The Heavy Lift

Our movement has a heavy lift for 2020: full funding for the federal effort to end the HIV epidemic in America. The money is essential to support the 57 jurisdictional plans submitted at the end of 2019 (only 53 jurisdictions submitted plans). As NMAC noted earlier, the nearly $300 million in new funding for 2020 was just a down payment.

Do we have the capacity to make this real? If we are serious about ending the domestic epidemic then, beyond the science and reaching communities that were previously missed, it takes money. Without the money, our movement cannot bring to scale the programs needed. Remember we need to reach 500,000 people living with HIV and 900,000 more people who would benefit from PrEP.

Scale will be an important driver of our work. Do the new initiatives reach thousands if not tens of thousands people living with HIV and/or people who could benefit from PrEP? Programs that reach hundreds will not be sufficient. Working off the herd theory of immunity, we need to get large numbers of people living with HIV to undetectable and even larger numbers of people on PrEP.

Where To Start?
From NMAC’s perspective, jurisdictions should follow the data. What does the data say? Not just HIV data. It is important to look at STD and hepatitis data sets. There is an epidemic of STDs. If you overlay states with the highest gonorrhea rates per capita:

and the states with the highest syphilis rates:
and the states with more than half of the people living hepatitis C. Those states include California, Florida, Michigan, New York, North Carolina, Ohio, Pennsylvania, Tennessee, and Texas.

and finally, the states with the highest rates of HIV per capita:

Florida Mississippi, Louisiana, Georgia are in the top 10 for gonorrhea, syphilis, or hep C and HIV. South Carolina, Alabama, and Nevada are in the top 10 for HIV and gonorrhea or syphilis and North Carolina is in the top 10 for gonorrhea, syphilis, and hep C. Jurisdictions in these regions must prioritize STD/HIV/hep C testing sites, health centers, and community organizations that provide tests. Everyone who is tested should also be counseled about U=U and PrEP. Treatment on demand for U=U or PrEP should be available. History has shown that we lose too many people when they have to wait or return to find out results or treatment.

Since the infrastructure is already in place, these services can hit the ground running using existing agencies. There needs to be funding to hire and train staff. While this will work for people willing to access healthcare systems, new structures are needed for those communities that have trust issues. This is where Dr. Redfield’s disruptive innovation will be important.

Need Your Help
It takes money to end the HIV epidemic. It also takes money to support the efforts in Congress for the necessary appropriations. While, historically, our movement has been very effective managing the HIV portfolio on the hill, the need for full federal funding will require unprecedented cooperation and collaboration between the many organizations with a DC presence.

For the last three years in partnership with AIDS United, NASTAD, NCSD, and The AIDS Institute, NMAC has used the services of outside lobbying and communication firms for the partnership’s joint policy efforts. Our collaboration pushed HHS to build the plans and raise the funding to end the epidemic. This year, in addition to existing partnership firms, NMAC will bring on the pro bono services of Kelley Drye. Kelley Drye has more than 125 lawyers, government relations professionals, and economists based in the DC office. NMAC has retained their pro bono services to support our efforts to end the HIV epidemic in America.

AIDS United’s AIDS Watch is coming to DC March 30-31 and is so important this year. At this event, HIV advocates from around the nation join efforts to directly engage our elected officials to bring better services and research to stem the HIV epidemic. And on April 1, NMAC is partnering with health organizations from around the nation to discuss the state of pharmaceutical and other private funding in the HIV field and its explicit or implicit influence on our collective work.

While federal money is critical, that is just the government’s portion. Can the private sector match this amount? There are many efforts that the government cannot cover, including all of the work in Congress. Now is the time for the private sector to step-up. Who will be our champion?

Yours in the struggle,
Paul Kawata

Paul Kawata