Ending the HIV Epidemic in the US: Why Now Is the Right Time

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has been fighting HIV/AIDS since the 1980s when the virus was first discovered.

Now, thanks to a joint effort by multiple arms of the US Department of Health and Human Services, he’s making headway.

Highlighted in President Donald Trump’s State of the Union address earlier this year, the plan to end the HIV epidemic in the United States is in effect with the goal of achieving a 75% reduction in new HIV infections over the next 5 years and a 90% reduction over the next 10 years.

With 1.1 million people living with HIV, 14% of whom are unaware of their infections, and 38,000 new infections each year, it’s clear HIV is still a problem across the United States. But unlike previous efforts to tamp down on new diagnoses, the new plan features simultaneous cooperation from the National Institutes of Health, the US Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Indian Health Service, among other agencies.

“We don’t have any excuses anymore since we have the tools...this is the right people in the right place at the right time,” Dr. Fauci told the audience at the opening session of the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) on March 4, 2019, in Seattle, Washington. “[It] is the first time an accelerated effort to implement treatment and prevention in the United States has been simultaneously undertaken by multiple HHS agencies that are focusing on highly specific and concentrated target populations.”

We now have the science and the tools to squash the rate of new HIV infections in the United States; we just have to tackle the implementation gap, Dr. Fauci said.

Investigators have known for decades that HIV disproportionately affects certain demographics. But what has just begun to come into focus over the last few years is the impact of geographic hotspots. For example, there are 3007 counties in the United States, but more than 50% of new HIV infections in 2016-2017 occurred in 48 of the counties, plus Washington, DC, and Puerto Rico, Dr. Fauci said. If public health officials can learn how to tackle that hurdle, the road to reduction will be a lot easier.

It will take a combination of diagnosing early, treating quickly, capitalizing on pre-exposure prophylaxis (PrEP) for at-risk individuals, and responding rapidly to detect and respond to clusters.

“The plan is not a basic or clinical research plan. It’s fundamentally an implementation plan,” Dr. Fauci said. “We really now do not have any excuses to do what the right thing is. We have the tools, [and] many people [here] have been working for decades to create those tools. Right now…this is a moral obligation.”