Today, National Black HIV/AIDS Awareness Day, we are reminded that African Americans have the highest rates of HIV in the United States. Let’s also take a look at what's being done to help pull those numbers down.
Last summer the White House announced the National HIV/AIDS Strategy, an approach to fighting the epidemic that recognizes its disproportionate impact in black communities. The plan has three primary goals: reduce new HIV infections by 25 percent within five years, increase access to care, and reduce HIV-related health disparities. The basic idea is that, by redirecting the $19 billion spent annually on domestic AIDS to the populations most vulnerable to infection, prevention efforts will be more effective.
I talked to Jeffrey Crowley, director of the White House Office of National AIDS Policy, about the strategy’s implementation so far, what gains have actually been made in fighting domestic AIDS, and why it’s too soon to celebrate reports of a so-called "cure."
The Root: When the National HIV/AIDS Strategy was announced last July, President Obama gave leading federal agencies (including HHS, Justice and HUD) 150 days to come up with their implementation strategies. Is anything happening now?
Jeffrey Crowley: They were due in early December. December and January has been a period for the Offices of National AIDS Policy and Management and Budget to look at these plans and request revisions if necessary. We’re also working on synthesizing the plans together, and at some point in the near future we’ll be reporting to the public on what’s in them.
TR: The country has already been spending $19 billion annually on domestic AIDS prevention, care, and research, but we rarely hear any promising news. What evidence is there that existing HIV prevention efforts have worked?
JC: I hope that the American people aren’t too cynical in what we’ve done. We’ve gotten a lot of things right in how we respond to the epidemic. We’ve maintained a strong national response for 30 years. We’ve maintained a significant financial investment. We’ve also seen the results. We’ve seen HIV mortality fall once we got effective drugs. The number of people becoming infected in this country each year has fallen dramatically. At one point we were counting about 140,000 Americans infected with HIV each year. Now it’s fallen to about 56,000. We’ve virtually eliminated HIV transmission among newborns. We’ve seen dramatic drops in HIV transmission rates among injection drug users, particularly among black injection drug users, and infection rates are holding steady for heterosexuals.
TR: Since it will take more than federal intervention to fight the epidemic, what would you like to see happen at state and local levels?
JC: Before going into that, even at the federal level I’m not just trying to defend what we’ve done. We want people to know that this country may have gotten off to a slow start, but we’ve developed effective drugs and lowered infection rates in response to this epidemic. But certainly, President Obama believes that the federal government still needs to make a stronger effort. But we won’t be successful if you’re getting leadership out of the federal government and the same response [as before] from everybody else. We’re hoping that state and local governments will start to do a better job integrating their planning for the resources they have.
In the summer we launched, using new investments from the Affordable Care Act’s prevention and public health fund, a program at the CDC called Enhanced Comprehensive HIV Prevention Planning. We’re looking at the 12 jurisdictions in the United States that are responsible for 44 percent of living AIDS cases. So, just 12 metropolitan areas – including DC, New York, Los Angeles, San Francisco, Chicago, Miami, Atlanta, Houston and Dallas – are responsible for nearly half the HIV epidemic. We’re funding them to do some initial work on how they can do a better job using all the resources in their community, and funding the interventions that are going to be most effective. This is exciting not just for these 12 jurisdictions, but for what it can teach us about all of our responses in the country.
TR: In December, German researchers claimed to have cured a man with HIV through stem cell transplants – but then we didn’t hear much more about it. And at the World AIDS conference last summer, researchers announced news of a vaginal gel to protect women against HIV. How realistic are these breakthroughs really?
JC: There are three things going on. You mentioned that so-called cure and the vaginal gel. The other big thing were prep results that came out in December, which provided proof of concept that if you give HIV negative individuals any retroviral medication, that can be an effective way to prevent new infections.
I think this idea of a cure is fascinating from a medical perspective, and it probably tells scientists some things, but it was only in one patient. People who looked at the study later have raised questions about some of it. So, I don’t know how big of a deal it is, as far as having current clinical applications to our response to HIV.
The other two trials are very exciting because they offer the promise of a new tool for prevention to be added to our current tool chest. The prep result studies show that it was effective in gay and bisexual men. We have a lot to learn, including whether we can apply it to other populations and how to apply it effectively. But it is fair to say that this past year was a banner year for HIV research. We still have a lot to learn, but some of these important investments are paying off. We think this will provide exciting direction for the future.