What Should the Next U.S. President Do to Advance the Fight Against HIV?

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We're over 30 years into the HIV epidemic and still have a long way to go. With the upcoming election and health care issues being top of mind, we wonder what the next U.S. president will do to continue the fight against HIV. We asked some of the leading HIV experts and advocates what they would tell the next U.S. president to do in order to keep advancing the fight. These interviews were conducted at CROI 2016 in Boston.

Additional reporting for this slide show was provided by Myles Helfand and JD Davids.

Miguel Gomez

Miguel is director of AIDS.gov, and senior communications advisor at the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.

One of the messages we have for public health leaders, at the local level, at the national level, congressionally, across the board -- even within our faith communities -- is that in public health one of the tools we have available to us are digital tools. We know our target audience is listening to each other, is engaging on social media tools and devices, on which we are not always putting our information.

It's not necessarily about how to find an HIV test, how to learn more about PrEP; it can also be: How can I find a hospital that I'll feel comfortable in? So across the board, one of the number one things we need to do in today's digital world is be digital-ready.

Alexander Kintu, M.S.

Alexander is a research assistant at Harvard University.

The biggest issue is maintaining the funding. It's clear that the funding is quite reduced, whether it's for treatment or not. I think subsequently, as countries do better -- like South Africa -- drug recipients won't get funds as they move into a middle-income or high-income country. I think the biggest issue is whether we can retain the same level of funding, especially for drugs, without some countries losing out just because their income's a lot better than it used to be.

But I think the big issue is not reinventing the wheel, raising new things, but just maintaining funding, at least for treatment.

Keri Althoff, Ph.D., M.P.H.

Dr. Althoff is an assistant professor at Johns Hopkins Bloomberg School of Public Health.

HIV prevention is key, and HIV treatment is essential, to protecting individual and population health. Remove the barriers to the tools we know are successful in preventing HIV, including access to clean needles. Address the social barriers, namely stigma, to testing and treatment. Learn more about the most vulnerable populations, including (but not limited to) older adults with HIV, transgender persons, women and young, black men who have sex with men. Use conversation, legislation, and research priorities to increase access to HIV prevention tools and treatment, decrease HIV-associated stigma, and learn more about how to serve the populations in greatest need.

Rajesh Gandhi, M.D.

Dr. Gandhi is an associate professor of medicine at Harvard Medical School, and the director of HIV clinical services and education at Massachusetts General Hospital.

Because HIV is a disease that we have a real prospect of ending, that is with prevention, PrEP, all the things we see here, with treatment as prevention, or maybe with PEER [Partnerships for Enhanced Engagement in Research] -- this is one disease that you don't want to scale back on too soon. It took decades to get where we are, where we're finally bending the curve down in terms of improving the numbers and improving lifespan. This is the time to put your foot on the accelerator, rather than put it on the brake or take it off the accelerator. This is not a time to be coasting.

Laurel Sprague

Laurel is the research director at Sero.

I think the most important thing our next president can do is to invest in communities and community-based approaches, and to listen to the critical issues that people with HIV and affected communities are already bringing forward, such as making sure that we end criminalization based on HIV status, making sure that we support the fight against criminalization of people because they use drugs or are sex workers or are part of LGBT populations, and all of the other issues that different groups of people with HIV are already raising.

David Alain Wohl, M.D.

Dr. Wohl is an associate professor of medicine in the Division of Infectious Diseases at the University of North Carolina and site leader of the University of North Carolina AIDS Clinical Trials Unit at Chapel Hill.

I think the most important thing for me is just paying attention and talking about it. We've seen that there've been presidents who don't want to talk about it and presidents who do, and administrations that deal with it. I think issuing white papers and putting it at the forefront is a really good idea. Funding, of course, comes down to what we care about as well because we can't take our eye off the ball. What happens when we take our eye off the TB [tuberculosis] control ball? Then we see a resurgence in TB. So just because we're successful doesn't mean we pull back. We have to keep the pressure up. If cases are going down (and we're not really sure that they are), we have to continue the pressure.

So we need to get PrEP [pre-exposure prophylaxis] out there. PrEP has to be institutionalized as being just like vaccinations or contraceptives. Something that's out there, something that's available that's protective. That would be a priority for me, but keeping it front and center and not forgetting about it. One in 300 people in America have HIV. In some cities like Washington, D.C., there are astronomical numbers. We can't forget about that.

Monica Gandhi, M.D., M.P.H.

Dr. Gandhi is a professor of medicine in the HIV/AIDS division at the University of California, San Francisco.

Continue and even expand PEPFAR [the President's Emergency Plan for AIDS Relief] given its substantial impact on health infrastructure globally, the provision of both HIV and other treatments, the potential for local partnership and investment within its framework. Continue substantial NIH [National Institutes of Health] funding for HIV/AIDS-related research priorities.

