HIV/PrEP - President Trump's New 10 Year Initiative and Lobbying Status

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President Trump's 10 Year Initiative to Eradicate HIV/AIDS

Trump's the 10-Year Initiative to Eradicate HIV/AIDS will use data and tools to reduce 75% of new HIV infections in five years and a 90% reduction by the tenth year. The plan targets vulnerable populations and will provide economic, technological, and medicinal support to those most likely to be affected and eradicate new instances of the disease. Treatment can take the risk of contracting HIV from someone else by up to 97%. The key strategies of the plan is to diagnose, treat, prevent, and quickly respond to outbreaks. A summation of the initiative and a timeline since its February announcement are described below.

Summation

  • In 2017, there were 38,739 new HIV diagnoses in the US, yet another 15% of 1.1 million HIV positive people do not know that they have it. Specific populations and geographic areas are disproportionately affected by HIV requiring special emphasis on gay and bisexual men, African Americans and Hispanics/Latinos, and Southern states.
  • Gay and bisexual men are the most affected by HIV throughout the country, and in 2017 they accounted for 66% of all new HIV diagnoses and 82% of diagnoses among men. African Americans represented 43% of new diagnoses, and Hispanics and Latinos represented 26%, despite the fact that these groups only represent 13% and 18% of the population respectively.
  • The plan will fund 3 areas of action to be "increasing investments in geographic hotspots", using data to identify regions where HIV is most rapidly spreading and help inform decision makers on how to address prevention, care and treatment at a local level.
  • Knowledge of HIV status is the entry point to receiving effective care and treatment and prevention services for those who are negative.
  • Among those living with HIV, only 63% received some HIV medicinal care, 49% were retained in continuous HIV care, and 51% achieved viral suppression. PrEP is a daily pill that reduces the risk of sexual transmission of HIV by 90%, but has only been prescribed to fewer than 10% of those that could benefit from it.
  • New infections are concentrated among men that have sex with men, African Americans and Hispanics/Latinos, and people in southern states.
  • Stigma keeps people from receiving the services and health care is a social challenge that needs to be targeted and addressed as well.

Progress since announcement

  • After the announcement of the initiative on February 5th by Trump, the CDC data confirmed that HIV prevention had stalled on February 8th and further demonstrated the need for the initiative.
  • March 11th, HHS announced that Minority HIV/AIDS Fund resources are going to be used to support the plan's initial activities. Trump also proposed $291 million in the FY2020 HHS budget. On March 18th, a new CDC analysis revealed that about 80% of new HIV infections in 2016 were transmitted by people who were unaware they had the disease or people who knew but were not receiving treatment.
  • On May 9th, HHD disclosed that Gilead Sciences would donate PrEP medication for 200,000 uninsured people each year for up to 11 years.
  • Trump administration awarded $1 million in Ryan White HIV/AIDS Program grants to 10 metropolitan areas for technical assistance to enact improvements across the continuum of care on June 27th. Also, on June 27th, IHS and the Cherokee Nation launched an HIV pilot program that will use $1.5 million in funding from the Minority HIV/AIDS Fund to begin implementation and evaluation of key foundational activities to enhance progress in Indian Country.
  • The last updates by hiv.gov are HHS awarded pilot funds of $1.5 million each to counties in GA, Md, and La to jump start HIV prevention activities on July 3rd. On July 8th, the Assistant Secretary for Health ADM Brett Giroir announced that a "team of U.S. Public Health Service Commissioned Corps (USPHS) officers will provide regional support" those same three regions.
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HIV/PrEP - Lobbying Status

Pre-exposure prophylaxis commonly known as PrEP is a combination of two drugs that is taken before sex to prevent HIV infection. People who take these two drugs: tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) as PrEP have a 90% lower chance of being infected with HIV than those who do not.

The use of PrEP increased by almost 500% between 2014 – 2017, and more than a third of people at risk of HIV infection are now protected with the medication. It is estimated that 20-25 % reductions in HIV incidence among men who have sex with men could be achieved through PeEP, which could lead to a1 million decrease in new infections over 10 years. According to HIV.gov, the largest organizations working to prevent new HIV infections increase access to treatment for people with HIV are: The World Health Organization, Gilead Sciences, The Global Fund and International AIDS Society. Below is an overview of the key players and progress regarding the lobbying status of HIV/PrEP in the US.

