With promise to “eliminate the HIV epidemic,” and “defeat AIDS in America and beyond,” administration raises questions about policies

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While plan will target 48 “hot spots” with services, and people at high risks with PrEP, will it change policies that fuel HIV?

More details are available today on plans to “eliminate the HIV epidemic,” announced by the president in his State of the Union address last night, and while they raise new questions as well, that is how plans unfold, speakers leading federal health efforts today noted in a press teleconference.

“People will slip through the cracks,” Department of Health and Human Services Assistant Secretary Dr. Brett Giroir said. Those people will highlight gaps, making the plan “reiterative,” he added. “It will get better and better.”

With increased investments in 48 counties across seven U.S. states, where rates of HIV incidence are high, and with focus identifying and reaching populations facing the highest risks, efforts to end transmissions of the virus will include the powerful tools of implementation science and PrEP, antiretroviral medicine taken to prevent infection.

All of the speakers, who included National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, and U.S. Centers for Disease Control and Prevention Director Dr. Robert Redfield, expressed confidence that money to increase diagnoses, treatment, prevention and surveillance in the targeted areas will be available. With the administration’s budget proposal for 2020 not yet available, however, where the money will come from, and what it might be diverted from remains unclear.

And while speakers agreed that stigma and discrimination, as well as limited access to health services contribute greatly to the high risks faced by the targeted communities and populations, whether the policy environment around the multi-agency efforts, or what speakers referred to as “the program,” will change, also remains unclear.

But the role that universal access to health care plays is already clear in Cuba, the first nation to be recognized by the World Health Organization to have eliminated mother-to-child transmission of HIV and syphilis. The role of strong support for measures that reduce the harms of injecting drug use, including syringe services has been clear in Amsterdam, where goals to control the epidemic by ensuring that 90 percent of people with HIV know it, that 90 percent of them are on treatment, and that treatment is effectively suppressing the virus in 90 percent of them by 2020, have already been met and exceeded.

The role that marginalizing immigrant populations can play in stalling success against HIV has been spelled out by researchers in Botswana, where the government offers free antiretroviral treatment to all of its citizens who live with the virus — preventing transmission as well as illness, but not to non-citizens. And Uganda, once considered a success story in its coordinated HIV prevention efforts, but now one of the few African countries where incidence of the virus increased in recent years, has demonstrated the impacts of structural stigma and discrimination, against LGBT individuals, and against people living with HIV.

The Infectious Diseases Society of America and the HIV Medicine Association, which produce this blog, are among groups that have highlighted concerns about policies at home that stand to interfere with a shared and important goal, in a response to the State of the Union Address Tuesday.

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