When national public health leaders met Wednesday with state and local health officials, they made it clear they didn’t come to Baltimore to impose a top-down approach to ending the HIV/AIDS epidemic.
“We’re here to listen,” said Dr. Robert Redfield Jr., the director of the U.S. Centers for Disease Control and Prevention, who came from the University of Maryland School of Medicine in Baltimore.
The health officials gathered to discuss local strategies for eradicating the virus after Baltimore City and Montgomery and Prince George’s counties were selected as part of a nationwide program that will work to stamp out the disease in the U.S. The program, first announced by President Donald Trump in his State of the Union address in February, aims to reduce new HIV cases by 75% within five years and by 90% in the next decade by targeting areas with the highest infection rates.
Of the nation’s more than 3,000 counties, 48 of them plus Washington, D.C., and Puerto Rico account for half of new HIV diagnoses, according to the U.S. Department of Health and Human Services. The program will target those areas, as well as seven states where HIV/AIDS is prevalent in rural areas.
Though local infection rates have decreased, Maryland still ranks fifth among all states when it comes to new HIV diagnoses.
“We’ve seen tremendous gains in lives saved and reducing the numbers of new infections,” said Maryland Health Secretary Robert Neall. “Because we’ve been disproportionately impacted by HIV for decades, it’s essential that we maintain progress and we must continue to drive down the rates of transmission.”
To demonstrate the initiative’s priority, Trump’s proposed budget for fiscal 2020 — which is unlikely to be enacted by Congress — includes $291 million in new spending for the national program, including $140 million for the CDC.
Adm. Brett P. Giroir, a physician and assistant U.S. health secretary, said his agency is not waiting on those funds to launch the program. The Department of Health and Human Services allocated $30 million to jump start the program — funding that will be administered through the CDC to local partners, he said.
The program’s overarching strategy will revolve around partnering with communities to reach people with HIV/AIDS who have gone un-diagnosed, while working to keep those infected with HIV in stable treatment, said Redfield, a longtime AIDS researcher who co-founded the University of Maryland’s Institute of Human Virology and worked at the medical school until he was selected last year to head the CDC.
With vigilant therapy, people with HIV can reduce their viral load to the point where it is undetectable and essentially impossible to transmit.
“We have the tools,” Redfield said. “The challenge is we have to use the tools.”
The program also will work to protect at-risk populations and respond quickly to clusters of HIV infections.
More details are expected to be unveiled in the coming weeks regarding how the programs will roll out locally.
Redfield and Giroir said they want to work with the Maryland Health Department and municipal health departments to support local health workers based on each area’s needs. The CDC and HHS also will look to learn from strategies that have been effective in combating HIV’s spread.
In Baltimore, where 10,453 people were living with HIV in 2017, the city has curbed new cases transmitted by needles through its syringe exchange program, said Dr. Adena Greenbaum, the Baltimore City Health Department’s assistant commissioner of clinical services and HIV/STD prevention. The number of annual diagnoses in Baltimore fell from 794 in 2008 to 231 in 2017, in part because of lower transmission rates among intravenous drug users.
Montgomery County health officer Dr. Travis Gayles said Montgomery County has learned from some of Baltimore’s best practices. But, she said, the causes behind the spread of HIV vary from county to county, as do the most vulnerable populations.
In Montgomery County, more than half of HIV cases were spread by heterosexual contact in 2017. In Baltimore City and Prince George’s County, the leading exposure category was male-to-male sexual contact — 32.2% and 46.7%, respectively.
When he assumed his role last year, Giroir said said he was shocked to learn that there were 38,000 to 40,000 new cases of HIV diagnosed annually in U.S.
“I really asked myself, ‘Why is that? Why in the era that we live in now, where we have effective therapy, when we have effective treatment, are we still seeing 40,000 cases a year?’” Giroir said. “And the only answer I could get was that no one made the decision that we were not going to have 40,000 cases anymore.”
Initially, Redfield said he expects rates of new HIV diagnoses to spike if the program is effective in diagnosing people who have been living with the virus for years. But he said the goal of eliminating AIDS after those new cases come to light is realistic.
“This is really an historic opportunity for us,” Redfield said.