During his State of the Union address on 5 February, US president Donald Trump announced a goal of  ending HIV transmission in the US by 2030.
“Scientific breakthroughs have brought a once-distant dream within reach,” he said. “Together, we will defeat AIDS in America.” Trump didn’t lay out a specific amount of money that his next budget would dedicate to the cause, but said the initiative would be included in his request to Congress for funding.
At the height of the AIDS epidemic in the early 1990s, Americans were being diagnosed with HIV at a rate of between 650,000 and 900,000 people per year. With new medicines and increased awareness of the risk of transmitting HIV, new infections have decreased since then, plateauing for the last several years to around 50,000 people per year.
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There is some way to go, then, to achieve elimination. The US isn’t alone in this ambitious target. On 30 January, the UK announced the same goal, and in 2014 the Joint United Nations Programme on HIV and AIDS set a similar target with key milestones in the coming years.
Global goal
The is a global one that aims to have most people living with HIV diagnosed and on antiretroviral treatment by 2020, and to maintain suppression of the virus until 2030. If that happens, the number of new infections and transmissions globally would be so low that we could effectively say the epidemic had been eliminated.
To meet the UN goal, the US would have to show that 73 per cent of people with HIV have their infection under control by 2020. “Are we on track to achieve that target? As best I can tell it’s certainly possible,” says Jessica Justman at Columbia University.
In other words, the US already has the tools to meet Trump’s goal, but they aren’t yet in widespread use. Southern states, such as Florida, Georgia, Missouri and Louisiana, have high rates of HIV infection, and Justman says they may need more help to build public health programs. By contrast, clinics in cities like New York and San Francisco already offer same-day test results and provide month-long medication kits to people who test positive for HIV.
We now have antiretroviral medications that can be prescribed both before and after exposure to HIV – one pill a day can protect those who don’t have the infection but may be exposed through a sexual partner, and those who have tested positive for HIV can start on a daily course of medicine to limit the possibility of passing it on.
Taking the stigma out of an HIV test could also help, as will educating those who test positive about the potential to live long lives with the virus. Justman says she had a recent HIV-positive patient who wasn’t aware that most people who treat the infection can have almost a normal lifespan.
Drug use is also a concern. Justman says that between 2011 and 2015, the rate of new HIV infections among people who inject drugs was on the decline, but with the opioid epidemic, those numbers may rise.
Trump’s new effort to focus on eliminating HIV infections in the US may be just the ticket, then, if it is properly funded. But to be successful, it will require HIV positive Americans to have access to long-term healthcare, and careful attention paid to opioid users, so that one epidemic doesn’t hinder us from ending another.
