Federal Agencies Explain How They Plan to Fulfill Trump's AIDS Promise

"In my mind, the program has already started." 

During Tuesday’s State of the Union address, President Trump put HIV, a virus that affected 38,739 people in the United States in 2017, squarely in his crosshairs. He boldly announced that his new budget would seek to end the HIV epidemic within ten years. But on Wednesday, several federal agencies clarified details about what that plan would actually entail.

“My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years,” he said in the address. “Together, we will defeat AIDS in America and beyond.”

In a call with reporters on Wednesday, representatives from several federal agencies said that a program is already underway, explaining how its new approach may actually achieve success.

Previously, the Trump administration has been criticized for cutting funding for international AIDS relief programs. The plan Trump revealed to end HIV within ten years, however, is actually a plan that’s already been concocted by the United States Department of Health and Human Services (HHS). It’s set to launch in 2020 with two major goals: To reduce new HIV cases by 75 percent in the next five years and to reduce new HIV cases by 90 percent over ten years.

“In my mind, the program has already started,” said Brett P. Giroir, the HHS assistant secretary for health, on the call.

What is Actually New?

The Health Department’s plan to reduce new HIV cases in the next ten years has a lot in common with previous plans to curb HIV, like the United Nations’ 90-90-90 initiative. The new plan looks to diagnose new cases as early as possible, treat existing cases more quickly, and help protect people who might be at risk for developing HIV.

The HHS is taking a hyper-specific geographic approach. It plans to focus specifically on 48 counties where the HIV case load is high as well as target rural areas in Oklahoma, Missouri, Kentucky, Arkansas, Alabama, South Carolina and Mississippi.

AIDS HHS
The new plan to reduce HIV cases by 90 percent in the next ten years focuses on 48 high-burden counties and seven states with substantial rural case loads. 

“What’s new about this is the laser focus of multi-agencies synergizing together on those areas,” said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, during the call. “So this is something that hasn’t been done before.” The agencies represented during the call also included the Centers of Disease Control and Prevention, the Department of Health and Human Services, the National Institutes of Health, the Health Resources and Services Administration, and the Indian Health Service.

Leading the efforts in targeted geographic areas will be a “HIV HealthForce,” described by the HHS as a “boots-on-the-ground workforce of culturally competent committed public health professionals that will carry out HIV elimination efforts in HIV hot spots.”

What Will The “HealthForce” Do?

The goal of the HealthForce is to halt the cycle of HIV transmission in these 48 counties using two existing strategies.

Though there is no cure for HIV, the actual virus can be controlled through anti-retroviral therapy (ART), a class of drugs that can stop the virus from replicating. Over time, these drugs can reduce the levels of the virus within an individual to such low levels that it becomes unlikely that the virus will get passed on to someone else.

Increasing ART use can greatly reduce the spread of HIV, but there are also precautionary measures those without infections can take. For those who may be at-risk for HIV but don’t actually have the disease, many health departments recommend using pre-exposure prophylaxis (PrEP), a course of medication that can help reduce the risk of getting HIV by 92 percent.

Truvada HIV
PrEP medications, like Truvada, play an important role in reducing HIV transmission, but can be unaffordable for some. 

“If you put those two together, theoretically then, if you get everyone who is infected on ART and decrease the viral load to below detectable levels and give everyone who needs PrEP, PrEP, you can theoretically end the epidemic as we know it,” Fauci said. “The question is implementing.”

Ideally, the HealthForce will answer that question of implementing, though they will have to grapple with some of the financial costs that come along with providing these treatments. Truvada, one of the brand-name PrEP medications recommended by the CDC, is usually covered by most health insurance companies, but out-of-pocket costs can still make the therapy unaffordable.

Responding to questions about whether the HealthForce will address the costs of these medications, Giroir added:

“The secretary and this administration is highly focused on making drugs more affordable, that includes PrEP. We will be working on a number of aspects of affordability to support this program as well as many. As you know, this is part of a larger story.”

When Will This Program Start?

The program is set to begin in 2020, so don’t expect to see any boots on the ground before then. However, parts of the program had been set in motion far before Trump referenced it during the state of the Union, said Giroir. He has already had meetings with multiple groups.

For now, there are many unanswered questions, not least of which is how much of Trump’s budget will be set aside for the program. Details about how the HealthForce will operate in each of the 48 counties, in addition, remain to be released.