About 1.1 million Americans currently live with HIV, and approximately 40,000 are infected each year, according to federal data. But in his State of the Union address, President Donald Trump promised to “eliminate the HIV epidemic in the United States within 10 years” — a plan that hinges on a multi-agency push for better diagnosis, treatment and prevention in at-risk communities, health officials said Wednesday.
Trump introduced the plan during his annual address on Tuesday but offered few details. Health officials fleshed out the plan during a call with reporters on Wednesday.
The initiative will be overseen by the Department of Health and Human Services (HHS) and will bring together the Centers for Disease Control and Prevention (CDC), the National Institute of Allergy and Infectious Diseases (NIAID), the Health Resources and Services Administration and the Indian Health Service. They will target 48 U.S. counties where HIV transmission is high, focusing on at-risk populations including transgender individuals, men who have sex with men and people of color. Efforts will focus on early diagnosis and treatment for people who are infected; access to proactive measures, such as the preventative drug PrEp, in vulnerable populations; and outbreak response, said Dr. Brett Giroir, Assistant Secretary for Health at HHS, on the call.
The CDC and the National Institutes of Health’s (NIH) 19 Centers for AIDS Research will work with local health authorities to augment responses in these counties, said CDC Director Dr. Robert Redfield and NIAID Director Dr. Anthony Fauci on the call. The ultimate goal is to reduce new infections by 75% within five years, and by 90% within a decade, Redfield said.
While the exact amount of funding for the initiative has not been disclosed, Giroir said “significant new resources” will enable the multi-agency effort. That’s a change from past years; though it wasn’t enacted by Congress, Trump’s 2018 budget called for a roughly 18% funding cut to the NIH, including cuts to the NIAID and Office of AIDS research. He has also proposed budget cuts to programs including the Ryan White HIV/AIDS Program and the President’s Emergency Plan for AIDS Relief.
Funding for the new plan won’t kick in until 2020, but officials said each agency is already at work using existing strategies. “We have tools that, if applied, could have a major impact on our goal of ending the HIV epidemic in the United States,” Fauci said on the call.
The initiative echoes other bold presidential health promises, like President Barack Obama’s 2016 State of the Union proclamation that America could be the country “that cures cancer once and for all.” Sherry Deren, co-director of the Center for Drug Use and HIV/HCV Research at the NYU College of Global Public Health, calls the HIV group’s goal “ambitious” but not impossible, though she says it may take longer than a decade to achieve.
“If there’s really a full-hearted effort to undertake addressing prevention and treatment, I think it could certainly move closer to that goal,” Deren tells TIME. But that effort, she says, will require more than redeploying existing strategies.
“It’s not only doing the things we’ve done before. That in itself hasn’t been sufficient,” Deren says. “It’s also looking into the future and saying, ‘What are some of the challenges or dangers that may come up?’”
Eradicating HIV will require a closer look at factors that have prevented tools like PrEP from fully succeeding already — namely geographic and economic barriers that prevent people from getting the care they need, as well as stigma around HIV infection, Deren says. (Health officials also said they are prioritizing these issues.) The best way to solve these problems is by involving individuals who are affected by HIV in treatment and prevention efforts, she says.
“Although it’s great to work with health departments,” you also have to engage the target population to fully understand the barriers, Deren says.
Another obstacle is the opioid epidemic, she says. Since a substantial number of new HIV infections are related to injection drug use, Deren says evidence-backed strategies for fighting illicit drug use — such as medication-assisted treatment, syringe exchanges and safe injection facilities — could also bring down rates of HIV infection.
Giroir said he is “fully supportive” of tools like syringe service programs, but said the new effort will not focus on these resources.
Researchers are also looking into tools that may be more accessible and easier to use than pills like PrEP, such as longer-lasting anti-HIV injections or immunotherapies. Some scientists are also at work on HIV vaccines, though none have succeeded so far.
Some groups are skeptical of the administration’s focus on HIV, since those at high risk of infection include the LGBTQ community, people of color and individuals in lower-income areas — groups to whom Trump’s policies have not traditionally catered.
“If this administration wants to combat the spread of HIV, they need to immediately end their efforts to cut Medicaid funding, undermine the Affordable Care Act and license discrimination against the most at-risk communities when they seek healthcare,” David Stacy, director of government affairs for the Human Rights Campaign, said in a statement. “This administration simply cannot achieve this goal while, at the same time, charging forward with attacks on health care for the communities most impacted by HIV. The American public deserves a real commitment from their government to end the HIV epidemic.”
In late 2018, the administration also faced criticism from HIV researchers after the NIH implemented an internal freeze on human fetal tissue research, which is often used in HIV work. Though HHS and NIH officials said that labs currently using human fetal tissue were not meant to be affected, researchers from at least one HIV lab — including Dr. Warner Greene, director of the Center for HIV Cure Research at the Gladstone Institutes — said the policy halted research.
Greene, who at the time called the disruption “devastating,” tells TIME he was surprised but “delighted” by Trump’s new commitment to progress against HIV. (Greene also says his own research has resumed.)
Nonetheless, Greene says meeting Trump’s 10-year goal will be difficult. “Ten years, I think, is an aspirational goal,” Greene says. “Any time someone puts a timeline on HIV, HIV defies that timeline.”
Stopping its spread in the U.S. will require addressing the multiple “mini-epidemics” happening throughout the country, including those in the South and Southeast and among men who have sex with men, Greene says. A particular priority, he says, should be encouraging screening and early diagnosis, since many cases of HIV are spread by asymptomatic people who do not know they are infected.
Challenging as it may be, though, Greene says the Trump Administration’s goal is admirable. “We should be much further along as a country in dealing with HIV infection than we are. It’s great to see the President focusing on this now.”