President Joe Biden on Wednesday unveiled a new national strategy to address HIV/AIDS, saying while the country has made “remarkable progress” in the fight against the virus, the United States must put increased focus and funds towards those most at risk of contracting HIV.
“This year on World AIDS Day, we are focused on addressing health inequities and inequalities and ensuring that the voices of people with HIV are at the center of our work to end the HIV epidemic globally,” a Tuesday proclamation from the president read in part.
The president commemorated World AIDS Day, which takes place on Dec. 1, in a speech from the East Room of the White House on Wednesday afternoon.
"It's because of all of you — the dedication of scientists and activists around the world — that we've been able to dramatically reduce new HIV transmissions and make individuals with HIV today live long, health lives," Biden said to a group of lawmakers, activists and health experts assembled at the White House.
"As you know, it's because of the persistence and resilience of the HIV community that we've changed so much about the way we approach health care research," he added.
The president was joined and introduced by Gabriel Maldonado, an HIV/AIDS Advocate, as well as officials from his administration. Dr. Anthony Fauci, chief medical advisor to the president, was also in attendance at the event, and Biden praised Fauci as a man who "never walk[s] away from an issue or a problem."
Fauci has spent over half a century in public health, and was at the forefront of combatting the HIV/AIDS epidemic when it first surfaced in the 1980s. He also received the the Presidential Medal of Freedom from George W. Bush in 2008, the president who also launched the first iteration of PEPFAR.
PEPFAR, or the President's Emergency Plan For AIDS Relief, is one of the largest global health operations to target a single disease, and has allocated billions of dollars towards those suffering from the virus or related conditions in countries around the world.
"Since President Bush launched PEPFAR 2003, we've saved more than 21 million lives," Biden noted Wednesday. President Biden has requested $670 million from Congress towards ending the HIV/AIDS epidemic, saying he is confident "we're going to get that done."
Over 1.1 million Americans were living with HIV as of the end of 2019, the latest year for which data is available from the U.S. Centers for Disease Control and Prevention (CDC). Around 700,000 Americans have died from AIDS-related illnesses or complications since the start of the epidemic.
HIV, or human immunodeficiency virus, is transmitted through certain bodily fluids and attacks the host’s immune system. While there is currently no cure, HIV can be managed with proper medical treatment. If left untreated, HIV can lead to acquired immunodeficiency syndrome, or AIDS.
The national strategy to tackle HIV/AIDS was last updated under the previous administration on Jan. 15, 2021. It calls for a 75% reduction in new HIV infections by 2025.
Wednesday’s announcement offers more details to the goals laid out in January, in part by using new research to tailor solutions towards those who need the most support.
The four overarching goals are:
- Prevent new infections of HIV by increasing knowledge, awareness and access to prevention and treatment
- Improve health outcomes and quality of life for people with HIV-related conditions
- Address and reduce barriers to HIV treatment
- Integrate and coordinate nationwide efforts to address HIV epidemic across all partners
The White House has “taken more of a whole-of-government approach to the national HIV/AIDS strategy,” senior administration officials said Tuesday.
“This strategy recognizes racism as a serious public health threat,” officials said of the changes. “We talk about the important role of the Affordable Care Act in providing access to services for people living with HIV, as well as those at risk. There's a new focus on people with HIV who are aging.”
The revised strategy pays particular attention to marginalized communities, specifically to Black and Hispanic or Latino men who identify as either gay or bisexual, or otherwise have sex with other men — groups that are at the highest risk of contracting HIV, per new CDC research.
Gay and bisexual men make up 66% of new HIV cases each year, although the estimated number of new infections did not change overall between 2010–2019.
In the decade prior to 2020, the rate of new HIV infections among white gay or bisexual men decreased, while the rates for Black, Hispanic and Latino gay or bisexual men remained both higher and relatively unchanged.
While there have been significant advancements in HIV testing and treatment over the past several decades, the CDC noted “social and structural barriers” — including systemic racism, stigma, poverty and homelessness — coupled with “missed testing opportunities in healthcare settings” have prevented men in the LGBTQ+ community from experiencing widespread treatment benefits.
The Biden administration will address the disproportionate spread of the virus in marginalized communities in part by leaning on information gleaned during the COVID-19 pandemic.
Officials on Tuesday pointed to the widespread availability of COVID-19 vaccines in local pharmacies, saying those same businesses “have the ability to provide access to HIV testing, information about HIV, and in some states, pharmacists can also get someone started on HIV prevention medication.”
The administration hopes to include more organizations for outreach and support, an effort similar to Biden’s summer series of nationwide programs to encourage Americans to get their COVID-19 vaccines.
Other priority groups include Black women, transgender women, individuals between 13-24 years old and people who use intravenous drugs. By tailoring solutions towards groups with the highest rate of new HIV infections, federal officials hope to slow the spread of the virus and ultimately stop its transmission altogether.
Another focus will be to work alongside the 35 states with laws criminalizing HIV exposure to update their policies in order to best reflect modern science. Health experts say that many of the outdated laws serve only to further stigmatize those with HIV, and may discourage them from seeking treatment for the virus.
The Department of Justice and the Department of Health and Human Services will work at the federal level to support reform efforts.
"There are still laws in the books that criminalize spitting by people with HIV," President Biden said Wednesday, noting that it is not possible to transmit HIV or AIDS via saliva.
"I mean, it's 2021 in the United States of America," Biden continued. "We have to follow science, and that means eliminating laws that perpetuate discrimination, exacerbate disparities, discourage HIV testing and take us further away from our goal."
A full implementation plan will be released early next year, as federal agencies are still “thinking about different things that they can do in light of coming to the table and working with [the administration], also hearing from the community about what's needed with some of those programs,” officials said.
For example, the Department of Housing and Urban Development (HUD) will look at ways public housing programs can be used to advance HIV/AIDS education as the White House looks at “the intersection where food insecurity and housing instability” contribute to high-risk outcomes for HIV patients.