or at the Ryan White Program [which provides HIV care for low-income people].
[Also read: Here’s who’s most affected by HIV today]
WE: How do you get across to communities that they should join you in this effort, given that some HIV interventions are controversial?
BG: The way you start is you get the president to say this is important to the country. We know that 10% of HIV transmission is associated with IV drug use. Addiction is a disease. People deserve treatment, and this is a catastrophic consequence of the disease. We understand stigma is the enemy of public health.
This is a public health issue that we have to take seriously as a public health issue and embrace everybody who has the disease or is at risk for it.
It’s really a community-driven program to meet people where they are. And that could be in needle exchange programs, that could be in opioid treatment programs. It’s going to be in homeless shelters. It’s going to be everywhere, because the people who are not reached are not reached because they’re the hardest to reach.
HHS has been very vocal about supporting syringe services programs. It not only decreases HIV, but it’s been shown to be an on-ramp into treatment. I fully hope that it’s adopted by states throughout the country because this is one of the things we need to do to battle HIV transmitted by IV drug use.
WE: What about supervised injection sites?
BG: We are not supportive of supervised injection facilities. They are illegal now, but that is independent of our assessment of the evidence. We did do an overview of all evidence. We had all the experts around the table, and we really don’t feel that the evidence about increasing survival is strong at all.
WE: The LGBTQ community is disproportionately affected by HIV but distrusts the administration because of past policies. Do you hope critics will give the administration a chance to show it is sincere in its goals?
BG: In the last couple of weeks, we clearly have been given a chance. I’m a physician. My goal is to help people and to make them healthier and improve their quality of life. I don’t care about anything else. And nobody here cares about anything else except doing the right thing.
There are going to be occasional policy differences and differences based on well-meaning approaches. But I feel that this initiative is something that everybody should get around. And I feel people are. We need to earn people’s trust. I understand that. We are prepared to do that.
If you have the opportunity to eliminate a disease — I mean really eliminate a disease — I think it’s a moral obligation to do so.
