The Trump administration has chosen South Carolina as one of seven states to help wipe out HIV by 2030 because there are so many cases in rural areas of the state.
But during a recent roundtable and conference call discussion with executives of national HIV advocacy organizations, the health leaders highlighted their concern with the plan.
Experts say that America has never eradicated a virus without either a vaccine or cure; HIV has neither.
“We’re trying to do something that has never been done before," said Paul Kawata, executive director of NMAC, formerly known as the National Minority AIDS Council.
At this year's State of the Union Address, President Donald Trump announced a plan to eradicate HIV that came with a promise of $291 million in federal funds.
The federal Health Resources and Services Administration explained parts of the plan. One is to give more funding to HRSA and its health centers. The Centers for Disease Control and Prevention will also get additional funding for testing and prevention.
The hope is to strengthen HIV diagnosis, prevention, treatment and response in areas where the HIV burden is heavy.
The initiative will kick-start in 2020. The goal is to reduce the number of new HIV infections to less than 3,000 by 2030. In 2017, CDC reported over 10 times that number of cases.
Kawata said all of the most affected communities having a voice during the planning is crucial for the 3,000 goal to be reached. It's even more important due to the absence of a vaccine.
“It's going to take all of us working together to make that happen," Kawata said.
What does it mean for SC?
The Trump plan will focus on Washington, D.C., San Juan, Puerto Rico, and 48 counties, all of which have high HIV burdens. It will also focus efforts in South Carolina and six other states with a high rural HIV burden.
Jason Kirk, the development director with Palmetto Community Care, said the Trump plan needs more fleshing out.
“We’re worried that this is sort of short-sighted," he said.
Palmetto Community Care is a Lowcountry-based health agency that works to address the HIV epidemic. Kirk explained that they are excited to see HIV being talked about more. Increased awareness means more people know it's still a problem, he said.
In 2018 Palmetto recorded 23 positive cases of HIV. This was an increase from the numbers seen in 2017 and 2016.
But it's going to take more coordination for South Carolina to benefit from the plan, Kirk said. For example, he said Palmetto has learned to address several individual needs while addressing a person's HIV needs.
He said if a person is in need of housing or food, their health often doesn't get prioritized. So the nonprofit works to secure HIV patients with housing, jobs and transportation in addition to medical support.
"That’s when people are taking the best care of themselves medically," he said.
So any plan to eradicate HIV has to take those extra needs into account he said. Trump's plan so far hasn't offered information on whether that will be addressed, he said.
He and Kawata agree the plan has to make room for erasing the HIV stigma. The reason, they explained, is that it's creating a lot of barriers to prevention, awareness and people seeking HIV treatments.
“We need local communities to fight the stigma and discrimination," Kawata said.
The advantage of a lot of urban communities Kirk said, is that there is more room for anonymity. In rural communities it's different.
"You know everyone, you know their business," he said.
So there are more personal hurdles for people getting help with tests and treatments, he said.
Going more in-depth
Demographics that are the most affected by the virus also have to be invited to have their voices heard, Kawata said. Particularly, people of color.
According to NMAC, there are 400,000 people living with HIV who have fallen out of care and most of them are people of color, Kawata said.
In South Carolina, the state health department reports that almost 20,000 were living with HIV as of December 2017. The majority of those cases were African American men and women.
Black gay men and the transgender community are also affected by the virus, Kirk said. So erasing stigmas associated with those communities is a vital component of ending the epidemic.
Between 2009 and 2014, the CDC reported that over 2,000 transgender people received an HIV diagnosis. Around half of transgender people who received that diagnosis were from Southern states.
In 2019, the CDC estimates that 14 percent of transgender women have HIV. Most of them are African American.
“Yet they're being stigmatized and ostracized even more than ever," Kirk said. “That’s a whole community that’s being left out.”
Kirk compared eradicating HIV to a four-legged stool. The medical side is one leg.
For HIV prevention the world has Pre-Exposure Prophylaxis or PrEP, a daily pill that significantly reduces a person's risk of HIV infection. There are also treatments that make the virus manageable.
So the medical leg is strong, he said. But even with this the CDC and the health department are still seeing high HIV numbers.
A lack of emphasis on social services, housing and stigmas will weaken other legs, Kirk said. If the other vital legs are weak, it doesn't matter how strong the medical side is.
"The stool doesn’t work anymore," he said.
Kawata and Kirk say the Trump plan needs more information. They first want to know which organizations will get funding. They also want to know if that funding comes with heavy oversight.
For Palmetto Community Care, Kirk said it would be ideal if they would get more creative freedom with the funds. That way if a program is not working, they can immediately make adjustments.
Though the plan to get to less than 3,000 new cases by 2030 is a lot, experts like Kirk and Kawata believe it is possible. It's just going to take a lot of effort and participation.
At this point Kawata believes the plan has to work.
“If we fail, we fail in communities that are sometimes the most marginalized communities in our society," he said.