On this 35th commemoration of World AIDS Day, we remember those we have lost to HIV/AIDS and commit to accelerating our efforts to fight the disease and support those with and experiencing risk for HIV. The Biden-Harris Administration remains committed to implementing the National HIV/AIDS Strategy (NHAS) and achieving the bipartisan goal of ending the HIV epidemic domestically and globally. This year, the Administration also celebrated the 20th anniversary of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation in history to fight a single disease.
The global community, including the U.S., is making progress toward eliminating HIV transmission, but we must accelerate these efforts. In too many communities, barriers to comprehensive HIV prevention and treatment limit awareness, access, and engagement in HIV services by priority populations with or most at risk of HIV. In addition, HIV-related criminalization, stigma, and discrimination continue to undermine the effective use of tools to reduce HIV transmissions to our 2030 goals.
Nevertheless, thanks to the efforts of community, state, and federal partners, we are making important progress toward the National HIV/AIDS Strategy (NHAS) and the PEPFAR Strategy goals. Recent data that indicate that:
- New HIV infections in the U.S. have declined in recent years, after a period of general stability. Estimated annual new HIV infections were 12% lower in 2021 compared to 2017—dropping from about 36,500 infections to about 32,100.
- Overall, in 2022, 36% of the 1.2 million people in the U.S. who could benefit from PrEP were prescribed it, compared to 23% in 2019, though significant racial/ethnic and gender disparities persist.
- Nearly 90% of Ryan White HIV/AIDS Program clients receiving HIV medical care in 2022 reached viral suppression, significantly higher than the 69.5% in 2010.
- Over the course of its 20 years, PEPFAR saved 25 million lives and enabled 5.5 million babies to be born HIV-free to mothers living with HIV.
- Across 55 countries, PEPFAR supports lifesaving antiretroviral treatment for more than 20 million people.
Over the past year, the Administration has taken action to:
Accelerate Our Domestic HIV Efforts
- Releasing the NHAS Interim Action Report. On December 1, 2023, the White House Office of National AIDS Policy (ONAP) released the 2022 NHAS Interim Action Report, highlighting work done by federal and community partners to energize and invigorate our collective national work to end the HIV epidemic and ensure that no population or region is left behind.
- Implementing the Ending the HIV Epidemic in the U.S. (EHE) initiative. The U.S. Department of Health and Human Services (HHS) initiated EHE in 2019 to provide a targeted infusion of funds and resources to populations and regions with the greatest need. EHE advances innovative, community-driven solutions that leverage scientific advances in HIV prevention, diagnosis, treatment, and outbreak. It also works to address racial, ethnic, and geographic disparities. Increasing pre-exposure prophylaxis (PrEP) coverage is one of the key prevention strategies outlined in the EHE initiative. Among many EHE accomplishments, in October 2023, CDC published preliminary data on PrEP coverage indicating that in 2022, for the first time, more than one-third of people in the U.S. who could benefit from PrEP had been prescribed it. Further, HHS’s Health Resources and Services Administration (HRSA) Health Center Program awarded more than $17 million in EHE–Primary Care HIV Prevention Awards to 46 health centers to expand access to PrEP and other HIV prevention services that decrease the risk of HIV transmission in underserved communities.
- Requesting unprecedented investments to end the HIV epidemic. In his FY2024 budget proposal, President Biden requested $850 million to aggressively reduce new HIV cases by increasing access to HIV prevention, care, and treatment and supporting research initiatives implemented in the U.S. and worldwide. The budget included funding for domestic HIV activities across multiple agencies, a boost in funding for the EHE initiative, and proposals for a national PrEP delivery program to improve PrEP access for Medicaid beneficiaries.
Respond to HIV/AIDS Globally
Over the last 20 years, PEPFAR has supported more than 55 countries worldwide, saved more than 25 million lives, enabled 5.5 million babies to be born HIV-free, and prevented millions of new HIV infections, all while strengthening global health and economic security. The Administration has taken action over the past year to build on that impact, including by:
- Building on 20 years of lifesaving impact. When PEPFAR was announced by President George W. Bush in 2003, an AIDS diagnosis was a death sentence, with only 50,000 of the more than 4 million people across Africa who needed life-saving HIV/AIDS treatment receiving it. To date, PEPFAR has saved more than 25 million lives and prevented millions of new HIV infections. PEPFAR’s flagship Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program, which has reached millions of adolescent girls and young women, has played a major role in reducing new HIV infections across 55 countries PEPFAR supports. In FY23, PEPFAR supported more than 71 million people with HIV testing services and 1.95 million people to newly enroll in antiretroviral pre-exposure prophylaxis (PrEP), an increase of 30 percent over FY22. In addition, PEPFAR directly supported more than 327,000 health workers to deliver HIV-related prevention, treatment and supportive services in FY23, building on its longstanding investments to support and train health workers around the world. Based on modeling data based on FY23 results in 12 high-disease burden countries, PEPFAR projects that it will prevent at least 5.2 million AIDS-related deaths and 6.4 million new HIV infections (including 1 million new infections among children), as well as prevent more than 4 million children from being orphaned due to AIDS between 2024 and 2030.
