As the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies considers this week what programs to fund in the 2023 budget, many public health concerns will demand their attention. One funding decision that would aim to end HIV — and that goal can be achieved — would also provide long-term benefits for the entire health care system. HIV continues to infect thousands of Americans each year, many of them gay men, even though an effective prevention tool known as pre-exposure prophylaxis (PrEP) is available. PrEP, which lowers the risk of contracting HIV by 99%, was first approved by the FDA in 2012 as a daily pill and is now available in a superior form as an every-other-month injection.
The silent tragedy of the COVID-19 pandemic is its devastating impact on people with other health conditions. For those illnesses, declining attention has persisted even as the threat of COVID-19 is declining. HIV provides a striking example of the setback — and how the effects are looming in the shadows. In December, President Biden set a goal of reducing new HIV infections to just 3,000 a year by 2030, a decline of more than 90 percent from current levels. That goal is achievable as long as Congress and the administration are putting the right policies in place and people can access and afford their medications.
The end of the HIV/AIDS epidemic in the United States could soon be in sight. While we don’t yet have an HIV vaccine, we have drugs that are nearly 100% effective in preventing people from contracting HIV. These medicines are the cornerstone of a prevention approach called pre-exposure prophylaxis, or PREP. And since the start of 2021, PrEP drugs are supposed to be available at no out-of-pocket cost to most patients with private insurance. Yet obstacles stand in the way of implementing this highly effective prevention tool. These include awareness, stigma, and cost–yes, cost, despite the legal requirement that these drugs be provided free to patients. We must push forward on all these fronts to eliminate this virus once for all.
As 2021 comes to a close, it is a good time to take a moment to reflect on the year and think about the challenges ahead. This year, we commemorated the 40th anniversary of the first cases of what would become known as AIDS, welcomed a budget proposal from President Biden that more than doubled the funding for the Ending the HIV Epidemic in the U.S. initiative and was fully supported by both the House and Senate. President Biden gave his full commitment to ending HIV during a White House World AIDS Day event and released an updated National HIV/AIDS Strategy for the U.S. 2022–2025. We in the HIV community have many reasons to be hopeful, and yet our work is far from done. We must come together as a community focused on ending the HIV epidemic in new and different ways.
The leadership of the US Senate Appropriations Committee delivered welcome news recently to HIV and public health advocates with the release of their fiscal year 2022 spending bills. Like their colleagues in the House, the Senate has proposed significant funding increases to the Ending the HIV Epidemic in the U.S. initiative with at least $245 million more to focus on increased testing, prevention, treatment, and research programs. This matches the amount proposed in President Biden’s budget and approved by the House.