We all have a stake in ending the HIV epidemic, even President Trump
By W. David Hardy
May 09, 2019 at 9:15 AM
The Trump administration has rejected efforts to equalize health care access and embraced discriminatory policies toward those most impacted by America’s HIV epidemic. Yet it has also launched one of the most ambitious, historic and inspiring health initiatives of our time — assuming Congress funds it.
President Donald Trump announced earlier this year a goal to reduce new HIV infections in America by 90 percent over the next decade. And it’s completely doable; we have the tools. The medicines that restore and protect the health of people living with HIV also suppress the virus, stopping its transmission. And a daily pill — called a pre-exposure prophylaxis, or PrEP — prevents people from acquiring HIV.
So why haven’t we solved this already? Just 54 percent of people living with HIV in the U.S. have access to the health care and treatment necessary to suppress the virus. In fact, data released in March show the United States is dead last on rates of HIV viral suppression among 12 comparable high-income countries.
President Trump pledged in his State of the Union speech to “eliminate the HIV epidemic in the United States within 10 years.” San Francisco may beat that timeline. It's on track to be the first city to eliminate new HIV infections — or at least come close.
The reason we have poorer HIV outcomes than other high-income countries is not because we lag behind those nations in resources; it’s because we lag behind in ensuring a basic level of health care throughout the country. That must change, and it will require significant funds to do it.
The communities targeted by the White House initiative tell the story. Each is home to persistent barriers to services that are grounded in stigma, inequity, discrimination and neglect, including in places where the knowledge, skills and technology needed to control this epidemic are available, but for many, out of reach.
The list includes Los Angeles County, where I saw my first patients with AIDS. It’s also where much of the early research that helped us understand the disease took place, and where unmet needs persist three decades later, fueling the epidemic among black and Hispanic men who have sex with men.
It includes Baltimore and Washington, D.C., where I work now, home to well-resourced academic medical centers — and to the greatest impacts of substance use disorders in people of color.
It includes South Florida, home to Mar-a-Lago, but also towns with high rates of people without health insurance coverage.
It includes Texas, where I grew up and became interested in medicine, but also where, like Florida, officials have refused to expand Medicaid to lower income adults and families.
The challenge now is reaching economically and socially marginalized people at higher risk for or living with HIV with little or no access to health care. Nearly doubling our rate of viral suppression in 10 years will require funding, and innovative approaches to delivering health care and eradicating stigma.
New funding for HIV prevention at the Centers for Disease Control and federally funded Community Health Centers, and for care and treatment through the Ryan White HIV/AIDS Program is a necessary start, but this Initiative cannot rely on annual congressional funding cycles.
Support for this initiative must be demonstrated with a long-term commitment protecting it from shifting political priorities. The President’s Emergency Plan for AIDS Relief, which over the last 15 years has saved millions of lives globally by supporting HIV prevention and treatment in more than 50 countries, began with five-year funding authorization. This plan deserves no less. Health care coverage must be also available through Medicaid expansion and through private insurers.
It is up to Congress to make this investment and ensure that this shared vision of ending the HIV epidemic in America — something every one of us has a stake in, even President Trump — is realized.
Dr. W. David Hardy is an adjunct professor of medicine at Johns Hopkins University School of Medicine and chairman of the board of directors of the HIV Medicine Association; his email is firstname.lastname@example.org.