The International AIDS Society (IAS) welcomes the bold goal set forth in US President Donald Trump’s 2019 State of the Union address to “eliminate the HIV epidemic in the United States within 10 years”. The US Department of Health and Human Services has since posted a factsheet detailing a goal of a 75% reduction in new HIV infections in the US over the next five years and at least a 90% reduction in the next 10 years.
“Reaching this target is doable with the prevention and treatment tools that exist today, but it will require the full muscle and funding of the US government,” Kevin Osborne, Executive Director of the IAS, said. “This goal can only be achieved by acknowledging and addressing the drivers of HIV – including stigma, discrimination and social inequities that limit access to healthcare.”
The US has long been a leader in HIV science and a leader in the global HIV response, particularly through the President’s Emergency Plan for AIDS Relief (PEPFAR), which was reauthorized for the third time this past December. These commitments by the US are a reminder that even in the wealthiest nations, the epidemic is not over and US leadership on HIV and AIDS is critical to the global response.
We applaud this commitment. However, we must also acknowledge that this announcement is inconsistent with the policies and rhetoric that directly attack trans people and the larger LGBTQ community, people who inject drugs, people of colour, refugees, sex workers and women’s rights.
Addressing these disparities will require more than treatment and prevention programmes alone. For the US’s new HIV strategy to succeed, Congress and the US Administration must examine the harmful policies and practices that reinforce stigma and social and gender injustice, including a ban on trans people in the military, and dismantling of public LGBTQ health and protection programmes.
This new target builds on a powerful legacy. President George Bush first announced PEPFAR during the 2003 State of the Union address, and it remains one of the country’s greatest bipartisan success stories. Prior to that in 1990 President Bush also enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act aimed to improve the quality and availability of care for medically underserved individuals and families affected by HIV and AIDS. With the Affordable Care Act, President Barack Obama removed barriers to health coverage for millions of Americans with pre-existing conditions.
The 23rd International AIDS Conference (AIDS 2020) will be held in San Francisco and Oakland in July 2020, providing a critical platform to examine both US and global strategies. Holding AIDS 2020 in the Bay Area, a capital of AIDS activism, political leadership, HIV science and community engagement, will be a powerful platform to challenge some of the underlying causes that would hinder us from achieving this goal.
To end this epidemic domestically and around the world, the US must commit to addressing HIV at the highest level and in a way that will be sustained.