- Leveraging PEPFAR’s strong programmatic base. On August 1, 2023, Secretary of State Antony Blinken launched the U.S. Department of State Bureau of Global Health Security and Diplomacy (GHSD), which brings together the strong PEPFAR programmatic base with the State Department’s diplomatic depth and experience to further progress toward control of infectious diseases like HIV/AIDS and address other global health security threats. Longstanding PEPFAR investments in creating sustainable health systems to respond to HIV/AIDS have enabled PEPFAR and partner countries to respond quickly and effectively to cholera, COVID-19, Ebola, H1N1 influenza, tuberculosis, and other health threats.
- Sustaining U.S. global leadership. For more than 20 years, PEPFAR has enjoyed strong bipartisan support and has been one of our nation’s most profound, transformational investments. The United States has invested more than $110 billion since 2003 in the global HIV/AIDS response through PEPFAR and the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria. The United States held a historic Global Fund Replenishment in 2022, helping to raise over $15.7 billion in pledges. To achieve the goal of ending HIV/AIDS as a public health threat by 2030, the Biden-Harris Administration supports a clean, five-year PEPFAR reauthorization.
Address HIV Stigma and Discrimination
- Following the science. The U.S. Food and Drug Administration updated its blood donor eligibility guidance, ending longstanding discriminatory policies that excluded gay and bisexual people from donating blood while maintaining appropriate safeguards to protect recipients of blood products. Further, the U.S. Public Health Service Commissioned Corps updated its medical standards to accept future applicants with chronic hepatitis B and HIV, expanding eligibility for those who want to serve their nation in uniform as a Public Health Service Officer.
- Affirming the U=U message. HHS continued to affirm the federal government’s commitment to “undetectable=untransmittable” (U=U) messaging, meaning that people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load will stay healthy and will not transmit HIV to their HIV-negative sexual partners. For example, CDC updated language for clinicians on treatment as prevention to reference U=U; SAMHSA’s Center for Substance Abuse Treatment (CSAT) published a nearly $21 million notice of funding opportunity to increase HIV services in existing substance disorder treatment programs, including incorporating U=U messages into communication strategies. HHS continued implementing “I am A Work of ART,” a community-informed campaign to encourage people with HIV to seek care, stay in care, and achieve viral suppression through antiretroviral therapy (ART).
- Diversifying PACHA membership. President Biden added 13 new members to the Presidential Advisory Council on HIV/AIDS (PACHA), representing the full diversity of the HIV epidemic, to share their knowledge and help further inform our HIV response. Membership includes people with HIV, clinicians, advocates, and leaders of national organizations such as Chicanos Por La Causa, Inc. and NMAC (formerly the National Minority AIDS Council.)
- Engaging with the HIV community. The Centers for Disease Control and Prevention (CDC) and HRSA co-sponsored a series of regional town hall listening sessions to collaborate with the community to address longstanding HIV-related disparities and reach NHAS and EHE goals. PACHA also held numerous PACHA-to-the-People community engagement sessions, and federal leaders visited EHE jurisdictions and participated in virtual town halls and discussions with people with lived experience of HIV, community-based organizations, state and local health departments, HIV advocates, and others.
- Advancing equity for marginalized and underserved Americans. To mark Pride Month 2023, the Biden-Harris Administration announced new actions to protect LGBTQI+ communities from attacks on their rights and safety. These include launching a new LGBTQI+ Community Safety Partnership, strengthening resources for LGBTQI+ youth, and shielding LGBTQI+ Americans from book bans threatening their rights. Further, the Centers for Medicare & Medicaid Services (CMS) announced the posting of a proposed National Coverage Determination for FDA-approved PrEP to ensure PrEP access for those for whom cost-sharing and deductibles are barriers to this highly effective HIV prevention tool.
