As an HIV researcher and clinician, I have seen firsthand the virus’s disproportionate devastation of sexual minorities, the poor and many people of color. Nevertheless, steady research progress during recent years has allowed us to envision and work toward the end of the epidemic. Until recently, our efforts were effectively guided by the first-ever National HIV/AIDS Strategy, released seven years ago next month.
But the gains we made can easily be lost, and they are in grave danger. The Trump Administration and some Congressional leaders have chosen to abdicate government’s responsibility for the poor and disadvantaged and devalue the health of the American public. They have proposed stripping Medicaid from millions of low-income people, leaving them without access to healthcare or other essential services. They want to bar federal funding for Planned Parenthood, which provides women with HIV and STD prevention services. And they've hampered efforts to develop cures and improve prevention and treatment by proposing to cut funds for research.
Even actions that may not seem directly related to health would have a large impact, like slashing funding for federal housing programs, education, food assistance and other social welfare programs, and reinstating previously failed policies that harm public health, like incarcerating drug users instead of treating them and promoting abstinence-only sex education programs. Since January, each new policy announcement has threatened our fragile success in beating the HIV epidemic.
My hope is that we can make the nation great for everyone rather than returning to the days when it was great for only a few. If the Administration and the Congress do not reverse the direction we are headed, America’s prognosis is grim.
The HIV and public health communities have our work cut out for us. Here's how to get started:
The annual number of new HIV infections in the U.S. fell by 18% from 2008 to 2014, saving treatment costs of $14.9 billion. The percentage of people with an HIV diagnosis who are effectively treated increased to 55%. The uninsured rate among people with HIV dropped by 6% in states that expanded Medicaid, and the percentage of people with HIV who were effectively treated in these states increased significantly after just one year.
Follow the science
Unprecedented research advances over the last three decades have driven our progress, resulting in more effective and less toxic treatment. There is now overwhelming evidence that effective treatment keeps people with HIV healthy and reduces their risk of transmitting the virus to near zero. On the prevention front, considerable evidence supports the effectiveness of interventions, such as syringe exchange and comprehensive sexual education, and new tools, such as Pre-Exposure Prophylaxis, known as PrEP.
The Trump Administration and members of Congress can still make a course correction and prevent national public health crises on a number of fronts, including HIV, opioid addiction and hepatitis C. Rather than leaving millions of Americans without health care coverage—including many who count on the Medicaid program—policymakers should work with healthcare providers, patient advocates and others to reduce healthcare costs and build on, rather than reverse, the gains of the last few years. They should prioritize the health, wellbeing and education of the most vulnerable when making federal funding decisions and abandon their resurrection of policies that have failed in the past and sabotage public health.
We cannot turn back; 45% of people diagnosed with HIV are still not effectively treated for it. More than 200 U.S. counties are at risk for serious HIV outbreaks linked to injection drug use. Research indicates that as many as one in two black gay men could be diagnosed with HIV in their lifetime. We need strong political leadership at all levels and activism to educate those in power about what’s at stake.
Adimora is professor of medicine and epidemiology at the University of North Carolina at Chapel Hill and a member of the Presidential Advisory Council on HIV/AIDS (PACHA). The views expressed in this commentary are her own and do not necessarily represent those of PACHA.