Successfully executing on our strategy to end the HIV epidemic here at home will come to be known as one of the great American public health victories.
As Prepared for Delivery
Thank you, Dr. Collins, for that kind introduction, and thank you to all the leaders from across HHS for coordinating this meeting and taking the time to be here.
All of you represent parts of HHS that implement our domestic and global HIV programs: from CDC, FDA, HRSA, IHS, NIH, OASH, OGA, and SAMHSA.
The work that goes on across HHS to fight HIV/AIDS, both here and abroad, is immensely complex. There is a need for targeted action on so many elements of the HIV/AIDS pandemic, and all corners of HHS have a role to play.
But the reason we’re gathered here today is simple: We now have the right data, the right tools, and the right leadership to end the HIV epidemic here in America.
All of you have helped develop the HHS strategy to make that happen, and today is an opportunity to further refine that strategy, drawing on the expertise and experience you all have.
You just heard from Dr. Collins, and soon you will hear Dr. Fauci present on the latest research and science, in his usual masterful way.
You’ll also hear a discussion among senior leaders from across the department about the HIV programs and activities that are underway.
I’m pleased to be here in part because fighting HIV and other infectious diseases has been a key focus of my career in healthcare, dating back to the work HHS did to help launch PEPFAR under President Bush.
At the time, we knew that dramatically expanding access to antiretrovirals in countries with high HIV prevalence would save millions of lives. What we didn’t know for certain was just how dramatically access to ARVs would also reduce the spread of HIV—which is one of the key insights that underlies our plan to end the HIV epidemic here in America.
Now, with PEPFAR’s support, several countries have demonstrated that we can turn the tide on the epidemic. UNAIDS has set out what are known as the 90-90-90 goals for 2020: 90 percent of people living with HIV know their status, 90 percent of people who know their status are on ARVs, and 90 percent of people on ARVs are virally suppressed.
As of 2018, the U.N. reports that six countries, including Botswana, Cambodia, and Namibia, have reached these goals, and other countries are getting close. UNAIDS has now also set the sights higher, with the goal to hit 95-95-95 for each of those metrics by 2030.
These are incredible successes.
I’m not sure any of us imagined this would be possible when President Bush first laid out PEPFAR in his 2003 State of the Union address, at a time when the epidemic seemed to be spinning out of control in the hardest-hit countries. But today, PEPFAR’s results speak for themselves.
Now, 16 years later, once again in a State of the Union address, we heard a President announce the next major HIV initiative: President Trump’s plan to end the HIV epidemic in America by 2030.
President Trump set out the bold, specific goals of reducing new HIV infections in the United States by 75 percent in five years, and by 90 percent by 2030—effectively halting the epidemic’s spread.
I can personally tell you how committed the President is to delivering on these goals. He’s told us that he was overwhelmed by how much positive feedback he received on the announcement, and when he’s discussing healthcare in public appearances now, it comes up all the time.
It used to be that drug prices could come up in any given healthcare speech, now you can add HIV to that list.
Because of our experience with PEPFAR, we know that the right strategic approach to this challenge can deliver very impressive results. The good news is that, like PEPFAR’s focus on countries with especially high prevalence, we have a sense of where we need to focus here at home.
We know that new infections in the United States are geographically concentrated. More than half of HIV diagnoses occur in just 48 counties, plus the District of Columbia and San Juana, Puerto Rico. These geographic hotspots include places where stigma and socio-economic barriers to treatment and prevention remain high, including rural areas and the South. Infections are also much higher among certain demographic groups, including men who have sex with men, black and Latino Americans, and American Indians and Alaska Natives.
Many of these challenges here at home can be similar to challenges we’ve faced abroad, which is why we want to make sure we’re sharing lessons from both spheres.
We have interventions that have proven to be effective and others that have failed, and this meeting is an opportunity to share and discuss those experiences.
There are, in all likelihood, lessons we can learn from supporting care in Rwanda or Malawi that can be applied to the work we need to do in rural parts of the South. There are common experiences we can draw on about how to provide services to hard-to-reach, vulnerable populations in an urban setting, whether that’s in Nairobi or in Baltimore.
We have examples already of how work at home can apply abroad, and vice versa. CDC’s famous Epidemic Intelligence Service, which trains “disease detectives” to work here in the U.S., became the model for their international Field Epidemiology Training Program, which has now worked in more than 70 nations, training thousands of disease detectives to work in their own countries.
On HIV in particular, HRSA’s AIDS Education and Training Center is a national network of HIV experts who provide consultations and technical assistance to local communities on how to tackle HIV.
It has served as the model for HRSA’s International Training and Education Center for Health, or I-TECH, which provides similar services now to international partners.
Those are just two examples of the kind of cooperation that can occur across the domestic and global spheres.
Leaders in this room have hundreds of years of collective program, policy, and research experience, tackling HIV at all levels, from international strategy on PEPFAR down to on-the-ground public-health work and service provision.
Today is a unique gathering, and I hope it will help all of you think through bold and innovative ways to execute on our strategy for ending the HIV epidemic in America, while also thinking about how we can strengthen our work on PEPFAR.
PEPFAR has been described as one of the great humanitarian initiatives of all time. This team has a chance now to build a similar legacy.
Successfully executing on our strategy to end the HIV epidemic here at home will come to be known as one of the great American public health victories.
We cannot do that without all of you, so thank you again for being here and for having me here today.
