As the federal Ending the HIV epidemic takes form, experts talk details, challenges: “How do we get there from here?”
WASHINGTON, DC – Nearly four decades into an epidemic that has taken the lives more than 700,000 people in America, still close to 40,000 people in this country are diagnosed with HIV here each year. Half had the virus for at least three years before they knew it. Continued stigma surrounding the HIV, discrimination and institutionalized neglect of populations that include men who have sex with men, people who inject drugs, and immigrants, along with barriers to healthcare, housing, justice, transportation, exacerbate risks of HIV and other illnesses in communities across the country.
The federal Ending the HIV Epidemic initiative will have to confront all of those realities and more to achieve its goal, panelists agreed in a discussion here Friday Ending HIV as an Epidemic: How do we get there from here?
With all of those realities, significant strides in medicine, policy and epidemiology have put the goal of ending America’s longest epidemic within reach, Dr. Tammy Beckham of the Department of Health and Human Services said. And while funding for the initiative, which was to begin in the fiscal year that started Tuesday, remains in the limbo in the absence of a final spending bill, the work of gathering information and resources to put the plan in action has begun, she said. That includes a contract with the makers of Truvada, the original drug approved pre-exposure prophylaxis — or PrEP — to prevent HIV acquisition, to donate, and initially coordinate the distribution of enough doses to ensure that anyone who has a prescription and does not have insurance covering prescription medicines will have access to the drug.
Visits to all of the jurisdictions in the first phase of the plan — which targets 48 counties and seven states across America, as well as the District of Columbia and San Juan, Puerto Rico, have provided feedback on some of the most critical issues, including urgent imperatives to bring services to patients, address needs for housing and transportation, respond to the impacts of disparate sentencing and other inequities, and to engage and employ community members in efforts to ensure they are sustainable.
Also needed, said Dr. Carlos del Rio a physician and professor of medicine at Emory University in Georgia, one of the priority states and home to four of the priority counties all part of the Atlanta metropolitan area where he treats patients, will be a health workforce sufficient to meet the needs of greatly expanded numbers people identified and linked to services.
“I don’t know who will care for them,” Dr. del Rio said, noting a major shortage of HIV physicians. The shortage is even more acute in rural areas, said Dr. Judith Feinberg, a professor of medicine at West Virginia University, and newly elected president of the HIV Medicine Association (which, with the Infectious Diseases Society of America, produces this blog). The impacts of the opioid epidemic have made efforts to prevent and treat HIV transmissions all the more urgent in rural areas, particularly in central Appalachia “the cradle of the opioid epidemic,” she said. Yet, she added, with the exception of Kentucky, no Appalachian states or counties are among the HIV initiatives priority communities.
Dr. Beckham replied that this is the first phase of the 10-year plan. In the meantime, she said, change — or as panelist Dr. John Brooks of the U.S. Centers for Disease Control and Prevention said “disruptive innovation,” will be an essential element.
“If we could have done it the way we were already working,” Dr. Beckham said, “we would have done it,”