Top officials in the Department of Health & Human Services laid out details on Wednesday of President Trump’s plan to end the HIV/AIDS epidemic by 2030, asserting “significant new resources” would be in the upcoming budget request for domestic HIV/AIDS programs after two years of proposed cuts.
In a conference call with reporters, the officials fleshed out the plan announced by Trump this week during the State of the Union address, saying the goal was to reduce new HIV diagnoses by 75 percent within five years, and by 90 percent within 10 years.
Robert Redfield, director of the Centers for Disease Control & Prevention, described the effort as a “laser-focused program” that will target 48 counties in the United States, D.C., and San Juan, Puerto Rico, as well as seven states where the epidemic is mostly in rural areas.
(A map pinpointing those locations, including the seven states — Missouri, Kentucky, Oklahoma, Arkansas, Mississippi, Alabama and South Carolina — can be found online at hiv.gov.)
Those areas, Redfield said, largely form the basis for where new HIV infections are happening in the United States.
But Redfield also said minority communities, including LGBT people, are especially at risk for HIV infection.
“Recent data has showed our progress in reducing the numbers has plateaued, increasing the burden of new infections, particularly in African-American and Latino gay and bisexual men, transgender individuals, women of color and people living in the South,” Redfield said. “Now is the time to change this and we have the tools to end the epidemic and we have to apply them.”
Redfield said the targeted geographical areas were identified as a result of monitoring trends for much of the 38,500 new HIV/AIDS infections last year.
“I was shocked that it was only 48 counties out of over 3,000 counties in the United States, so it shows that we had a very geographically focused outbreak, that if we could augment the capacity of those 48 counties in response to these new infections, and begin to prevent new infections, we could drastically reduce the number of new infections,” Redfield said.
The additional seven states, Redfield said, were selected because new infections were happening there, but were in rural areas and less concentrated.
The health officials said the new efforts will reenergize the fight against HIV/AIDS after a period of stagnation in which the effort to stop new infections has plateaued.
Brett Giroir, assistant secretary of health, said 40,000 new infections are still happening throughout the United States each year.
“HIV has cost America too much for too long,” Giroir said. “We have lost 700,000 American lives since 1981, and unfortunately, despite the emergence of new tools and new techniques, we are at high risk of another 400,000 becoming infected with HIV over the next decade.”
In response to a question from the Washington Blade, Giroir said the new approach to fighting HIV/AIDS would take the form of increased funding for HIV/AIDS programs in the budget request Trump will submit to Congress next month.
“We absolutely want to confirm that there will be significant new resources to support the effort you just heard outlined,” Giroir said. “The scientific community…as well as our closest advisers and technical experts devised a plan, submitted a plan to the budget, and we’re very confident we will have the sufficient resources provided in the 2020 budget for us to begin this very aggressive plan.”
A budget proposal with increased funds for HIV/AIDS would be a change for Trump. His first two budget requests to Congress sought funding cuts for both domestic HIV programs, chiefly the Ryan White Care Act, and programs designed to fight the global epidemic, such as PEPFAR. Although the cuts to domestic programs were diminished in the second budget, the cuts to global programs were still considered draconian.
Giroir, however, said the increased funds in the next budget request will be for domestic efforts, so the global fight is another matter.
“I was speaking specifically about the domestic programs,” Giroir said. “I don’t have any information on global programs.”
In response to subsequent questions from reporters, the health officials wouldn’t give details about the extent to which domestic funds would be increased, but affirmed new money would come from requesting additional funds as opposed to restructuring existing programs.
Of course, those funds can only be appropriated by Congress despite whatever request the Trump administration, as evidenced by the recent war between Trump and Congress over funding for a U.S.-Mexico border wall.
Giroir emphasized the importance of Congress appropriating the funds for the Trump administration to pull off the HIV/AIDS plan.
“We are very confident the president’s budget, as will be proposed, will be sufficient to support our 2020 activities in this initiative, so we need Congress to support the budget and support the increased resources that we ask for,” Giroir said.
Key to the strategy, the health officials said, will be ensuring these communities have access to PrEP, or pre-exposure prophylaxis, for HIV prevention.
Anthony Fauci, director of the National Institute of Allergy & Infectious Diseases, maintained the importance of PrEP and medications to reduce viral loads as part of this effort.
“You treat an individual and bring their viral load to a below detectable level, they will not transit their virus to another individual, and we know that pre-exposure prophylaxis works in more than 97 percent of the cases,” Fauci said. “If you put those two together, theoretically, then, if you get everyone that’s infected on anti-retroviral and decrease the viral loads to below detectable levels, and give those who need PrEP PrEP, you can end the epidemic as we know it, and that is our goal.”
Although the U.S. government is already taking steps to confront HIV/AIDS, the health officials also billed the effort as a multi-agency approach to HIV/AIDS in coordination with local communities that hasn’t been seen before.
Fauci said NIH would contribute to work by the Centers for AIDS Research, which are 19 centers throughout the country that worked on the AIDS epidemic in the 1980s.
“This is a five-to-10 year program, and we know when we do things in certain areas, we can do better as the years go by, so we’re committed to working very closely through our stakeholders with our colleagues to make sure that we implement to the best degree possible the program to make it successful,” Fauci said.
George Sigounas, administrator of the Health Resources & Services Administration, said two programs — the Ryan White and HRSA health centers — will play an essential role in the plan.
Although Ryan White, which provides care to low-income people with HIV, will continue its role, Sigounas said HRSA health centers “will play a major expanded role in providing pre-exposure prophylaxis to those populations at the greatest risk of acquiring HIV infection.”
Michael Weahkee, principal deputy director of the Indian Health Service, said his organization will also play an important role in the initiative.
“In partnership with Native communities, we can end the HIV epidemic in Indian country by strategically focusing on those communities that have been most impacted,” Weahkee said.
According to Weahkee, American Indian and Alaska Native populations have seen a 63 percent increase in new infections among young Native men who have sex with men.
One reporter asked whether the plan reported by the New York Times within HHS that would eliminate transgender people from the definition of sex under the law would impact HIV/AIDS efforts.
Redfield, repeating comments he made earlier when asked about the anti-trans proposal, denounced stigma as the “enemy of public health” and said the “transgender population in particular needs to be reached out to.”
Fauci talked particularly about the importance of reaching the transgender community in fighting HIV/AIDS.
“Transgender people are certainly at high risk of infection and also are overrepresented in the group that are infected, so this program…will treat transgender people the way we treat any other patient, giving them the respect they deserve whether they are infected or whether they are at risk of infection,” Fauci said. “And that’s a commitment that we all have very firmly.”