Key Players

World Health Organization (WHO)

  • WHO directs and coordinates international health activities in the United Nations system. Their goal is to "build a better, healthier future for people all over the world."
  • WHO is strongly recommending men who have sex with men to consider taking antiretroviral medicines such as PrEP as an additional method of preventing HIV infection alongside the use of condoms.
  • WHO has offices in more than 150 countries and their staff work s with governments and other partners to ensure that everyone receives the highest level of health attainable.

Gilead Science

  • Gilead Sciences supports PrEP Education to "increase HIV prevention and awareness."
  • As part of a comprehensive HIV prevention strategy, Gilead Sciences has granted funding to 66 organizations to support community projects and programs that provides education for PrEP.
  • Gilead awarded the grants to organizations that provide PrEP education to undeserved populations at high risk of contracting HIV. This includes "young adult men who have sex with men, Hispanic & Latinos, transgender women and African American heterosexuals".
  • The organizations that Gilead Science has granted funding aims to develop programs with educational concepts that can be duplicated and executed across the United States, which will in turn maximize the potential to reduce the number of new HIV infections.

The Global Fund

  • The Global Fund which is a partnership designed to accelerate the end of various epidemics including HIV/AIDS has mobilized and invested more than US$4 billion a year to support programs coordinated by experts in over 100 countries.
  • The Global Fund works in collaboration "with governments, civil society, technical agencies, the private sector, and people affected by the diseases" to pool resources and invest strategically in programs and build resilient and sustainable systems for health.
  • The Global Fund 2017 results showed improvement in the HIV treatment progress. The results show that 11 million people are receiving antiretroviral therapy for HIV through Global Fund-supported programs, which is a 19% increase from the previous year.

International AIDS Society

  • The International AIDS Society is the world’s largest association of HIV professionals, with members from more than 180 countries working on all fronts of the global AIDS response.
  • The International AIDS Society advocates and drives urgent action to reduce the global impact of HIV. The organization is also the organizer of the International AIDS Conference and the IAS Conference on HIV Science which are the world’s two most prestigious HIV conferences

Progress

California Makes PrEP and PEP Available Without Prescription

  • California is the first state in the US to allow pharmacists to dispense PrEP and PEP, drugs that can prevent new HIV infections. Under a new law that will come into effect on January 1, 2020, pharmacists who undergo special training will be able to provide HIV prevention medications without a doctor’s prescription.
  • The bill signed into law by Govenor Gavin Newsom authorizes pharmacists to furnish at least a 30-day supply and up to a 60-day supply of drugs used for PrEP, without a prescription It also allows for pharmacists to provide a full course of drugs used for post-exposure prophylaxis, of PEP.
  • The California Health Benefits Review Program estimates that the new law will increase the use of PrEP and PEP by 2% in its first year in effect, preventing 25 new cases of HIV.

FDA Approves Once-Daily Descovy for PrEP

  • In October 2019, Descovy was approved for adults and adolescents weighing at least 35 kilograms (77 pounds) in order reduce the risk of contracting HIV through sex, except for receptive vaginal sex.
  • The approval is a part of the ongoing efforts by the FDA to end the HIV epidemic and provides more prevention options for certain patients at risk for contracting HIV.

Advocates Push For PrEP Outreach To Black Women

  • Since the approval of Truvada by the FDA in 2012, many advocates and experts in HIV and women's health have been expressing their concern about the unequal issuance of PrEP to women.
  • Leisha McKinley-Beach, a national HIV/AIDS consultant said that there have been little change in the rates of HIV transmission among blacks, both men and women, while rates among white men have since dropped by 10%. They are pushing for the same outcomes for the black communities since black women are the group most vulnerable to HIV.

Mutual of Omaha Agrees to Cover PrEP Users After Lawsuit

  • Mutual of Omaha has agreed to stop denying insurance to Massachusetts residents who use the HIV prevention medication Truvada,
  • Before the lawsuit, Mutual of Omaha denied life and long-term care insurance to Truvada users.
  • The lawsuit, which was brought about by GLBTQ Legal Advocates & Defenders (GLAD), was settled in January 2019 will now allow for applicant and users of Truvada to apply for disability, long-term-care and life insurance.

Research Strategy

We commenced our research by searching through trusted media sources such as the New York Times, CNN and HuffPost. We found new articles regarding achievements and measures that are currently in place to widen and approve the use of PrEP. We thereafter searched credible HIV Organization websites for links and information on key players and advocates of HIV/PrEP. The HIV.gov, which is the US federal government's leading source for information about HIV provided a list of the top organizations that are contributing to end the HIV epidemic. We selected our key players from the list we found.
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