Q&A: At UN meeting, leaders recommit to fight against HIV/AIDS
The United Nations convened a high-level meeting this week to review progress made in the past 5 years since global leaders adopted strategies to eliminate HIV/AIDS as a public health threat by 2030.
Healio spoke with Carl Schmid, MBA, executive director of the HIV + Hepatitis Policy Institute and co-chair of the Presidential Advisory Council on HIV/AIDS, about the meeting and the future of the fight against HIV/AIDS.
Healio: What are the major accomplishments and setbacks of the effort to end the HIV/AIDS epidemic by 2030?
Schmid: The biggest accomplishments were having the focus and the leadership to end HIV, of course, along with the funding. Over the last 2 years, we were able to get $400 million more for HIV programs, bring more people to treatment, get more people tested, get more people on PrEP. I think the biggest thing is to get the focus and the leadership and the resources and, of course, just get people talking about HIV.
The first thing that the plan did was to require jurisdictions to put together plans to end the HIV epidemic. The high-priority districts, where 50% of all the cases are in the United States, were the ones who had to do this and it was done by their governments, but they had to do it with community input, which got people to focus.
It's important to talk about HIV in the South, where half of all HIV cases occur and there is a lot of stigma. We had a lot of problems with policies from the Trump administration in terms of health care, leading to discrimination issues among the LGBTQ+ and transgender communities and creating roadblocks, but at least they set us forward on a path. Now, the Biden administration is taking up continuing the effort to end HIV, which is wonderful. He is putting in great people, just recently announcing Harold Philips as director of the White House Office of National AIDS Policy, and he's increasing the budget $216 million. The Trump administration had proposed more money than what Congress gave us last year, so what Biden is doing is almost bringing it up to the level that Trump proposed last year.
Additionally, there’s the Ryan White program, which provides treatment and support services to low-income people living with HIV. They received additional money, and using that money, around 6,500 new people came into the program and around 3,500 people were reengaged.
Overall, I think there's been a lot of progress, but then COVID-19 happened and that really impacted the effort despite readapting. For example, instead of going in for an HIV test, they did a lot of self-HIV testing and the CDC provided funding to jurisdictions to send kits out, and also telehealth was adopted more. We're continuing those efforts now. So, we may have had some setbacks with COVID-19, but I think there's hope on the horizon, new technologies and hopefully a vaccine.
Healio: What, if any, new recommendations were made during the U.N. high-level meeting?
Schmid: They did pass a declaration. What happened was that Russia tried to take out focus on special populations, sexual education, all those things, and it lost. The U.S. and several other countries spoke up against it. The declaration recommits to ending HIV and focusing on the correct populations, and human rights, which is very important. They focus on the inequities, too, and that's a big thing. There's a lot of different global inequities you can't compare Africa with the U.S., for example; we have our own inequities and a lot of it comes down to poverty and race. We need to make sure we focus on the communities facing these inequities because we have such higher HIV rates among Black, African American and Latino people than among white people, which holds true in the gay community and among women as well.
Also, the group talked about the leadership and funding commitments. It's good that the world recommits and refocuses itself on the HIV epidemic after 40 years.
Healio: What do patients hope to see from meetings like this? Was this meeting on their radar?
Schmid: UNAIDS tries to keep us informed. I'm not sure if all people living with HIV were aware of the meeting, but the advocacy community and the activist community were definitely aware and involved. They had representatives there, and there were people living with HIV from the U.S. that were invited to attend. I think it is more of a government meeting than a patient meeting, but there is an opportunity for people living with HIV from around the world to participate, not just the U.S.
Healio: What do you think clinicians hope to see following this high-level meeting?
Schmid: I think a continued focus on bringing people into treatment, getting more people on prevention and PrEP, but also making sure it's done in a way that respects the communities that are impacted. I think that is a barrier particularly here in the U.S.
Healio: We’ve reported that pandemic-related disruptions could have a negative effect on HIV in the U.S. and also globally . There is also hope that the research that went into developing messenger RNA vaccines — which was helped by research into HIV vaccines — could turn around and give us more insight into HIV vaccines. What will be the net effect of this pandemic on HIV/AIDS in the U.S.?
Schmid: First of all, you're absolutely correct. Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Disease, says this all the time if not for HIV, we would not have been doing so well in the COVID-19 response. And it's just not the scientific stuff, it’s the health care system and the public health infrastructure. Now, I think there's a big difference between COVID-19 and HIV. The reason why they were able to develop a vaccine so quickly is, yes, the new technology, but also COVID-19 does not replicate as fast as HIV.
You also asked for the net impact. I hope that more people are aware of HIV because of COVID-19. In the early days, in every press briefing that Deborah Birx, MD, Fauci, former President Donald J. Trump and former CDC director Robert R. Redfield, MD, held, HIV was spoken about. The biggest problem with HIV is stigma these days and so, it is hoped that talking about it made people more aware about HIV and infectious diseases because of COVID-19. People are not dying from HIV like they used to, and so maybe it is not front and center on people's minds as it was in the past.