Mitchell Warren

Mitchell is the executive director of AVAC.

I think the most important thing is to maintain a long-term strategy. It is very tantalizing to talk about the end of the epidemic. And the fact that we even talk about it now, beginning in 2011 with the HPTN 052 results, and then the treatment-as-prevention drugs: It's exciting; it's thrilling. But this epidemic isn't ending.

And if we only focus on the short-term delivery, whether it's treatment or prevention, and lose sight of investing in research -- I'm incredibly optimistic about PEPFAR and what it's able to do; I'm optimistic about the new National AIDS Strategy, which needs to be funded and implemented, as any strategy does. But my biggest worry is the current sense that I hear on Capital Hill that it's almost oversold success. And if you're a policy maker who's looking at shorter-term wins, you think you've won the AIDS epidemic; you can turn your resources to fill-in-the-blank. Is it Zika? Is it Ebola? Is it Alzheimer's? Is it cancer?

We need to ensure that we don't lose sight of the pivotal importance of research and development. We still need, desperately, a vaccine. We clearly need other prevention methods. Because oral PrEP and the dapivirine ring, while exciting, by themselves are not enough.

I worry a bit that the next president could get lulled into thinking, "Well, I could end the epidemic on my watch." And they can't. They can't, even in eight years of presidency, from 2017 to 2025. We're not going to end this epidemic. And we will certainly not sustain the end if we don't continue to invest in R&D. So I think that's the most important thing to go forward.

Stephen Berry, M.D.

Dr. Berry is an assistant professor of medicine at the Johns Hopkins University School of Medicine.

I'm a huge fan of the Ryan White HIV/AIDS program. I think it should be looked to as a model and an example for other disease processes -- whether it's diabetes or other chronic diseases -- of how an agency can address extremely challenging problems, social problems, medical problems, and provide support for them that saves lives -- that every single day, by making those copays possible, by providing a nurse to do adherence counseling, by helping somebody with bus fare to come to clinic, honest-to-goodness saves lives.

Recognition of that, understanding just how important those services are for nearly half of Americans living with HIV, would be critical, whoever's going to be in the White House. And you know, it gets its money from Congress, but the Health Resources and Services Administration is part of HHS [the U.S. Department of Health and Human Services]. So it directly rolls up into the White House administration.

Anna Grimsrud, Ph.D., M.P.H.

Dr. Grimsrud is the program specialist at the International AIDS Society.

I think we need a sustained response, in terms of funding. There are some efficiencies that can be gained, absolutely. Given that we need to more than double the number of people on treatment, we still are going to need money earmarked for HIV.

Cindra Feuer

Cindra is senior communications and policy advisor at AVAC.

We know that HIV is a human rights issue, and health care is a human right. So I would say that universalized health care and not just this sort of willy-nilly -- not willy-nilly -- this quasi attempt at universal health care. I think that we really need single-payer health care, for everyone to have easy access -- quality access -- to health care and culturally competent access.

And there are other issues, such as dismantling the prison industrial complex and Citizens United, and moving all of the money from the Pentagon to health care and education and housing and the arts.

David Evans

David is director of research advocacy at Project Inform.

I wish the next president could force all the states that haven't expanded Medicaid to do so. Maybe there could be some ways to design some more incentives that would overcome the political incentive that Republicans have to keep blockading that.

Short of that, I think that whomever the next president is, making sure that their appointments at high-level cabinet positions really "get" HIV, and that they maintain leadership who understands the importance of addressing the real bottlenecks in serving people who need it.

Eileen Martin, Ph.D.

Dr. Martin is a professor of psychiatry at Rush University Medical Center.

I see it as two different things. I see a bigger push with the science, with the genetics that brilliant people are working on. I think a big push around issues that affect people's stigma and things like more support for substance use treatment. Don't treat this as if the people are morally wrong.

Do whatever you can do to support people to go get tested. Think about how you can get people tested in a way that they don't find culturally embarrassing. Work within -- in our country -- the African-American community, particularly the churches, to sort of get on board about a lot of this stuff.

But you can't do anything without funding. It's got to be initiatives and policy changes. You can have one person say things, and that's not enough, even if it's the president of the United States. People promise things. I want to see them follow through on it.

Joel Gallant, M.D., Ph.D.

Dr. Gallant is the medical director of specialty services at Southwest CARE Center.

Don't be a Republican.

Rebecca Scherzer, Ph.D.

Dr. Scherzer is research statistician in the Department of Medicine at the University of California, San Francisco.

Broadening access to health care coverage. The Affordable Care Act has moved the needle, but there's still a lot more to be done. And in my understanding, there are some cost disparities in HIV drugs. They're trying to achieve parity. So if you're taking a blood pressure medication, versus taking an HIV medication, my guess is there are still big cost differences there. I think that's really an area that could use some attention.