In Tuesday night's State of the Union address, President Donald Trump called for the elimination of HIV transmissions in the United States by 2030, raising hope and questions about putting an end to the epidemic.
The initiative aims to reduce new HIV infections by 75% in the next five years and by 90% in the next 10 years, "averting more than 250,000 HIV infections in that span," according to the US Department of Health and Human Services.
The agency also noted that most HIV infections are now highly concentrated in certain "geographic hot spots" in the United States. For instance, more than 50% of new HIV diagnoses in 2016 and 2017 were in 48 counties, the District of Columbia and San Juan, Puerto Rico, according to the department.
"In recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach," Trump said Tuesday.
"My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America."
'This is something that has not been done before'
Trump's plan will fund programs in geographic hot spots, data to identify and track the spread of HIV, and the creation of local efforts in targeted areas to expand HIV prevention and treatment.
"What's new about this is the laser focus of multi-agencies synergizing together on those areas," Dr. Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said Wednesday.
"So this is something that has not been done before. We have certainly discussed this type of approach, but this is the first time we've had a multi-agency approach where the individual agencies will be working very closely together," he said.
Previously, the Joint UN Programme on HIV/AIDS set a goal to end the AIDS epidemic by 2030. In its report, the United Nations estimated that "new HIV infections have been reduced by 47% since the peak in 1996" worldwide.
"The concept of that is very similar to what we're doing," Fauci said.
"What we're saying is that we know that if we can identify everyone who is HIV infected, getting them on therapy, and dropping the viral load to below detectable levels, we can actually end the epidemic," he said.
Dr. Scott Gottlieb, the Food and Drug Administration commissioner, tweeted Tuesday that the plan to end the HIV epidemic in America could be "one of the most significant public health initiatives we undertake together."
'Actions speak louder than words'
Many health experts applauded the effort, but some also criticized the White House for cutting funding for HIV/AIDS programs in the past and remained hopeful that the next budget will reflect Trump's new pledge. Millions of dollars were shifted away from HIV/AIDS prevention programs last year.
"President Trump's pledge to end the HIV epidemic within 10 years is encouraging, but it is difficult to reconcile this statement with his administration's systematic assault on the HIV community -- including undermining access to affordable health insurance and HIV drugs; cutting funds for HIV research; and attacking LGBTQ+ people," New York City Health Commissioner Dr. Oxiris Barbot said in a statement Wednesday.
"In New York City, we have reached a historic low in new HIV diagnoses, guided by Mayor (Bill) de Blasio's Ending the Epidemic plan, a commitment to end the HIV epidemic in New York City by 2020. The plan is grounded in efforts to increase HIV testing, treatment and prevention and to dismantle HIV-related stigma by relying on sound science and community engagement," she said.
"A pathway exists for the President to end the HIV epidemic, but he cannot reach this goal by alienating the very communities most affected by it. Any legitimate plan must begin by righting these wrongs."
Tom Hart, the North America executive director for the ONE Campaign advocacy group, said in a statement Tuesday that the President's new goal turns a "needed spotlight" on AIDS but "actions speak louder than words."
"For the past two years, the Trump administration has proposed drastic cuts to global AIDS programs," said Hart, who has written opinion pieces published by CNN.
"American foreign assistance and global leadership saves lives, lifts people out of poverty, promotes stability, spurs economic growth and brings hope to millions. It also moves us closer to the day in which American foreign assistance is no longer needed," he said in the statement. "We hope President Trump's upcoming budget proposal will reflect these priorities, focus on those who need it most, and fully fund America's global poverty and health programs."
'We are highly confident that the resources ... are sufficient'
Dr. Brett Giroir, assistant secretary for health at the HHS, said Wednesday that he is confident there will be "sufficient resources" in the 2020 budget for the new HIV/AIDS plan.
"We are not able to provide specific budget numbers at this time. ... But we are highly confident that the resources being provided in 2020 are sufficient to support this very aggressive program," Giroir said.
"In my mind, the program has already started. We have been working together for months putting this together," he said. "I've already addressed the American Public Health Association and received tremendous support and collaboration already this morning. So while the proposal will roll out increased resources in 2020, all of our individual agencies are already working on this."
About 1.1 million people in the United States had HIV at the end of 2015, the most recent year for which information is available, according to the US Centers for Disease Control and Prevention. Of those, about 15%, or 1 in 7, did not know they were infected.
Globally, 36.9 million people were living with HIV in 2017, and 21.7 million people were receiving antiretroviral treatment by the end of that year, according to the World Health Organization.
Around the world, there have been some successful efforts to work toward controlling the spread of HIV or human immunodeficiency virus, which weakens a person's immune system by destroying important cells that fight disease and infection.
The United Kingdom has exceeded targets set forth by the United Nations for HIV diagnosis and treatment, proving that efforts to control the epidemic can work. An estimated 92% of the 102,000 people living with HIV in Britain have been diagnosed, according to Public Health England. Of those, 98% are on treatment, and 97% of those on treatment are virally suppressed, meaning HIV is undetectable in their blood.
Those figures make the UK one of the first countries to reach the United Nations' 90-90-90 targets, which urge countries to achieve a 90% success rate in the diagnosis, treatment and viral suppression of HIV, according to the health body.
In the United States, "I think that the commitment of the administration is important and very promising," said Dr. James Curran, dean and professor of epidemiology at Emory University's Rollins School of Public Health and co-director of the university's Center for AIDS Research. "Throughout the history of the AIDS epidemic in the United States, political commitment at all levels, including the federal level, has been crucial and central to making progress against AIDS.
Curran, who's not involved in the Trump administration's new initiative, coordinated the AIDS task force at the CDC in 1981 and then led the HIV/AIDS division until 1995.
"We have the opportunity to improve people's lives; actually save their lives from a treatable condition, through which there's still too many deaths; and then reduce transmission to others. In order to do this, we need to have resources which are very well coordinated," he said. "This begins at the federal level with additional resources, but then it has to be translated to the state and county and local levels."
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