Modern HIV treatment and prevention can make possible the goal of ending the HIV epidemic. People living with HIV who remain on successful treatment and achieve an undetectable viral load can live a near-normal lifespan and cannot transmit HIV to others. The adoption of pre-exposure prophylaxis by people who are HIV negative can also decrease HIV acquisition by up to 97 percent. President Trump’s State of the Union pledge to end the HIV epidemic in the United States by 2030 is thus not just an aspiration, but a mission we can accomplish.
The Trump administration’s budget request for fiscal 2020 seems to back his pledge with the resources needed to make it possible. Guided by an adequately funded new federal HIV strategy, the aim is to provide support to 48 counties, the District of Columbia, San Juan, Puerto Rico, and seven states with the highest number of new HIV diagnoses in the country. According to the U.S. Centers for Disease Control and Prevention, these cities, municipalities, and states, viral “hot-spots,” accounted for more than 50 percent of new HIV diagnoses in recent years.
Since 2014, 23 U.S. cities and counties have joined more than 270 “fast-track cities” working to close local HIV testing, prevention, and treatment gaps. Officials from fast-track cities and municipalities ranging from Denver to Miami-Dade County are using data-informed approaches to expand access to HIV services. As a result, more Americans are getting tested and accessing prevention and treatment services. Many communities are seeing fewer HIV infections and AIDS-related deaths. But despite these gains, more work remains to end urban HIV epidemics.
Globally, fast-track cities are also achieving progress, including in countries where challenges to accelerating local AIDS responses were deemed intractable. The U.S. President’s Emergency Plan for AIDS Relief has prevented millions of HIV infections, including 2.4 million babies who have been born HIV-free. Moreover, through PEPFAR’s investment, sub-Saharan African countries such as Lesotho, Namibia, Rwanda, and Zambia are on track to achieve HIV epidemic control. Success in urban AIDS responses is making a real impact on these national HIV epidemics. Comparable results are possible in the United States, given the sort of approach that the Trump administration is proposing.
To end the HIV epidemic in the United States and abroad, life-saving (and affordable) medicines must reach the people who need them, yet many people remain unaware of their HIV status. So long as HIV-related stigma remains an obstacle for people to seek HIV testing, even the best intentions can only achieve limited results. In the United States, new HIV infections are highly concentrated among gay and bisexual men, African-Americans, Latinos, and Native Americans. Many of these individuals contend with dual or multiple stigmas that affect people who use substances, live with mental health conditions, are formerly incarcerated, or struggle to find affordable housing. Moreover, gender, race, sexual orientation, and socioeconomic status are also sources of stigma that can increase a person’s vulnerability to HIV.
The new federal HIV strategy seeks to reduce new HIV infections by 75 percent in the next five years and by 90 percent in the next 10 years. Fighting stigma will be a critical part of this effort, in addition to a biomedical approach that leverages modern HIV treatment and prevention. Everyone, especially the most vulnerable among us, needs equal access to HIV testing, treatment, and prevention services to end this epidemic once and for all. Trump’s pledge is ambitious, but with sustained commitment, it can become a reality in our lifetime.
Dr. Jose M. Zuniga is president/CEO of the International Association of Providers of AIDS Care, or IAPAC, which is the core technical partner of the Fast-Track Cities initiative.
