Not only has COVID-19 killed a million Americans, it also has slowed the bipartisan effort to close the books on another terrible virus, HIV/AIDS.
In a thorough study released Oct. 27, the health research firm Milliman found that COVID-19 has had a “negative impact on HIV testing, diagnosis, and treatment initiation” across the United States. Earlier studies found a 68% to 97% reduction in weekly HIV tests between 2019 and 2020 and rising positivity rates as a result. UNAIDS, the U.N. organization responsible for fighting the disease worldwide, concluded in June that “progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result.”
The new research found that the declines have continued well after the pandemic’s peak, indicating a “prolonged impact on overall HIV transmission and management.” That’s a serious setback on this, the 35th annual World AIDS Day.
For example, the Milliman study estimated that, between March 2020 and October 2021, some 33,000 Texans missed HIV testing because of COVID-19, a figure exceeded by just three other states. In the Fort Worth-Arlington-Grapevine metro area, testing dropped 37% — the fourth-worst record in the nation. Dallas fared much better on testing, but new treatment initiations dropped 20%.
The setback is disheartening because the U.S. was making significant headway against the disease, thanks to cooperation across party lines and scientific breakthroughs. In 2019, the Trump administration launched the “Ending the HIV Epidemic Initiative: A Plan for America,” an effort to reduce new HIV infections – running at 35,000 in 2019 – by 75% in five years and by 90% in 10 years. On last year’s World AIDS Day, President Biden released a new National HIV/AIDS Strategy with the aim of ending the HIV epidemic in the United States by 2030.
HIV, or the human immunodeficiency virus, weakens the immune system to make it vulnerable to all sorts of bacteria, viruses and other disease agents. HIV leads to acquired immune deficiency syndrome, or AIDS, which was a death sentence before the development of miraculous antiretroviral therapy about 30 years ago.
The first case of what would later be identified as HIV/AIDS was discovered in 1981. Since then, the disease has killed 700,000 Americans. Deaths dropped sharply after the advent of antiretroviral therapy, which allows people with AIDS to live a long and healthy life, and, more recently, pre-exposure prophylaxis or PrEP, which prevents spread of the virus during sex. Research has also found that when antiretroviral therapy reduces viral levels to where they can’t be detected in the blood, someone living with HIV can’t pass it on — a phenomenon known as U=U, or undetectable equals untransmittable.
But 5,000 Americans still die of AIDS-related illnesses each year; in 2019, it was the ninth-leading cause of death for those aged 25 to 34. Some 1.2 million people in the U.S. are living with HIV.
Even without a vaccine or a cure, we now have the tools to wipe out HIV/AIDS, especially with PrEP, which, according to the Centers for Disease Control and Prevention, “reduces the risk of getting HIV from sex by about 99% when taken as prescribed.” Under the Affordable Care Act, PrEP has to be provided at no cost to members of all health insurance plans. The CDC credits the treatment with helping reduce annual infections by 8% between 2015 and 2019.
The latest data from the CDC show that “in 2020, about 25% of the 1.2 million people for whom PrEP is recommended were prescribed it, compared with only about 3% in 2015.” But that leaves 800,000 Americans who are at special risk for contracting a highly communicable disease without the means to prevent it.
What to do? The only answer is to intensify the drive to test, treat and prevent — especially in the South, which accounts for 51% of new HIV cases. Before COVID-19, Blacks accounted for half of new Southern HIV cases and Hispanics for one-fourth. (The CDC includes Texas and Oklahoma in its definition of the South.)
The promises of both Trump and Biden will ring hollow and thousands will needlessly die if Congress fails to move quickly — perhaps through the government funding bill that needs to pass this month — to address the dangerous shortfall in testing and treatment that has developed.
It’s understandable that COVID-19 interrupted the march toward eradicating HIV/AIDS in America, but with the trend continuing, we have to redouble efforts initiated by both Republicans and Democrats to get back on track.
James K. Glassman, who was founding executive director of the George W. Bush Institute in Dallas, advises health care companies and nonprofits. He wrote this column for The Dallas Morning News.
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