The federal government plans to target a dozen cities including Baltimore as it aims to drastically reduce HIV and AIDS nationwide. (Baltimore Sun video / Kevin Richardson)
Baltimore is one of dozens of hotspots the federal government plans to target as it aims to drastically reduce HIV and AIDS nationwide during the next decade, according to the U.S. Department of Health and Human Services.
The city, along with Montgomery and Prince George’s counties, is among the areas where the federal health department estimates about half of new HIV cases occur — including 48 of some 3,000 counties nationwide, seven states, Washington, D.C., and Puerto Rico. The department plans to direct funding to those areas to boost resources for fighting HIV and AIDS.
But the day after President Donald Trump announced the initiative in his State of the Union address, neither the Maryland Department of Health nor the Baltimore City Health Department had received details about how the initiative might be implemented locally.
The program was among the public health goals Trump mentioned in his State of the Union address Tuesday.
“In recent years we have made remarkable progress in the fight against HIV and AIDS,” Trump said. “Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America.”
While Trump spoke of eliminating HIV within 10 years, the program’s actual goals are to reduce new HIV infections by 75 percent in five years and 90 percent in a decade, according to a statement posted by Health and Human Services Secretary Alex Azar.
Maryland ranked fifth of all U.S. states and territories in HIV diagnosis rates, with 20.4 diagnoses per 100,000 people in 2017, according to data from the state health department and the Centers for Disease Control and Prevention.
Baltimore City and Prince George’s County had the highest diagnosis rates in the state that year. In Baltimore, the rate of new HIV diagnoses among patients age 13 and older was 44.7 per 100,000 people in 2017, according to the city health department.
In Baltimore, 231 new HIV cases were diagnosed in 2017, the most recent year for which data were available, said Dr. Adena Greenbaum, assistant commissioner of the clinical services and HIV/STD prevention for the Baltimore City Health Department. She said the city already surpassed its goal of a 25 percent reduction in annual HIV diagnoses between 2010 and 2020.
More than 12,000 people are living with HIV in the city, she said. Statewide, there were 30,566 adults or adolescents living with HIV at the end of 2017, according to state health department data.
Federal health officials analyzed data on the spread of HIV to identify the counties with the highest number of new HIV diagnoses and states with high rates of HIV in rural areas, according to information from the department. The initiative will provide funding to those jurisdictions in phases, “starting with the areas with the highest burden,” according to the federal health department.
The Maryland Annual HIV Epidemiological Profile for 2017 estimated 11.6 percent of people living with HIV in Maryland had not been diagnosed.
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Of those people who were diagnosed with HIV in Baltimore, about 73 percent were men, 24 percent were women and 3 percent identified as transgender according to Greenbaum. About 80 percent of those patients were black, 13 percent were white and 3 percent were Hispanic. And 37 percent of all the new cases were diagnosed in people younger than 30, she said.
“HIV does not affect all communities equally. That’s true nationwide and it’s also true in Baltimore, and there are those who are disproportionately affected by HIV,” Greenbaum said. “We cannot address HIV without reducing disparities and reducing health inequities.”
The city health department already offers free HIV testing, works with community groups and clinics to reduce the stigma around HIV and AIDS, and is aiming to increase access to a pill that can prevent HIV infection for people who are exposed to the virus. The department also works to link HIV and AIDS patients with health care providers by making appointments and arranging transportation for them.
The new report is the latest measure of how well public health authorities are doing at boosting rates of early diagnosis and care for HIV — goals that will extend life expectancies for patients and reduce the virus’ spread.
While Trump spoke of wiping out HIV in 10 years, the program’s actual goals are to reduce new infections by 75 percent in the next five years and by 90 percent in a decade.
Azar said the initiative would increase investments to existing programs in geographic hotspots, establish a new program through community health centers to provide medicine to protect persons at highest risk, use data to target services and fund the creation of a local HIV HealthForce in these targeted areas.
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The proposal was met with a mix of skepticism and cautious optimism by activists in the fight against AIDS. And state and local health officials warned the administration not to take money from other programs to finance the initiative.
"This effort cannot move existing resources from one public health program and repurpose them to end HIV without serious consequences to our public health system," said Michael Fraser, CEO of the Association of State and Territorial Health Officials, in a statement.
It’s unclear how much the federal program will cost. Funding for the initiative, in addition to investments in current efforts to fight HIV/AIDS, is expected to be part of Trump’s budget request for fiscal 2020.
AIDS activists said they're ready to work with the White House but also wary because of Trump's previous efforts to slash Medicaid, the health insurance program for low-income people, and his administration's ongoing drive to roll back newly won acceptance and rights for LGBTQ people.
"To date, this administration's actions speak louder than words and have moved us in the wrong direction," said AIDS United, which funds and advocates policies to combat AIDS.