What Would It Take to End the HIV Epidemic in the U.S. by 2030?
Ending the HIV epidemic is at once the simplest and most complicated task facing us in medicine today. Simple because we have the tools to end the epidemic. Complicated because ending HIV requires us to take egalitarian, humane, and rational approaches to health care. Poverty, disengagement, stigma, discrimination, and apathy are our biggest challenges in ending the epidemic. We must overcome these all-too-human shortcomings and apply science and a commitment to justice to end the epidemic in our lifetime.
Rajesh T. Gandhi, MD, is a professor of Medicine at Harvard Medical School and director of HIV Clinical Services and Education at Massachusetts General Hospital.
A miracle! We would need to increase HIV testing even further, widely expand same-day treatment on case detection, maintain HIV-infected persons in care and reach viral suppression, fund a massive increase in substance use treatment, fully fund needle and syringe exchange, make hepatitis C treatment affordable, and generate a wholesale change in attitudes toward all sexualities nationwide, along with expansion of pre-exposure prophylaxis (PrEP) for those at elevated risk of acquiring HIV.
Ending HIV/AIDS will not only require our government to commit unprecedented levels of spending for research, treatment, prevention, and education, it will also require decision makers to acknowledge that abstinence-only programs waste taxpayer dollars because they don’t effectively address HIV prevention. We need a holistic approach that includes race, disability, income, sexuality, gender identity, and other social determinants of health disparities in our country.
Funding for the [Trump administration's] initiative must be sustained, effective HIV prevention and care interventions must be brought to scale, and the administration’s policies must support rather than undercut the initiative. Fulfilling the first two conditions is not guaranteed, and the administration is failing the last. There is bold and visionary leadership at Health and Human Services, but HIV may end in the most capacitated jurisdictions and not others.
Timely data on the HIV epidemic is an unmet challenge—with an estimated lag of up to two years—making it impossible to use these data for timely tweaks to prevention efforts. A data system that leverages existing public and private data to estimate new HIV infections within a few weeks of diagnosis from “hot spot” areas with high HIV prevalence could help guide prevention efforts and provide a platform for research.
Keri Althoff, PhD ’08, MPH ’05, is an associate professor in Epidemiology at the Bloomberg School and the 2019 Johns Hopkins Provost Fellow for Research Communication.