The Biden administration recently released the National Strategy on HIV / AIDS (2022-2025), an update to the 2010 and 2015 versions led by then-President Obama. Seeing this in my email inbox and in social media calendars was a welcome sight, which means our federal government has not forgotten about its commitment to ending the HIV epidemic, despite the continuing scourge. of COVID-19. The 98-page document not only covers the main objectives of the national strategy, but also describes how these objectives will be implemented and how systems will be held accountable for achieving measurable results.
What’s in the plan?
First, the strategy aims to achieve a 75% reduction in new HIV infections by 2025 and a 90% reduction by 2030. This is similar to the goals of the 2019 End the HIV Epidemic (EHE) initiative. In fact, the updated strategy describes how the two initiatives work together, with the national strategy focused on the overall federal response and the EHE program targeting communities and areas disproportionately affected by HIV.
The national strategy for combating HIV / AIDS has four main objectives:
- Prevent new HIV infections: This strategy describes various approaches to increase access to education, knowledge and tools for HIV prevention, while increasing the diversity of the workforce.
- Improving HIV-related health outcomes for people living with HIV: They recommend ways to improve linkages and engagement with clinical care; they also recommend providing holistic care that emphasizes addiction programs, mental health and elderly care for long-term survivors; and investing in next-generation antiretroviral therapy (ART) and finding cures.
- Reduce HIV-related health disparities and inequalities: Here, they recommend approaches to reduce stigma based on race, sex, gender, sexual orientation and HIV status, as well as to improve the diversity of the workforce (including people living with it). HIV) and develop innovative communication and marketing strategies to reach diverse populations.
- Achieve integrated and coordinated efforts to address the HIV epidemic among all partners and stakeholders: This strategy endorses a âsyndemicâ approach to understanding community vulnerability to HIV; encourages the coordination and sharing of best practices between the public, private, community (CBO) and academic sectors; and emphasizes improving the quality and accessibility of shared data, as well as ways to improve the mechanisms by which we measure progress.
The updated strategy takes us in new directions compared to previous iterations. It contains more information on measuring certain indicators, such as knowledge levels, PrEP coverage, viral suppression rates, and even HIV-related stigma. There is a section on tackling HIV in the context of COVID-19, a discussion on the role of pharmacists and a commentary on better inclusion of people living with HIV in leadership positions for programming and implementation. implemented. I was also delighted to see a detailed examination of the role of racism in HIV care; aging concerns among people living with HIV; and a discussion on how to approach the intersection of stigma, mental health and addiction treatment.
Will the updated HIV / AIDS strategy go far enough?
Reading the document, the question of whether the updated strategy itself goes far enough wasn’t quite the right one to ask – instead, we should ask ourselves if it does. will be go far enough to achieve the goals set.
Our country continues to be ravaged by the COVID-19 pandemic, remains politically and socially polarized, and still lacks a national health plan to cover the medical needs of every citizen. About 10% of American adults aged 19 to 64 do not have health insurance, with uninsured rates higher among black and Latino adults. Twelve states have yet to approve the expansion of Medicaid to facilitate HIV treatment and access to care, including seven in the Deep South, where 51% of new HIV infections occur. In this content, the updated strategy sounded good on paper, but we need to hold our government accountable for execute this comprehensive plan to reduce health inequalities linked to HIV.
Implementing the plan, however, seems like trying to use multiple bandages to stop the bleeding from someone who has just received multiple bullets with a machine gun. The foundation of the medical infrastructure on which this national HIV / AIDS strategy is based is flawed and collapsing, starting with the lack of a national health plan. Indeed, this has negative implications for any American citizen, but is particularly troublesome for those living with HIV trying to access and maintain health care coverage, many of whom rely on Medicaid, Ryan White, the AIDS Drug Assistance Program (ADAP) and others to meet their health needs.
While the updated National HIV / AIDS Strategy contains many forward-thinking initiatives, I would have liked to see a few additional or expanded sections. First, although there were a few empty words at the intersections of mental health, stigma, and substance abuse, the plan lacked more concrete suggestions for delivering HIV care in these settings. . Additionally, given that the world of HIV prevention and treatment is predominantly biomedical, the plan did not sufficiently address the biases among healthcare systems and staff, which are a known barrier to prevention and treatment for HIV. Finally, âmistrustâ or âmistrustâ was mentioned a few times regarding barriers to HIV care. I would have appreciated a review of the literature demonstrating the medical history and current policies and behaviors that promote mistrust among black communities and other medically marginalized subpopulations, rather than a brief mention of mistrust as a quality innate in certain demographic groups. It should also have included practical solutions to improve these relationships and ask the medical profession to be more introspective. Instead of asking, “Why don’t patients trust us? Ask, “What can we do best to earn the trust of the communities we serve?” “
The COVID-19 pandemic has taught us the value of better public communication and how collaborations between the public and private sectors are essential moving forward. It’s important to note that these lessons apply to the HIV epidemic as well – and President Biden’s strategy does an admirable job of checking all the boxes on the necessary social, structural and political considerations. Is it perfect? No. Are some things correct? Yes. The plan offers an extensive roadmap with clear and measurable goals. But it will take a concerted effort to move that from a PDF document of platitudes to tangible solutions in our neighborhoods and communities. The devil is really in the details.
David Malebranche, MD, MPH, is a qualified doctor in internal medicine, researcher and specialist in the prevention and treatment of sexual health / HIV.
Malebranche has served on the advisory boards of Gilead and ViiV, regarding HIV prevention and treatment.