10 Things Policymakers Can Do NOW to End HIV
The Nation has the tools to slow, and eventually end, the epidemic in the United States. With ongoing leadership, sustained funding commitments, strategic action, and emerging digital tools and technologies to help inform and educate, the American people are closer than ever to the day when the Strategy's vision will be attained.
-- National HIV/AIDS Strategy: Updated to 2020
On December 1, World AIDS Day, people worldwide will once again join together to show their support for people living with HIV and commemorate people who have died since the beginning of the epidemic. On this day, I'm reminded of my own journey as a gay man growing up in the Midwest. For me, those early days of the epidemic were filled with so much uncertainty, fear and utter despair about what was causing too many of my friends to leave this earth far too soon. Even in my own experience of being diagnosed in 1986, there were many times when I wondered if I would make it. I think about how much of a miracle it is that I'm alive today and thriving. Back then there were very few tools to fight HIV. We didn't know what the cause of the mysterious illness was nor what to do about it. All we could do was provide comfort to those who were dying.
Since then, over 650,000 Americans have lost their lives to AIDS and approximately 50,000 people in the United States become infected with HIV each year. Currently, there are more than 1.2 million Americans living with HIV. Today, almost half of all Americans know someone living with HIV.
Fortunately, times have changed and so, too, have the tools we have to fight the epidemic. With the National HIV/AIDS Strategy (NHAS), for the first time ever, we have a national framework guiding our domestic response to the epidemic from the federal government down to the local community level. We've also seen passage of the Affordable Care Act (ACA), which has greatly increased access to comprehensive care for so many individuals who would otherwise go without lifesaving care and treatment. But much work remains to be done. And if we can work together, I'm confident we will realize a future free of new HIV infections in the United States and healthier, longer lives for people living with HIV. So, how do we get there? Here's ten things we can do right now:
10. Work and think in completely new ways: collaborate, leverage resources, and advocate with all stakeholders. We must undertake a more coordinated national response to the epidemic, similar to the End AIDS plan in New York, Getting to Zero in San Francisco or End AIDS Washington. Success will require the commitment of governments at all levels, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV and others.
9. Ensure that the Ryan White HIV/AIDS Program remains strong and fills gaps in services. The Ryan White HIV/AIDS Program provides HIV-related services in the U.S. for those who do not have sufficient health care coverage or financial resources. The program fills gaps in care not met by other payers and is a model for achieving optimal health outcomes for people with chronic conditions. With adequate funding, we should consider if the program could provide access to lifesaving medications and services to people mono-infected with hepatitis C as well as services for other infectious diseases, including STDs. This is good for public health and a tremendous cost savings for taxpayers.
8. Ensure that public health, payers, primary health care and other systems interact seamlessly with each other to improve access to a range of public health prevention and care services.
7. Break down data siloes and improve collection, timeliness and accuracy in order to make decisions that improve outcomes and keep people engaged in the health system. Our surveillance system, for example, must "talk" to our programmatic databases and inform such steps along the continuum to care including linkages to and retention in care and therefore ultimately increase viral load suppression.
6. Revolutionize public health services for the transgender community and gay men -- not at the exclusion of other populations -- but in particular for young gay and bisexual men and transgender women of color, with a particular emphasis on leveraging digital tools and technologies such as social media and mobile apps to reach people where they are. Gay and bisexual men and transgender women continue to be the communities most impacted by the epidemic in the U.S. and we cannot end HIV without addressing its impact on these communities. The role of public health's Disease Intervention Specialists (DIS) needs to be reimagined to more effectively engage gay and bisexual men and transgender women in the health care system.
5. Provide comprehensive drug user health and harm reduction programs to address the needs of people who inject drugs and in particular, the epidemic of opioid abuse; public health, law enforcement and substance use programs must collaborate in new ways. WE MUST END the Congressional ban on the use of federal funds for syringe access programs. Decisions must be based on science and what works and NOT on political ideologies. We can avoid outbreaks like the one we recently experienced in Indiana when we all work together to develop and implement policy based on sound evidence.
4. Meaningfully address social determinants of health and reduce health inequities and stigma, including programs to undo racism and homophobia; incorporate #BlackLivesMatter and other social movements into programming and other public health work. This includes addressing policies related to employment, housing and other basic needs and other supportive services for people living with and at-risk for HIV. We must also re-examine laws that impose excessive criminal penalties on people living with HIV who know their HIV status and who potentially expose others to HIV.
3. Increase research and development of long acting treatments, cure and vaccines as well as new treatments to address drug-resistant strains of STDs and other diseases. We are at a critical point in the epidemic where we are poised to make dramatic new discoveries in prevention, treatment, vaccine, and cure research. While much progress has been made, and globally 15 million people are on HIV treatment, 20 million are not on treatment and there are over 2 million new HIV infections every year. Domestically, new HIV infections have been steady at 50,000 per year for three decades. Funding for research must continue to be a priority.
2. Scale up the use of pre-exposure prophylaxis (PrEP), a prevention option for people who are at high risk of acquiring HIV, making it available for all who could benefit from it. Full implementation of PrEP, coupled with continue scaled up of HIV anti-retroviral treatment, can be a game changer and significantly reduce HIV incidence and prevalence.
1. Provide routine HIV, hepatitis C and STD testing to everyone without barriers and provide treatment to ALL living with HIV and hepatitis C as soon as possible. Strong evidence exists that individuals living with HIV who are virally suppressed through consistent treatment do not transmit the virus to others. In addition, we must provide mental health and substance use treatment to those who need it and ensure everyone who gets HIV, hepatitis C and STD treatments have stable housing so their treatments will succeed.
Murray Penner is an HIV and hepatitis treatment and drug pricing expert who has been living with HIV since 1986. Murray is also the executive director at the National Alliance of State & Territorial AIDS Directors (NASTAD). NASTAD strengthens state, territory and global-based public health leadership, expertise and advocacy and bring them to bear in reducing the incidence of HIV and hepatitis infections and on providing care and support to all who live with HIV and hepatitis.