That’s a five-year improvement on former President Donald Trump’s aim to end the epidemic by 2030. Now that Biden’s in the White House, how realistic is that goal?
Currently, an estimated 1.2million people are living with HIV in the U.S., and approximately 40,000 people are diagnosed HIV positive each year. That figure has remained pretty stable over the last half a dozen years.
Although anti-retroviral medication has made HIV a long-term manageable disease, the war against HIV continues.
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set a target for countries to hit of 90-90-90 by 2020 in efforts to curb the virus: That’s 90% of people with HIV diagnosed, 90% of those diagnosed on treatment, and 90% of those on treatment to be virally suppressed.
Some countries have achieved this, such as the UK and other parts of Western Europe, prompting UNAIDS to now upgrade its target to 95-95-95 by 2030.
However, the U.S. continues to lag behind.
Only an estimated 86% of those with HIV in the US have been diagnosed, and of those, just 65% were virally suppressed or undetectable, according to data from 2018.
Despite this, there’s one thing most experts agree upon: The United States has the tools at its disposal to end the epidemic.
ACT NOW: END AIDS is a community action group founded by over 20 HIV organizations, including AIDS Alabama and the San Francisco AIDS Foundation, among others. Last year, it published a roadmap for how the US can bring an end to the HIV epidemic.
As those 90-90-90 targets suggest, the key is getting those with HIV diagnosed, and then on to treatment and virally suppressed. Once this happens, they cannot pass the virus on to others, effectively halting transmission in its tracks.
Encouraging at-risk groups to get regularly tested, follow safer sex practices or to take PrEP is another part of the toolkit. There have also been encouraging breakthroughs in recent months in the development of long-term HIV and PrEP treatments, which may help further.
Educating people that U=U (undetectable = untransmittable), and fighting stigma, is also vital.
However, that roadmap – which runs to over 130 pages – also explains some of the particular challenges the U.S. faces. Many of these stem from inequality when it comes to access to care. It highlights how HIV impacts Black and Latin communities worse than others, and how the southern states are disproportionately being affected.
A 2018 report estimated 50% of Black, gay men will become HIV positive in their lifetime. That same year, Black Americans represented over 40 percent of all new HIV diagnoses despite comprising only 13 percent of the U.S. population. Trans communities are also hit worse than others.
To bring an end to HIV, the reasons behind this need to be addressed.
ACT NOW: END AIDS asked the Presidential candidates last summer about their plans to tackle HIV. The Biden campaign gave long, fulsome answers that touched upon many of the main roadmap points already laid out.
It ran for several pages, but in brief, promised to:
- Update the Obama-Biden Administration’s comprehensive National HIV/AIDS Strategy, and “fully fund the Ryan White HIV/AIDS Program.”
- “Plan to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex … allowing Americans who are uninsured or who don’t like their coverage to buy into a Medicare-like public option.”
- Allow Medicare to negotiate lower prices with pharmaceutical companies, allow consumers to buy prescription drugs from other countries, and improve the supply of quality generics.
- Tackle the opioid crisis, which is leading to HIV transmission through dirty needles.
- Ensure that federal health plans provide coverage for PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis).
- Tackle the systemic racism that leads to health inequalities, and the crippling impact of poverty and homelessness. And to tackle HIV stigma.
These are all great aims… But finding anyone who would go on record and confidently say the HIV epidemic would be defeated in the next four years proves a harder task.
Since his inauguration in January, advocates have been encouraged by some of President Biden’s appointees, including respected HIV/AIDS researcher Rochelle Walensky of Harvard Medical School and Massachusetts General Hospital to direct the Centers for Disease Control and Prevention. However, taking office, the other spanner in the works has been the Covid-19 pandemic.
Indeed, a request to the White House for comment for this piece went unanswered, while a spokesperson for the NIAID (National Institute of Allergy and Infectious Diseases) said all their experts were currently too busy with Covid-19 to provide a statement.
Edric Figueroa, the ACT NOW: END AIDS Coalition Coordinator, told Queerty he was, “hopeful that the Biden-Harris team and CDC appointees such as Rochelle Walensky and Demetre Daskalakis (both of whom are coalition allies) can take direction from HIV leaders when updating the federal EHE (Ending HIV Epidemic) plan to make the 2025 goals achievable in all communities.”
He stressed there would be, “no end to any U.S. epidemic without removing structural barriers to healthcare and embracing a human-rights approach that centers communities most impacted by HIV in the planning and implementing of public health interventions,” adding, “efforts to expand health-care coverage to the most vulnerable Americans are critical.”
“A biomedical approach alone will not end HIV in communities marginalized by structural inequities.”
