Telling our stories is culturally responsible.
Steven Tierney, August 5, 2009
On the morning of February 4, 2019, I received an e-mail from Dan Vergano, a reporter for Buzzfeed, informing me that the President planned to address HIV in the State of the Union Address, which was happening the next evening. To be honest, my first thought was, “Well @*%$ (fill in your favorite word), now I have to watch it!” That day, I gave interviews to Dan Vergano (2019) and Caitlyn Stulpin (2019), a reporter from Healio.com. Caitlyn had me answer her questions in an e-mail, which was good because I can now share my responses with you (with only a little bit of editing). Remember that my responses happened a day before the speech.
What Would It Take to End HIV Transmission by 2030?
It would take an immediate and committed scale-up of access to a coordinated HIV prevention and treatment program, which would include the following:
- Acceptance and funding of prevention programs that have been proven effective (i.e., in well-planned and implemented research with clear evidence of efficacy). Everything should be included in a comprehensive HIV prevention program from condom use and behavior change to chemical prevention through pre-exposure prophylaxis and postexposure prophylaxis to outreach to drug users with needle/syringe exchange programs and treatment options.
- Universal access to HIV testing, prevention programs for people who test negative (including pre-exposure prophylaxis and postexposure prophylaxis), immediate treatment for people who test positive, and follow-up to the partners of people who test positive.
- Immediate access to treatment for all people who have ever or will ever test positive for HIV. This would require universal access to comprehensive health care and medications to treat HIV. We now know that people living with HIV who are in consistent care and who take their medications can achieve undetectable viral loads and that people who are undetectable cannot pass the virus to others, as in Undetectable = Untransmittable.
- Proven programs to stop stigma related to HIV infection as well as to people who are living with or at risk for HIV. We must stop the discrimination commonly directed to sexual minorities, people who live in poverty, people who use drugs, women, races and ethnicities that are not White, and immigrants.
Basically, we would need the political will to accept a global approach to human rights and provide funding to overhaul the health care system, change people's attitudes, get people tested and treated, and stop discriminating against communities at risk.
Does This Pledge Seem Contradictory to How This Administration has Handled HIV So Far?
Absolutely. I will watch the speech with a whole load of skepticism. I will be happy if HIV is mentioned because getting HIV back in the public spotlight is usually a good thing. If it is mentioned, however, I will doubt this administration's commitment to spearhead the attack. I will believe that it is an honest policy commitment if I, for instance, see the administration (a) rescind the rules to limit the roles of gay, lesbian, and transgender members in the armed services; (b) commit to comprehensive women's health care, including birth control; (c) reverse the attack on Planned Parenthood; (d) develop a plan to provide comprehensive and universal health care coverage; (e) defund all abstinence-only programs for sex education and commit to K-12 comprehensive and science-based sex education; (f) provide federal support for needle/syringe exchange programs; and (g) provide federal support to increase access to in- and outpatient mental health and substance use programs.
Is It Doable?
Yes, given the above. Probability in this administration? VERY low. The current administration, with support from Congress in the past 2 years, has done all it can to repeal or stop advances in access to health care, public policies to support valid prevention programs, antidiscrimination legislation (including racial, gender, and sexual), and support for human rights. A program to end HIV will cost money, which would, in the long run, save money (estimated at more than $200 billion; Azar, 2019). Given the administration's spending priorities, however, I do not know how these funds would be generated.
The Good News
And so I watched the State of the Union with all the skepticism I promised. HIV was mentioned, and there was a request to Congress to fund a program to end the epidemic (https://www.cnn.com/2019/02/05/politics/donald-trump-state-of-the-union-2019-transcript/index.html). I am now aware that there is a strong team working on this goal, including Alex Azar, Secretary of the Department of Health and Human Services; Brett P. Giroir, Assistant Secretary for Health; and Robert Redfield, Director of the Centers for Disease Control and Prevention. Their plan, based on four “key strategies: Diagnose, Treat, Protect, and Respond” (Azar, 2019, p14), has been outlined and posted. I will watch as things progress with skepticism intact, and I will check off my criteria for success as (if) they happen.
Ending HIV in the United States by 2030: A Nursing Concern
I have taken the opportunity to respond to the State of the Union in this JANAC special topic issue. In these pages, you will find a variety of articles on preventing, testing for, treating, and dealing with stigma in the HIV epidemic. The issue was not difficult to put together; I simply used articles that had already been submitted and were in the review and editing process. In fact, you have seen these topics addressed in every issue of JANAC, which tells me that the members of ANAC and the authors for JANAC are way ahead of the game. We have been working on this goal for a long time, and we are well-equipped to contribute to ending the epidemic in the United States.