President Trump is set to ask Congress for “substantial new resources” to end the spread of HIV in the U.S., one of his top health officials said Wednesday.
Dr. Brett Giroir, the assistant secretary for health, told an audience at the American Public Health Association meeting Wednesday that the president’s budget would request more funding for agencies such as the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration in order to tackle HIV.
He declined to share the exact figures Wednesday morning because the rollout of the budget is delayed due to the government shutdown, but vowed that ending the spread of HIV was a priority for the administration.
“I certainly will hope that Congress will support this, and I have no reason why they would not,” Giroir said. He added in a later call with reporters that Trump was asking for new funding, not re-allocation of other resources, and that officials believe the request will be “sufficient to support this very aggressive program.”
Trump committed in Tuesday’s State of the Union address to ending the spread of HIV within 10 years, an ambitious goal but one that public health advocates have long believed is realistic. Roughly 1 million people in the U.S. are HIV-positive, and 40,000 more people are infected every year.
Though that’s a significant drop from the height of the HIV epidemic during the 1980s, when there were 130,000 new cases a year, progress has stalled.
“Nobody could give us the answer of why we still have so many cases of HIV,” Giroir said. “The answer was: There is no answer. Somebody just needed to decide to make a difference and change the trajectory we were on.”
Giroir said the administration’s plan was carefully mapped out, and that government agencies would be providing grants to local communities to advance the initiative, in particular focusing on places where rates of infection are especially high. CDC data show that half of new infections occur in 48 counties, the District of Columbia, and San Juan. Certain groups have a higher rate of incidence than others, including people who live in the South, African-American communities, people who use drugs, and men who have sex with men.
The government will aim to reduce the spread of HIV primarily by increasing access to medication. Pre-Exposure Prophylaxis, or PrEP, prevents the spread of HIV and is often known by its brand name, Truvada. Of the 1.2 million people who are at high risk of getting HIV, however, only 10 percent are taking PrEP. Giroir said the administration’s goal would be to increase that percentage to at least 50 percent.
If people do become infected, they can take drugs known as antiretrovirals to suppress HIV and stop the progression to AIDS, a disease that weakens the immune system. Antiretrovirals drugs allow people to live in similar way as they would with other treated chronic illnesses, such as diabetes. Antiretrovirals cost about $450,000 per person over the course of a lifetime.
Giroir said treatment needs to begin soon after diagnosis, but an estimated 1 in 7 people who are HIV-positive aren’t aware of it.
“We don’t need a miracle to happen,” Giroir said of the administration’s goal to end the spread of HIV. “It would be great to have a vaccine or a cure, but we can do this with the tools we have today, so let’s do it.”
He said in the call with reporters that the administration “fully supports” the use of needle exchange programs.
He noted that roughly 10 percent of new HIV infections occur among people who use drugs, a heightened concern given the U.S. is facing an opioid crisis involving heroin injection. He added, as well, that efforts to address HIV that is transmitted sexually needed to be a priority.
“These are highly integrated; it takes a comprehensive approach,” he said.
The planning for ending the spread of HIV began over a year ago, Giroir said, involving the input of Dr. Robert Redfield, a prominent HIV/AIDS researcher who is now CDC director. In the last six months, Redfield has been planning the rollout with Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Diseases; George Sigounas, HRSA administrator; and Michael Weahkee, principal deputy director of the Indian Health Service.
While the public health community welcomed the news about the goals on HIV, they have also questioned whether policies in other areas, involving immigrants and LGBTQ people, would get in the way of progress the administration is trying to make. Asked about this at the event, Giroir begged the audience to “give us a chance,” saying that “we know we need to earn the trust of many communities.”
“We want to care for people,” Giroir said. “I do not care about anything else but caring for individuals.”
