In February 2019, Donald Trump made history at his State of the Union address by becoming the first president to call for the end of the HIV epidemic in the U.S.
However, the call to action — with an ambitious 2030 deadline — left advocates puzzled.
How could the proposed $291 million set to fight the spread of HIV help if, at the same time, the Trump administration was cutting Medicare and Medicaid by more than $2 trillion over the next 10 years? It was a move that would essentially shrink funds for programs with the same mission.
Four years after the pledge, advocates have mixed feelings about whether America will meet the goal. But most agree with what Dázon Dixon Diallo, founder and president of Atlanta-based SisterLove (an HIV and reproductive health services and advocacy organization focused on women of color), told TheBody.com: “I think we’ll meet the goals for certain people, but the people most likely to be left behind, will be left behind.”
As with the Trump administration’s confusing and contradicting plans, states are now at odds with how they are addressing the HIV epidemic, leaving the most vulnerable people more at risk.
The U.S. needs to move forward with a unified plan under which people can access lifesaving treatments and drugs, no matter what state they live in.
Locally, there is a statewide initiative called Getting to Zero Illinois with a mission to end the HIV epidemic by 2030. And data trends are looking promising, according to John Peller, president and CEO of AIDS Foundation Chicago.
- New HIV diagnoses in 2011 were at 1,615. In 2020, the number went down to 1,159. The goal is to reduce the number of newly diagnosed people to 836 by 2023, and to 100 by 2030.
- Coverage of pre-exposure prophylaxis (PrEP), a drug that significantly reduces the risk of HIV infection, in Illinois went from 19% in 2011 to 29% in 2020. The target for 2023 is 50%.
- In 2011, 64% of people were linked to HIV care within a month of diagnosis. That went up to 81% in 2020. The goal is 90% by 2023 and 95% by 2030.
- The percentage of people who remained engaged to HIV care went from 46% in 2011 to 73% in 2020. The goal is 80% in 2023 and 95% by 2030.
- HIV-diagnosed people who were virally suppressed — meaning that the amount of HIV in their blood is very low, reducing the chances of passing HIV to others — stood at 33% in 2011 and 63% in 2020. The goal is 77% in 2023 and 95% in 2030.
“When you see that long trend going down, it shows that there is something very real that’s happening. The challenge, however, is that we are still seeing racial and ethnic disparities in the decline in new HIV cases,” Peller told us. “While we saw about a 50% drop among white people in Chicago, we are seeing about a 30% decline among Black and Latine people. It’s that 20 percentage point difference that we need to continue to double down on.”
Reporting by TheBody.com found that those disparities are most noticeable in southern states, where viral suppression plunged in recent years because of the decline in linkage to HIV care. States such as Mississippi, Alabama and South Carolina have not expanded Medicaid.
And then there’s Tennessee, which announced in January that it would no longer accept grant money from the Centers for Disease Control and Prevention meant for testing, prevention and HIV treatment. In 2020, Shelby County — where Memphis is located — had one of the highest rates of HIV and AIDS cases in the country.
While there are some systemic problems, advocates are staying encouraged and hopeful. There’s the steady trend of more PrEP use, more people knowing their HIV status and, most recently, news about of a fifth person confirmed to be cured of HIV.
“We need to change how we have been operating in order to do a better job of reaching the population most vulnerable to HIV, or most vulnerable to not being engaged in care,” Peller said. “I do think we can get there.”
It’s important to have a goal. But a way to realistically get us there faster is to have a plan where everyone is on the same page.
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