Arkansas is among seven states and 48 counties to be targeted by a high-profile federal initiative aiming to end new HIV infections in the U.S.
The initiative -- announced by President Donald Trump during his State of the Union address Tuesday and fleshed out in news releases from the U.S. Department of Health and Human Services -- will focus on "geographic hotspots" and states with high rural HIV burdens, including Arkansas.
According to the Health and Human Services Department, increased funding directed to those areas will support new and existing programs, use data to identify infection clusters and create local HIV "HealthForces" with the intent to cut new infections by 75 percent in five years and 90 percent in 10 years.
"Scientific breakthroughs have brought a once-distant dream within reach," Trump said Tuesday night. "My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. ... Together, we will defeat AIDS in America and beyond."
Arkansas Department of Health Director and State Health Officer Dr. Nate Smith says the initiative feels comparable in magnitude to the President's Emergency Plan for AIDS Relief, the 2003 global AIDS program announced by President George W. Bush during his State of the Union address that year.
"The time is ripe" to eliminate HIV in this country, Smith said.
"We've just been kind of managing it, rather than trying to take aggressive action to eliminate it," he said. "I'm very excited that Arkansas will have the chance to be part of it. I hope that we will not only make an impact for our state, but we will learn some lessons that will help other states as well."
A statement from Health and Human Services Secretary Alex Azar pointed to a "once-in-a-generation" opportunity provided by new prevention and treatment medications, as well as innovations in epidemiology that map outbreaks.
He wrote that 48 counties are showing more than 50 percent of new HIV diagnoses, and that men who have sex with men, racial minorities, people living in the South and users of injectable drugs, such as opiates, remain disproportionately affected by HIV and AIDS.
"We have lost more than 700,000 American lives to HIV since 1981," Azar wrote. "Without this new intervention, new infections will continue and we face the very real possibility that they will increase, costing more lives and the U.S. government more than $200 billion in direct lifetime medical costs for HIV prevention and medication."
The initiative will key in on geographical areas to target people most at risk, using several strategies meant to support efforts to end the epidemic. They include more rapid diagnoses and treatment, which can help prevent people from spreading HIV; increasing pre-exposure prophylaxis (or PrEP) use among high-risk groups; and use of new lab and epidemiological methods to identify and respond to infection clusters.
PrEP is a daily medication, sold under the trade name Truvada, that can reduce a person's chances of contracting HIV.
It's not yet clear how exactly the strategies described in the initiative will be implemented in Arkansas, where about 6,000 people live with HIV or AIDS. State officials are still waiting on budget details and specifics of supported programs, Smith said.
However, it's possible that the initiative could help the state Health Department roll out a program offering PrEP treatments, which it does not currently have funding for, he said. Other states are identifying infection clusters by analyzing HIV strains for genetic similarities, and with additional resources Arkansas might be able to do that as well.
He said the "accelerated" initiative will help address some of the particular challenges of treating HIV and AIDS in the state's many rural areas, where the stigma is more intense. It's also more difficult in rural areas for public health providers to reach people who are at risk or who are infected, and where some people, like many in the state's southeast, must travel long distances to reach clinics.
U.S. Sen. John Boozman, R-Ark., who sits on the congressional HIV/AIDS caucus, said in a statement that he hoped the plan would continue the work begun by President's Emergency Plan for AIDS Relief.
That relief effort "has been responsible for the life-saving care and treatment of patients around the globe living with HIV and AIDS. This initiative maintains strong support across party lines," Boozman said. "I am hopeful that we can build on this foundation and work toward the worthwhile goal of defeating AIDS."
Danny Harris, statewide outreach and prevention coordinator for health clinic network ARcare, said he would like to see more details before weighing in at length on the plan, which was mentioned only briefly during Tuesday's address. He expressed concern about the details of its funding.
"Unless they're going to increase the budget allotted for Ryan White [programs] to cover increasing the investment to these hotspots, that extra money will have to come from somewhere," he said. The Ryan White HIV/AIDS program supports low-income people living with HIV and AIDS.
Advocates whose work includes HIV matters were similarly guarded. Cornelius Mabin Jr., president and CEO of health education group Arkansas RAPPS, said the program would likely be discussed Friday at a meeting of an HIV planning group made up of community members and stakeholders. That group provides input on state programs to the federal Centers for Disease Control and Prevention.
He said there had been "mixed signals" on HIV and AIDS from the Trump administration, referring to the mass 2017 dismissal of the members of the Presidential Advisory Council on HIV and AIDS. (Some of those positions have since been filled.)
"We're open-minded, but certainly cautious," Mabin said. "For us, it's always going to be about sustainable funding."
Human Rights Campaign state director Denise Donnell shared a statement from the LGBT rights organization, saying the initiative announced Tuesday was undercut by Trump's and Vice President Mike Pence's records addressing HIV and AIDS.
The group mentioned an HIV outbreak in Indiana during Pence's term as governor. That outbreak was linked to a ban on needle exchange programs at that time, it said. Trump and Pence also have called for cuts in funding to Planned Parenthood, which often provides HIV testing services and treatment, the group said.
Despite qualms from some advocates, many joined public health officials in hoping that the initiative's goals are realistic.
"It's going to require a lot of hard work," Smith said.
"We've done a pretty good job in terms of treatment. ... Now it's time to look at, hey, this is an epidemic, and if we can interrupt transmission, we don't have to continue to deal with HIV as a chronic disease."
Metro on 02/07/2019