The Centers for Disease Control and Prevention (CDC) last week released a report finding a plateau in efforts to stop the transmission of HIV and suppress it for those who are living with the virus. The report, published by the CDC’s Vital Signs, surveyed data from 2013 to 2018 and concluded that four out of five people who could benefit most from pre-exposure prophylaxis (PrEP) are not getting it, and that PrEP use is especially low among young, black people and Latinx populations.
There were other sobering statistics. Despite the fact that an estimated 86% of people with HIV had received a diagnosis, less than two-thirds of those with diagnosed HIV infection had a suppressed viral load.
The report’s authors concluded that “accelerated efforts to diagnose, treat, and prevent HIV infection are urgently needed.” Such a conclusion is an understatement, according to Jim Pickett, director of prevention advocacy and gay men’s health at AIDS Foundation of Chicago. “The fight to stop (HIV/AIDS) has plateaued based on these numbers,” Pickett said. “You would have thought that our efforts to link people to care would have worked better than this. There is now a national effort to get to zero. On the path we’re on, there’s zero chance of that happening.”
Pickett pointed out that the efforts to get young black and Latinx people onto PrEP and into treatment have fallen far short. “We have the tools, but we must be better about dealing with systemic racism and homophobia and misogyny, and that goes for everyone working in this field, from doctors to case workers to housing policy experts. We’re all responsible.”
The report came out the day the Department of Health and Human Services announced its Ready, Set, PrEP initiative as part of the Trump administration’s plan to reduce the rate of new HIV infections by 90% by the year 2030. That program would provide PrEP medications, including Truvada (emtricitabine//tenofovir disoproxil fumarate) or Descovy (emtricitabine/tenofovir alafenamide), free of charge at participating pharmacies—but medical visits and lab costs, important parts of PrEP care that come with significant costs, are not covered. And undocumented immigrants are not eligible for Ready, Set, PrEP, either.
“Illinois has a Getting to Zero project, and the cost of PrEP drugs are covered here for those who can’t afford it, but I’m worried that the people who most need it, including gay, black, Latino, and trans people, will still have barriers,” Pickett said.
But Carl Schmid, deputy executive director of the AIDS Institute, is more hopeful about federal government efforts in accelerating prevention and treatment starting next year, at least in the amount of funding promised. “We should have been doing better before now, but the administration’s effort can give those efforts a jump start, and this is the first year that resources have been given to it.” Schmid says grants allocated to 182 health centers across the U.S., to be expanded to more than 500 next year, should make a significant difference.
“By the time the new federal budget is announced in February, we should have a good idea of how robust the federal effort will be,” Schmid continued.
The Trump administration has been touting the Ending the HIV Epidemic: A Plan for America initiative in stump speeches since it was first announced at the 2019 State of the Union Address. That plan calls for slashing new infections by 90% by 2030. Trump has even mentioned it in stump speeches in the Deep South, an area hardest hit by the epidemic. Southern states, plus Guam and Puerto Rico, have accounted for more than half of new HIV diagnoses in the U.S. in recent years. HHS Secretary Alex Azar said 57 target jurisdictions by the year’s end will have received grants to develop HIV/AIDS prevention and treatment strategies, and four jurisdictions have already received funding to begin hiring and implementation: Atlanta, East Baton Rouge, Baltimore, and the Cherokee Nation in Oklahoma.
Just speaking about HIV/AIDS is a worthwhile exercise, advocates say, to remind the nation that HIV/AIDS is not a disease of the past. But critics say the administration’s record on issues that intersect with the HIV/AIDS crisis—poverty, sexuality and gender, housing, immigration, and race—could undermine the money promised. The creation of the Conscience and Religious Freedom Division of HHS, which advocates for medical practitioners who object to providing certain health care services, such as abortion, gender-affirming surgery, or HIV treatment—as well as a “conscience rule” to allow these workers to opt out of those treatments—could set back efforts to curb HIV/AIDS, advocates say. Likewise, critics say Trump’s overturning of Obama-era regulations could also encourage discrimination against communities most affected by HIV/AIDS. Under these changes, the regulations no longer interpret the ban on sex discrimination in health care under the Affordable Care Act to apply to transgender people, and no longer bar federal grantees from discriminating against LGBTQ people.
Despite the promised dollars to fight HIV/AIDS, Pickett said, “we have an administration that is trans-phobic, anti-immigrant, anti-black, and anti-Latino, and those are the most vulnerable populations.”