On This World AIDS Day, Unite to End the Epidemics

By Murray Penner December 1, 2017

Last year on World AIDS Day, I shared my story of being diagnosed with HIV as well as my hopes and fears looking ahead to the change in leadership our nation was facing. Now a year later, we still face uncertainty and the challenges are many. But I’d like to reflect today on some successes we have had and obstacles we have overcome as well as look ahead, with hope and optimism, about what we can accomplish by working together and remaining vigilant in our resolve to end HIV and hepatitis. 

The fights to save the Affordable Care Act (ACA) and avoid harmful changes to Medicaid have been an ongoing battle this year and we, in partnership with many other organizations and coalitions, have overcome numerous challenges to repeal the ACA. But as I write this, another challenge is in front of us, with the potential repeal of the individual mandate in the ACA through tax reform. The uncertainty all the political gamesmanship has caused for people living with HIV and hepatitis as well as providers and others who work hard to ensure people have insurance has been very unsettling.  And these challenges will likely continue as we look ahead into 2018.

A legislative success this year that we hope is coming to a close is protecting most if not all of the funding for our HIV and hepatitis programs. While FY2018 appropriations have not yet been finalized, we are hopeful that we will have staved off the cuts that were proposed in the President’s FY2018 budget. NASTAD has worked in close partnership with AIDS United, NMAC, the National Coalition of STD Directors (NCSD), and The AIDS Institute to ensure that funding for our programs is maintained. We will continue this partnership, in addition to our ongoing coalition work. 

We’ve had other important successes as well. This year, NASTAD launched our Unite to End the Epidemics Chair’s Challenge which calls on health departments to stop allowing the imperfect nature of our systems to divide us and challenges all of us to put in place program and policy building blocks that are necessary to implement impactful HIV and hepatitis prevention and care programs. And as I write this blog, I’m heartened to receive news that President Trump proclaimed the Administration’s commitment to ongoing support in the fight against HIV/AIDS. 

And for the first time in history, we have nearly all of the tools necessary to end new HIV infections and a tremendous opportunity to focus on ending HIV and hepatitis within our lifetime. We saw large uptakes in pre-exposure prophylaxis (PrEP) and additional proof that people with an undetectable viral load absolutely do not transmit the virus to their sexual partners. The Undetetectable Equals Untransmittable, or U=U, message, is a powerful one that reduces stigma and empowers people living with HIV to maintain undetetectable viral loads. 

Despite these and many other successes, challenges remain in front of us. Following repeated legislative defeats to repeal the ACA, President Trump and Congress continue to take steps to dismantle the ACA. In addition to the potential repeal of the individual mandate I mentioned above, ending cost sharing reduction (CSR) payments to issuers and an executive order that will likely destabilize the health care marketplace and erode patient protections are huge threats that we must overcome.    

While we are seeing reductions in new infections in many areas, there are still unacceptably high rates of new infections among certain populations. We recently saw new data from the CDC that shows record high rates of chlamydia, gonorrhea, and syphilis (STDs) in the U.S. This alarming news presents us with an opportunity to leverage our HIV systems and focus our efforts on a more integrated, sexual wellness approach that includes STD prevention. 

Finally, in order to end HIV and hepatitis we must continue to reframe our public health approaches and interventions to include social justice action and intentionally deepen our understanding of the needs of our most vulnerable communities. That means removing discriminatory practices within our public health systems and boldly demonstrating through action that the lives of our most vulnerable brothers and sisters really matter. This is true now more than ever. We can’t end these epidemics if we do not do so among all populations. 

This is my 30th World AIDS Day. I once again renew my commitment to continue to be vigilant and remain strong and steadfast in this work. Key to confronting the challenges ahead of us is affirming the essential role of governmental public health in policies and programs that address the HIV and hepatitis epidemics, working in concert with communities and people living with HIV. To this end, NASTAD continues to be a strong advocate on behalf of governmental public health programs and a leader and partner in working with communities, organizations, and people living with HIV and/or hepatitis and we will continue to accelerate our work with a focus on ending HIV and hepatitis.

I remain inspired by each of you and that we can truly end HIV and hepatitis. I invite you to join me and NASTAD to unite to end the HIV and HCV epidemics, once and for all.

Murray Penner is an HIV and hepatitis treatment and drug pricing expert who has been living with HIV since 1986. Murray is also the executive director at NASTAD. NASTAD is a non-partisan, non-profit association that represents public health officials who administer HIV and hepatitis health care, prevention, education and supportive service programs funded by state and federal governments in all 50 U.S. states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the U.S. Pacific Islands. NASTAD also supports partner governments in Africa, the Central America region, and the Caribbean region and on providing care and support to all who live with HIV and hepatitis.