Kelsey Louie, CEO of the world’s older HIV and AIDS prevention service, GMHC, strikes a slightly more optimistic tone, saying the new administration and Congress, “have renewed my hope that we can end HIV in the United States before the end of this decade.
“President Biden has acknowledged that ending the HIV epidemic will require a comprehensive approach that includes addressing the health inequities that are continuing to fuel new infections in Black and Latinx communities and among LGBTQ+ people, particularly transgender and gender-nonconforming women of color.”
He also applauds Biden’s commitment to increasing access to health care, PrEP, and PEP, and hopes, “the president will continue to take more steps to end anti-LGBTQ+ discrimination that contributes to the HIV epidemic such as advocating for the passage of the federal Equality Act.”
Understanding the difference between the biomedical approach (PrEP, medication, regular HIV testing) and access to healthcare is a point that comes up again and again when speaking to those working in the field.
Ruston Taylor is Senior Director of Pharmacy Clinical Services and Outreach for Legacy Community Health in Houston, Texas. He tells Queerty of the importance of the Ryan White program, and why it must be adequately funded.
“I think one thing that’s really important to me as a pharmacist is just knowing that patient has a home to go to. I can’t get medications to somebody who’s homeless.”
Dr. Natalie Vanek is chair of the Texas HIV Medication Advisory Committee (the local AIDS Drug Assistance Program/ADAP) and a physician at Legacy Community Health’s flagship clinic in Houston’s Montrose district. She tells Queerty that the Biden aim of ending the HIV epidemic by 2025 is a “lofty” goal.
“I think it is possible. We do have the tools available. However … I don’t think it’s necessarily achievable. It’s a doable thing but it’s going to take a Herculean effort, in my opinion.
“We need to have much more robust funding so that we don’t leave any person or any community behind.
“We have to address the inequities that come along with this epidemic.”
Vanek says more needs to be done to target those disenfranchised with the healthcare system or who have trust issues around healthcare professionals. This includes recent immigrants and other minority groups.
“That’s a hard thing to do. Sometimes there’s not a lot of trust between the communities and healthcare provider.”
Vanek says one way to improve this is to actively involve community groups in the planning and delivery of healthcare and education, but she also says Covid-19 has made things tougher.
“In a way, [Covid] has really shined a bright spotlight on the health disparities because it has really shown how disenfranchised persons of color have really suffered the most, just like they have with HIV.
“Currently, in Texas, our ADAP program (the Texas HIV Medication Program), has suffered a $52million budget deficit, which is devastating. Part of that is because so many people have come on to the program because they’ve lost their jobs, because of the Covid epidemic.
“Thankfully, there is the Texas HIV Medication Program to provide medications for them, but at the same time, we have to find funding to try and cover that increase in costs. I know we’re not the only ADAP going through that.”
Mark S. King is an HIV activist, long-term survivor, and blogger.
Like Vanek, he tells Queerty that Biden’s 2025 deadline is a “lofty goal, an aspirational one, but already we have things that are slowing it down.”
King also highlights the Covid-19 pandemic.
“I’m a proponent of ‘kill the alligator closest to the boat’,” he says. “And right now, that alligator is Covid. We’ve been slowed down. The enormous price we’re going to have to pay financially, socially, economically, to Covid because of our criminal lack of attention to it over the last year, we’re going to feel that for a long time and it’s going to set us back as a country.”
Like everyone else Queerty spoke to, King highlights the fact more must be done to target the most vulnerable for there to be any hope of ending the HIV epidemic. He’s already encouraged that the Biden administration has earmarked money for the promotion of the Affordable Care Act.
“Trump made sure no dollars were being spent on a single goddam commercial or internet ad that said, ‘Hey, healthcare is available if you go to healthcare.gov’. There was none of that. Already Biden has earmarked money specifically for the promotion of our own healthcare marketplace. This is amazing. We’re actually promoting the fact that we have this.”
King is also hopeful that having a Black Vice-President may help.
“I am convinced that Kamala Harris is going to be looking over Joe’s shoulder every moment of the next four years going, ‘Don’t forget Black and Brown people. Don’t forget social justice. Don’t forget what got us here.’”
“Once you address racial justice, which includes access to healthcare, access to affordable housing, equitable pay … all of those things have a direct effect on HIV.
“Can we address racism in the United States in the next five years and have it all tidily addressed? Of course not,” King says, suggesting such a notion as naïve. However, he says the next four years can go some way to repairing “the damage of the Trump administration” and working toward equitable healthcare for everybody: “because that’s the only way we can get a handle on the HIV epidemic.”