February 14, 2019

“Ending the AIDS Epidemic: A Plan for America”: What Will Will It Look Like?

The Academy responded to the President’s February 5 announcement on HIV with a press release questioning whether it is possible to eradicate HIV transmission in the US by 2030 without addressing the access to care, stigma and prevention issues surrounding the epidemic.

Since then, additional information on “Ending the AIDS Epidemic: A Plan for America” has been released, although the initiative will not officially launch until 2020. To date, we know that it is federal plan developed by Dr. Brett Giroir (Assistant Secretary for Health), Dr. Tony Fauci (NIH), Dr. Robert Redfield (CDC), Dr. George Sigounas (HRSA) and Rear Admiral Weakhee (Indian Health Service).  Its goal is to reduce new HIV diagnoses by 75 percent by 2025. Then, the program will be fine-tuned and rolled out more broadly with the goal of reducing all new HIV diagnoses by 90 percent by 2030.

The President plans to add a new line item of $250 million to his 2020 budget for Ending the Epidemic (ETE). Existing HIV appropriations for CDC, HRSA, and the MAI are expected to remain at 2019 levels. ETE funding will be used to expand HIV prevention and treatment in the 48 counties in the US with the highest rates of new HIV infections. The program will also cover Washington, DC, San Juan, Puerto Rico, and seven states (Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina) where transmission rates are high. ETE funds will be disbursed mostly through the CDC and Ryan White HIV/AIDS Programs managed by local and state health departments.

Not surprisingly, this announcement has generated a range of responses and questions from people living with HIV and their health care providers and advocates. Twenty two HIV and AIDS patient advocacy groups wrote a joint statement affirming that “We stand ready to work with [Trump] and his administration if they are serious. But to date, this administration’s actions speak louder than words and have moved us in the wrong direction.”

As the New York Times observed, “To end the spread of the virus, federal health officials say they must reduce the stigma attached to gay men and transgender people who are at high risk so they will seek testing and treatment. But for two years the administration has tried to roll back legal protections for people in those groups.”

Not surprisingly, as Politico notes,“advocacy groups were quick to criticize Trump — or in some instances, even pan his proposal outright, given the administration’s repeated efforts to cut AIDS funding and roll back protections for patients with HIV and other pre-existing conditions.” The Washington Blade added that, “Critics have said the Trump administration isn’t serious about combatting HIV/AIDS as it seeks to restrict access to Medicaid, which covers an estimated 40 percent of people with the disease, and undertakes initiatives like Conscience and Religious Freedom Division, which is seen to enable medical practitioners decline to perform not only abortions, but also gender reassignment surgeries or HIV-related care.

Representative Barbara Lee (D-CA), co-chair and co-founder of the HIV/AIDS caucus and a former chairwoman of the Congressional Black Caucus, commented that, “While I’m encouraged that President Trump raised the domestic HIV epidemic in his speech, those of us who have worked on these issues for years — in the community and in Congress — are justifiably skeptical.”

For an AAHIVM-specific, on-the ground perspectives on this, we contacted two Florida members whose state is home to six of the 42 high-impact counties that will be targeted by ETE. Dr. Ed Braun in Tampa and Dr. Bob Wallace in St. Petersburg both said that, so far, they had heard very little about ETE. They agree, however, that there is substantial unmet need in their state for additional outreach, HIV testing, prevention services and medical care.

Both of them see many indigent patients who are not well informed about HIV prevention or treatment. Dr. Wallace noted that Florida has the highest HIV incidence in the country and “we have no support from our Governor” to address it. He asked if the President was planning to re-open the federal Office of National AIDS Policy – an unanswered question to date.

Dr. Braun remarked that it is hard to “get people to feel open and comfortable about getting care when they are feeling ostracized and alienated.” He sees the prospect of ETE as “optimistic” if it successfully provides more resources and skilled health care providers in the state. Both also agreed that offering PrEP and educating their patients about HIV prevention and treatment is essential in order to keep patients coming back. But, Dr. Braun added, homophobia and stigma are issues that keep people from coming in and must be addressed to ensure that people are linked to and retained in care.

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