WASHINGTON, D.C.—Federal officials expect efforts to reduce new HIV infections to begin in earnest as early as this summer following President Donald Trump's announcement of a public health initiative aimed at bringing an end to the HIV epidemic in the U.S. within 10 years.
Along with that announcement, Trump released a proposed federal budget that called for $291 million for the Ending the HIV Epidemic plan in fiscal year 2020.
The administration plans to award between $12 million and $13 million during the current fiscal year to local community health department workforce building, said Adm. Brett Giroir, M.D., assistant secretary for health at the U.S. Department of Health and Human Services (HHS), speaking at a Kaiser Family Foundation event Monday.
Giroir said his department also plans to begin using their own funds to launch pilot programs before the end of the year.
Nearly half of the $291 million proposed for the fight against HIV/AIDS ($140 million) is earmarked for the Centers for Disease Control and Prevention to work alongside state and local health departments to tackle this goal. In addition, the plan would allocate $120 million to the Health Resources and Services Administration (HRSA) to expand treatment access at federal health centers.
Two programs previously funded by Congress—including the Minority AIDS Initiative, which is a $54 million program—are not part of the $291 million requested for 2020 but will be part of the president's budget in future years.
There has been some controversy around this issue. In March, HHS announced new appointments to the Presidential Advisory Council on HIV/AIDS more than a year after the White House fired the 10 members of the council who had remained on board in January 2018. Six months prior, several members of the council quit over what they said was Trump’s lack of compassion for people who have HIV/AIDS. And as Trump requested HIV funding for HHS, critics pointed out his budget also called for a 12% cut to HHS' budget.
"This is the first year of a multiyear program. Budgets come one year at a time,” Giroir said. “As you can imagine, as more and more people get into care, we’ll need to invest more particularly in the first few years. Over 10 to 15 years this becomes an enormous money saver because every person with HIV will have additional healthcare costs over their lifetimes, but you need that investment up front.”
Here's what else Giroir said about the plans for the program:
- On his surprise about how many new cases of HIV are still being diagnosed in the U.S.: “I asked, 'Why are there still 40,000 new cases of HIV diagnosed every year in the United States?'” Giroir said. “The answer I got was really because no one really decided to make it not that way any longer.”
- On why now is the "right time" to tackle the HIV/AIDS epidemic in the U.S.: Giroir pointed to the fact anti-retroviral therapy can be delivered through a single pill with low toxicity and can effectively help patients attain an undetectable viral load. He also pointed to the use of PrEP, the pre-exposure prophylaxis of antiviral drugs, which has been found to be highly effective at preventing the spread of HIV/AIDS, and the demonstrated effectiveness of The Ryan White Program and the CDC's ability to target clusters of disease in new ways. "We don't need a miracle of science to happen for us to achieve our goal," Giroir said.
- On how his team modeled the impact of future efforts on the program in light of changing insurance coverage levels as the administration seeks to limit the Affordable Care Act and pare back Medicaid expansion: "We have to be fluid and dynamic. The world will change. We don't know what's going to happen tomorrow on a number of fronts," he said. "So we've set a structure that the six main agencies ... the directors of those agencies will sit on a policy team that will be meeting every month to review the situation with an integrated operations team that includes HRSA and the office of HIV/AIDS."
- On increasing access to PrEP: "In our model, we need to have somewhere between 50% to 60% of all people who have PrEP indicated on PrEP. I would love to have 100%. We really need to get that 50% to 60%, probably that 60% level which is a significant increase over the 200,000 people that we have," he said. "We predominantly think PrEP is going to be administered through community health centers because we feel many of the individuals coming into the system will not have insurance coverage. Community health centers leveraging the 340B program where we get highly competitive prices are really the way to go."
- On the price of PrEP: "We intend to use the 340B program which allows PrEP to be obtained by the government at a much lower cost," Giroir said. "We are in active negotiations with Gilead to try to make PrEP much more available, not just nibbling around the edges, but in a major way."