During Tuesday night’s State of the Union address, President Donald Trump pledged to end new HIV transmissions within a decade, and lauded the “incredible strides” made by the United States in recent years to curtail the infectious disease.
“Together, we will defeat AIDS in America and beyond,” Trump told the audience assembled in the House.
While new HIV infections have consistently fallen since the 1980s — when there were more than 130,000 new infections per year — the president’s message stood in stark contrast to the realities of injection drug use in 2018.
Last year alone, the nation witnessed HIV clusters linked to injection use around the country, including cases in Cincinnati, North Seattle, West Virginia, and Montana, as well as a larger outbreak in Lawrence and Lowell, Massachusetts, last spring, where the federal government was called in to investigate.
“HIV still takes advantage of stigma and social marginalization to spread.”
Even more recently, public health officials reported a cluster of HIV cases last week among people who inject drugs in Boston, and nearby Worcester, Massachusetts.
“The goal to eliminate HIV transmission is laudable,” said Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco. “It is doable by 2030, but not without much more attention to the ‘hidden pockets’ of transmission.” Ciccarone pointed to HIV’s spread among people who inject drugs as one of those.
“HIV still takes advantage of stigma and social marginalization to spread,” he added.
According to Alex Azar, the Secretary of the U.S. Department of Health & Human Services, the administration’s plan to stem the HIV epidemic will focus its efforts on the 48 counties where about half of new HIV infections occur. Those specific efforts will involve diagnosing patients early and treating them with antiretroviral drugs, so that they aren’t at risk of transmitting HIV to sexual partners. Other efforts will make Pre-exposure Prophylaxis (PrEP), a daily pill that prevents HIV infection, more accessible to people at risk for HIV.
By expanding access to antiretroviral drugs and PrEP to everyone who needs it, “you can theoretically end the epidemic as we know it,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases during a press briefing Wednesday. “The question is implementing it,” he concluded.
The bulk of new HIV infections aren’t acquired by needle sharing. Of the new cases diagnosed in 2017, just 6 percent, or 2,389 cases, were linked to injection drug use, according to the U.S. Centers for Disease Control and Prevention (CDC). Still, it’s an area of disease transmission the administration will have to consider if they plan to wipe out HIV by their projected deadline.