- Improving health outcomes for people aging with HIV. With funding from the Minority HIV/AIDS Fund (MHAF), HHS’s Office of the Assistant Secretary for Health Office of Infectious Disease and HIV/AIDS Policy (OIDP) and Administration for Community Living (ACL) organized the Innovations for Needs of People Aging with HIV/Long-term Survivors in Urban Communities Challenge and the $500,000 Rural HIV and Aging Challenge to support innovative efforts aimed at improving health outcomes for people aging with HIV and long-term survivors, particularly among racial and ethnic minority and LGBTQI+ populations. In addition, HRSA’s Ryan White HIV/AIDS Program (RWHAP) launched the Aging with HIV Initiative to support and evaluate groundbreaking interventions that seek to improve the well-being of people with HIV ages 50 and older served by RWHAP.
- Promoting the equality, dignity, and safety of transgender Americans. Transgender women are an NHAS priority population due to the disproportionate impact of HIV on this population. In honor of Transgender Day of Visibility, the Biden-Harris Administration announced new steps to support transgender communities, including issuing a landmark report on ways to support and affirm LGBTQI+ youth, especially transgender youth, and issuing guidance on gender inclusion in the workforce. These efforts build on the Biden-Harris Administration’s other historic work to advance equality for transgender Americans since taking office.
Support and Treat People at Risk for “Syndemic” Conditions
- Facilitating the linkage of HIV services to harm reduction programs. The NHAS calls for integrated programs to address the interacting or “syndemic” conditions of HIV, STIs, viral hepatitis, and substance use and mental health disorders, including by facilitating the linkage of HIV services to evidence-based harm reduction programs. HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) published its Draft Harm Reduction Framework, the first document to comprehensively outline harm reduction and its role within HHS. Among many strategies, the Framework calls for health hubs that offer integrated HIV, viral hepatitis, and healthcare services for people who use drugs. The Biden-Harris Administration has identified harm reduction as a federal drug policy priority.
- Supporting people affected by HIV during the mpox public health emergency. While anyone can get mpox, CDC research shows that about 40% of people diagnosed with mpox in the U.S. also have HIV. The Biden-Harris Administration focused on expanding mpox vaccination for at-risk individuals and making testing more convenient for healthcare providers and patients nationwide. HHS provided resources on ways communities can stay protected from mpox in advance of the summer months and worked with LGBTQ+ community partners in late winter 2022 and early Spring 2023 to motivate actions to prevent mpox during Pride festivals and events. NIH also launched the STOMP trial to determine whether the antiviral tecovirimat can safely and effectively treat mpox.
- Implementing new approaches to preventing sexually transmitted infections (STIs). CDC developed draft guidelines on using STI post-exposure prophylaxis with doxycycline (Doxy PEP) to prevent some bacterial STIs and released them for public comment. STIs are pervasive and increasing rapidly in the U.S., and Doxy PEP has demonstrated substantial benefits in reducing new chlamydia, gonorrhea, and syphilis infections. Doxy PEP can benefit the health of some gay, bisexual, and other men who have sex with men and transgender women who have increased chances of getting an STI. These draft guidelines represent a new approach to addressing STI prevention.
- Providing stable housing to people with HIV and their families. Achieving and maintaining stable housing can be a powerful structural intervention in preventing HIV and syndemic conditions and ending the HIV epidemic. The U.S. Department of Housing and Urban Development (HUD) announced $50 million in competitive funding through its Housing Opportunities for Persons With AIDS (HOPWA) program to support housing assistance and supportive services for low-income people with HIV and their families, coordination and planning activities, and grants management and administration. Further, with MHAF resources, SAMHSA announced a new funding opportunity to support up to three pilot sites to deliver portable behavioral health, HIV, and other services for unsheltered racial and ethnic minority individuals.
Advance New Research
- Implementing a multiyear HIV research plan. The National Institutes of Health’s (NIH) Office on AIDS Research continued implementation of its five-year NIH Strategic Plan, a roadmap for the NIH HIV/AIDS research program, ensuring that funds are allocated per established NIH scientific research priorities. The Plan guides the NIH investment, building on scientific progress and opportunities for advancing HIV/AIDS research toward ending the pandemic.
- Beginning a new clinical trial of an HIV vaccine. An NIH-supported trial of a preventive HIV vaccine candidate began enrollment at six sites in the U.S. and South Africa. The Phase I trial will evaluate a novel vaccine known as VIR-1388 for its safety and ability to induce an HIV-specific immune response in people.
- Reducing heart disease risk in adults with HIV. An NIH-supported study showed that statins, a class of cholesterol-lowering medications, may offset the elevated risk of cardiovascular disease experienced by people with HIV by more than a third, potentially preventing one in five major cardiovascular events (e.g., heart attack or stroke) or premature deaths in this population. The findings are expected to directly influence clinical guidelines and standards of care for the aging population of people with HIV.