Noting that only about half of those living with HIV in the United States actually know they have the disease, and that eight in 10 of all new HIV infections come from people who are not receiving treatment for their disease, the Trump administration has pledged new resources toward addressing these gaps and finally bringing the HIV epidemic to an end.

In a CDC Vital Signs press briefing on March 19, U.S. Surgeon General Jerome Adams, MD, MPH, made the case for why the timing is right for a concerted effort against this disease, stating that the right data and the right tools are in place to achieve success.

“We now know that achieving an undetectable viral load means that it’s virtually impossible to transmit the infection to a partner,” he said. “We also have pre-exposure prophylactics, one pill a day, that can prevent the acquisition of HIV from an untreated partner up to 97% [of the time].”

The administration is allocating $30 million toward the effort this year, and it is asking Congress to provide an additional $291 million in 2020. However, Adams noted that action against the disease will begin immediately with a phased-in approach. “Over the next five years, we will target the 48 highest-burden counties in the United States,” he said. “At the end of five years, we expect to have reduced new HIV infections in America by 75%.”

At this point, efforts will expand to include counties with the next-highest burden of HIV, and by year 10, health officials expect to have achieved a 90% overall decrease in new HIV infections, according to Adams. He also outlined the tactics included in the new initiative:

• Diagnose people with HIV as early as possible following infection;
• Treat HIV rapidly and effectively to achieve sustained viral suppression;
• Protect people at risk of acquiring HIV with intervention methods such as PrEP, a medication that can prevent HIV infection;
• Detect and respond rapidly to growing HIV clusters and new HIV infections.

During the same press briefing, CDC Director Robert Redfield, MD, noted there are currently about 39,000 new HIV infections diagnosed in the United States each year, and that after five years of decline, this number plateaued in 2013. “This is because effective prevention and treatment options are not adequately reaching all who need them,” he said. “The majority of new infections occur among gay and bisexual men, with black and Latino gay and bisexual men bearing a disproportionate number of those infections, especially among those between the ages of 25 and 34.”

Redfield pledged that the CDC will work closely with other health agencies as well as state and local authorities to help ensure progress is made.

“We will establish teams to eliminate HIV infection in high-burden areas, and provide important operational support,” he said. “We will also work with HRSA [Heath Resources and Services Administration] and state and local health systems and agencies to increase the capacity to diagnose HIV infections in high-burden areas. We will do this by implementing systems to increase routine HIV testing in clinical settings and to reach more people with nonclinical testing options.”

Redfield added that the CDC will work with local authorities to develop comprehensive prevention services, and that the agency will accelerate the deployment of effective cluster and detection response teams to identify and respond quickly to clusters of new HIV infections.

The administration’s approach will require collaboration among federal agencies as well as state and local health authorities and faith-based partners, Adams noted.

“This is going to be a whole-of-society initiative,” he said. “We have an unprecedented opportunity to end the HIV epidemic in America, and that is why the time to act is now.”