Infectious Disease

Biden’s plan aims to boost the HIV response and open the door to a stronger post-pandemic in the US

April 18, 2021

4 min read

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Gandhi does not report any relevant financial information.

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With the increase in funding for efforts to end the HIV epidemic in the US, the Biden budget is an important step in addressing the challenge of ongoing and future pandemics.

The previous administration’s initiative to end the HIV epidemic (EHE) commits the nation to the achievable, ambitious and essential goal of reducing HIV transmission in the United States by 90% within the next decade. It is achievable because we have the tools through treatment, technology, and biomedical prevention to make it happen. It is ambitious because it requires a unified will and investment of resources.

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The EHE initiative is directing much-needed funding and technical assistance to 48 jurisdictions, Washington, DC and San Juan, Puerto Rico, which accounted for 50% of new HIV diagnoses in 2016 and 2017, and seven other states with high HIV levels -Diagnoses in rural areas.

And while the initiative slipped from public and political importance over the past year, it has also shown that ending HIV as a public health threat is essential.

The last year has highlighted the importance of structural barriers to health care, as well as deep-rooted systemic inequalities and racism that fueled the American HIV epidemic and are now significantly exacerbating the COVID-19 pandemic. If we do not remove these barriers now, we will be exposed to the next public health threat. The current and new pandemic has shown us that if we are to contain the spread of preventable infectious diseases, we must ensure that we all have access to affordable, comprehensive health insurance.

What needs to be done to end the ongoing HIV epidemic? We need increased surveillance that includes data that encompasses differences in ethnicity, race, sexual orientation and gender identity. We need to address social determinants of health, which include highly unequal access to housing and education. We need to investigate how health services can be accessed and ensure that they are available to people in remote and rural communities, indigenous communities and communities that are largely invisible to marginalized populations due to discriminatory laws and policies. This includes people whose sexual or gender identity is stigmatized and targeted, people who earn income from sex work, people who are incarcerated, and people who have come to this country to pursue the same dream that brought so many here Has.

We need to ensure that integrated health services, including those that reduce harm such as injection services and overdose prevention, are accessible to people with substance use disorders. We need to ensure that individuals are not forced to choose between meeting their basic needs and having access to medicines that can keep them healthy through the prevention or treatment of HIV and other chronic diseases. And we need to make community engagement a standard and funded part of public health.

Before the pandemic, only 56% of people living with HIV in the United States were virally suppressed, according to the CDC. Only 18% of the approximately one million people who have benefited from PrEP have accessed and applied the preventive measure. And there are massive differences among PrEP users: Only 5.9% of Black / African American and 10.9% of Hispanic / Latino people who could benefit from this proven prevention measure received it.

Land has been lost in the past year. A review of commercial laboratory data by the CDC found that the 7-day average of HIV tests performed had dropped dramatically after March 13, 2020 and had not recovered by September 30, 2020. Analysis of PrEP prescriptions from a national database showed a 15.5% reduction in prescriptions for people with PrEP and a 31% reduction in the number of new PrEP users. While we don’t yet have national data or estimates on the effects on virus suppression, a San Francisco municipal clinic reported that patients are now 31% more likely to be virally suppressed at their clinic than it was before the pandemic.

According to a survey of clinics funded by the Kaiser Family Foundation’s Ryan White HIV / AIDS program, 30% had seen an increase in new customers and nearly 40% reported a change in payer status, mainly leading to an increase in customers that were not insured.

With all of this data now, accelerated efforts are imperative if the US is not to waste its investment in implementing evidence-based interventions in all of our communities.

But they also show the need for a strengthened public health infrastructure and services that are adaptable, diverse and reach those who need services most. Because of this, in addition to investing in the EHE initiative, we need more funding for the federal Ryan White program, initiated on behalf of a teenage boy living with HIV whose rights to basic services have been challenged, and for state and federal efforts Meet needs for services to diagnose, treat and prevent sexually transmitted diseases, viral hepatitis and substance use disorders, and meet reproductive health needs.

In addition, the search for improved treatment and better biomedical prevention tools must continue. The search for an HIV vaccine informed and fueled the search for a COVID-19 vaccine. Now we need to apply the lessons of COVID-19 vaccine research and development to the development of an HIV vaccine and other biomedical approaches to HIV prevention. We also need research informed by all people who will benefit from our advances by expanding the infrastructure for clinical trials and gaining access to populations disproportionately affected by HIV, including in rural areas and areas with limited resources. Again, this requires funding to support expanded efforts, communication and public relations.

The answers to the COVID-19 pandemic, as well as our longest and most widespread epidemic – HIV – continue to lie not only in dollars, but also in political will. The first numbers in the president’s budget proposal – $ 670 million for HIV in 2022, up from $ 267 million from 2021 – are encouraging, but more are needed. The full plan will tell us more, and it will be up to Congress to provide the resources to end the HIV epidemic.

What our elected officials do now will determine whether we as a nation can effectively fight the HIV epidemic and determine the outcome of the coming pandemics.

For more informations:

Rajesh T. Gandhi, MD, FIDSAis Chairman of the HIV Medicine Association, Professor of Medicine at Harvard Medical School, and Director of Clinical HIV Services and Education in the Infectious Diseases Department at Massachusetts General Hospital in Boston.

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