Don’t give up on ending the HIV epidemic

Sometimes all that’s needed to solve big problems is the willpower to see it through. That’s what we now face with ending HIV here in the United States. All the tools exist to bring this disease to an end and through targeted efforts, we can do just that. Recognizing this opportunity, the former Trump administration launched the Ending the HIV Epidemic initiative, which is an effort to bring HIV to an end in this country by 2030, by committing to provide the necessary resources and access to care and treatment for individuals at-risk or living with HIV.

In its first year, the Ending the HIV Epidemic initiative received its full funding request of $267 million from Congress. The following year, the Trump administration requested $716 million, but received only $404 million. While President Biden promised to end the HIV epidemic by 2025 during his campaign — 5 years early — his first presidential budget request of $607 million for the initiative is far below what is needed to meet that promise. That math just doesn’t add up.

As the nation’s fight against COVID-19 draws to an end, the fight against HIV will continue. More than 1.2 million people are living with HIV in the United States and approximately 38,000 individuals are newly diagnosed each year. Since 1980, more than 700,000 Americans have sadly lost their fight with this disease. Thankfully, we now live in a time where medical advancements have allowed individuals with a positive HIV diagnosis to enjoy a full and healthy life. We also have the ability to not only prevent new HIV diagnoses through preventative therapies, but also to allow those with a positive diagnosis to achieve levels of disease that are undetectable and therefore untransmissible.

Unfortunately, according to the CDC, more than 160,000 Americans are currently unaware they are living with HIV. Additionally, more than 250,000 individuals who are aware of their status are not engaged in care and treatment. Although diagnoses declined dramatically from the height of the epidemic in the 1980s, new HIV diagnoses are no longer on the decline. Instead, there has been a levelling off that started in the 2010’s and persists today.

The Ending the HIV Epidemic initiative’s goal of reaching 75 percent reduction of new HIV diagnoses by 2025 and at least 90 percent by 2030 may seem impossible, but out of over 3,000 counties nationwide, more than 50 percent of all new HIV diagnoses occur in only 48 counties, as well as San Juan, Puerto Rico and Washington, D.C. That’s why Phase 1 of this initiative is strategically focused on these 50 jurisdictions, plus seven states with a high rural HIV burden. 

The initiative focuses on four primary activities — diagnose, treat, prevent and respond — to finally bring this epidemic to an end. The first, and most important step, is for an individual to receive a diagnosis. Before the appropriate treatment or preventative actions can be determined, a diagnosis is required. Testing should be a simple step — but stigma, access, language barriers, medical mistrust, etc. all contribute to the challenge of getting individuals diagnosed and into care. It is critical to make HIV testing simple, accessible and routine. 

Throughout the COVID-19 pandemic, individuals’ opportunity and ability to access traditional testing sites and care was greatly limited. This has only highlighted the need for more innovative ways to test. This year, National HIV Testing Day on June 27 will focus on “My Test, My Way” to promote the various ways and locations individuals can receive an HIV test, particularly at-home testing, which is the linchpin to making it easier for people to get a diagnosis. At-home testing, however, needs to be available at a reasonable price to encourage routine testing and must also include appropriate support and linkage to care. 

The plan to end HIV in the United States is already in place and currently being implemented but is sure to fail without adequate funding to diagnose, treat, prevent and respond to this epidemic. The only thing preventing success by 2030 is the willpower and the leadership to provide the appropriate resources and see it through. 

Kyle McGowan is the former chief of staff at the Centers for Disease Control and Prevention (CDC). 

Amanda Campbell is the former deputy chief of staff at the CDC.

McGowan and Campbell are founding partners at Atlanta-based Ascendant Strategic Partners. At CDC they oversaw the day-to-day operations and served as senior advisors to the CDC director, including providing strategic planning and guidance in the development of the Ending the HIV Epidemic initiative.