Washington, D.C. — Ending the HIV epidemic in the United States requires a broad strategy that not only addresses the barriers to HIV treatment and care, but the impact of the opioid epidemic, access to insurance coverage, and the social determinants of health for those living with the disease, says a new report released today by the Bipartisan Policy Center.
The report, Ending HIV in America, examines the challenges and opportunities for federal, state, and local action to improve the effectiveness of the public health response against HIV. It offers policy considerations on how to achieve President Trump’s goal of reducing HIV infections by 75 percent in five years and 90 percent in 10 years.
Today, an estimated 1.1 million people live with HIV in the United States. Each year, nearly 40,000 Americans are newly infected, and more than 6,000 people die from the disease. Thanks to the advancements in modern medicine and public health achievements, HIV is now largely a chronic disease. However, health disparities still exist.
“Achieving the best outcomes for individuals with HIV demands more than just medicines,” said Anand Parekh, MD, BPC’s chief medical advisor. “Policymakers must tackle the opioids epidemic which has led to outbreaks of HIV, expanding health insurance coverage, such as Medicaid, which increases access to care, and address the social determinants of health by supporting those living with the disease with housing, transportation, and employment opportunities.”
BPC’s report points out that while HIV is often considered an epidemic of coastal cities, patterns of infection have shifted in recent years in affected populations and geographic regions. Now more than 50% of new diagnoses occur in the South, and more than 20% of new cases in the South and the Midwest occur in rural or suburban areas.
Additionally, two-thirds of new infections are among young men who have sex with men, and young black and Latino men have the highest overall rates of HIV infection in this group. These risks are worsened by high rates of late or undiagnosed HIV in these communities, coupled with racism, stigma, and barriers to accessing health care services.
BPC’s policy considerations focus on three key areas:
Improving Access to HIV Services
- Continue to invest in the Ryan White Care Program.
- Expand insurance coverage options for treatment and care.
- Improve access to preventive and care services, including telehealth, in rural areas.
Addressing the facilitators and barriers to the HIV response
- Reduce HIV stigma through federal policies that support those with or at a risk of HIV.
- Fund initiatives to address unmet social needs such as housing and employment opportunities.
- Invest in HIV public health infrastructure to enhance disease surveillance data.
Creating targeted programming
- Target high-risk populations, such as young men of color who have sex with men.
- Ensure maternal health, generational HIV transmission, and pediatric care remain widely available, especially in rural areas.
- Prioritize pre-exposure prophylaxis (PrEP) as part of comprehensive primary care and federal funding to states.
- Implement evidence-based interventions for HIV prevention, such as syringe service programs.
The report’s findings are based on insights from HIV health care providers and public health agencies in eight diverse jurisdictions across the country, including more rural epidemics, such as Scott County, IN; coastal urban regions such as the Bronx, NY and Seattle, WA; Midwestern areas such as Kansas City, MO; western communities like Clark County, NV (Las Vegas), and southern sites including Jacksonville, FL, Montgomery, AL, and Richmond, VA.
These areas were selected for BPC’s study based on new infection rates, of infections, and a balance of rural and urban-focused epidemics, state Medicaid expansion status, those with enough cases to receive direct Ryan White Part A funds, and political party of the state legislature and governor. The goal of the study was to understand the local approaches to fighting HIV and the actions needed to strengthen the response across the nation.
“Ending the HIV epidemic is an attainable goal,” added Parekh. “HIV has been a public health challenge for the nation over the past four decades. However, we now have the tools, the evidence-based strategies, and the resources to effectively end HIV in America as long as all sectors of society work together, particularly to reach high-risk populations, and we increase access to care and overcome the burden of stigma in this country.”
Federal spending for the domestic HIV epidemic totaled an estimated $28 billion in fiscal year 2019. The president’s 2020 budget requests an additional $291 for the U.S. Department of Health and Human Services to eliminate new HIV infections in the U.S.
BPC’s report is supported by Gilead Sciences, Inc. and The Elizabeth Glaser Pediatric AIDS Foundation.