In advance of World AIDS Day Saturday, a coalition of HIV/AIDS advocacy organizations have laid out a detailed plan to end the U.S. HIV epidemic by 2025.
The new roadmap sets ambitious goals for treatment and prevention and calls upon lawmakers to enact the kinds of changes that will help achieve them.
What that looks like is meeting what is called the “95/95/95” framework:
- 95 percent of people who have HIV are aware of their status.
- 95 percent of people who have been diagnosed with HIV are in treatment.
- 95 percent of people being treated have suppressed their viral load.
Studies have repeatedly shown — and the CDC agrees — that individuals who have reduced their viral loads to undetectable levels are incapable of transmitting the virus to others, prompting the slogan “Undetectable = Untransmittable,” or “U=U.” The 95/95/95 framework essentially means minimizing the number of people who can actually transmit the virus to others.
There are obviously many barriers to this goal, including educating people about the importance of knowing their status, ensuring they are tested, and making sure they have access to the care they would need. “The U.S. HIV epidemic lies at the intersection of structural inequalities,” the report explains. “Poverty, racism, sexism, gender bias, homophobia, and transphobia significantly influence the likelihood of exposure to HIV as well as health outcomes after seroconversion, and societal responses to HIV vary substantially by race, class, and geography.”
To address these disparities, the report recommends, for example, focusing more resources in the South and in small cities, and increasing efforts to reduce HIV-related stigma and improve health literacy. It also calls for expanding Medicaid access, buttressing Medicare, and increasing funding and flexibility for the Ryan White Program, which ensures care for people with HIV who are uninsured or underinsured.
The report also aims to greatly expand access to PrEP (pre-exposure prophylaxis), which has proven incredibly effective at protecting people from contracting HIV. If 40 percent of people vulnerable to HIV had access to PrEP by 2025, it would greatly reduce the number of new infections beyond the 95/95/95 framework.
The report also notes the impact of the opioid crisis and other structural barriers like the criminalization of HIV nondisclosure and sex work. “It is time to eliminate HIV-specific and related laws that are outdated, do not reflect current scientific understanding and are at odds with well-tested and effective public health strategies,” the report states.
Despite the many barriers to achieving these goals, the report is optimistic that it’s possible, so long as Congress and the Trump administration act decisively. “Only with a focused effort that prioritizes the needs of people with HIV, addresses health disparities, prevents new cases, improves the health care system, creates structural mechanisms to improve health outcomes through ancillary services, and produces groundbreaking, cross-cutting research will we together defeat one of the most complex viruses ever encountered,” it concludes.
There’s also a financial incentive. The report estimates that investing now to achieve these goals by 2025 could translate into savings of $57 billion or more that would otherwise be spent on HIV treatment efforts.