In 2011, Science Magazine’s “Breakthrough of the Year” was the discovery that antiretroviral drugs were a game changer in HIV prevention. The development of treatment as Prevention and Pre-Exposure Prophylaxis (PrEP) ushered in the concept of ending the HIV/AIDS epidemic, that by combining effective treatment for people living with HIV with simple and easy biomedical prevention for people at risk of HIV infection, we can eliminate HIV transmission and HIV acquisition, thereby breaking the back of the epidemic.
During his 2018 State of the Union address, President Trump announced a goal to end the AIDS epidemic in the United States by 2030. While HIV/AIDS activists and communities most impacted by the HIV epidemic — Black people, Latinos, LGBTQI folk, and women of color — have plenty of reasons to confront any announcement from the administration with skepticism, setting a goal to end the HIV/AIDS epidemic in 11 years should be celebrated. But like all efforts to accomplish a goal, the success of this one is dependent on the design and execution. As they say, the devil is in the details.
The underpinning of the administration’s plan is the recent surveillance data that shows that 50 percent of the U.S. epidemic is in 48 counties, Washington D.C., and San Juan, Puerto Rico, and seven states that have a substantial rural population living with HIV. While there is no question that focusing on the jurisdictions with the highest HIV burden makes sense, we must ask if focusing on geography alone — the where — will unlock the mystery of ending the HIV epidemic.
But with 60 percent of the Black HIV epidemic lying within the aforementioned jurisdictions, can we end the HIV/AIDS epidemic without also focusing on the other W’s, the who and the what?
Here’s the who: 43 percent of new HIV cases are among Black people. Black men who have sex with men represent 80 percent of the Black epidemic. Women, particularly women of color, represent one of the fastest growing HIV populations in the country. And though don’t have accurate data on the impact for men and women who are trans, it’s estimated that more than half of Black transwomen are living with HIV. If the plan does not explicitly address the unique needs of these populations, it will fail.
And here’s the what: HIV is virus. We finally have the biomedical tools to defeat it. That is easy and simple. But the American HIV epidemic is anything but easy and simple. Social determinants of health — poverty, homophobia, transphobia, xenophobia, sexism, racism, fear, and mistrust — drive our epidemic.
Insufficiently addressing the who and the what of the HIV epidemic has led to the HIV health disparities we see today. Only 46 percent of Black people who know they are living with HIV remain in regular care. Black men have lifetime HIV risk of 1 in 20, and for Black gay men, the risk is 1 out of 2. The lifetime risk for Black women is 1 out of 48, and more than half of trans people living with HIV are Black. People living in the South (where the majority of Black Americans live) are more likely to be diagnosed with HIV over the course of their lifetime than other Americans.
In the haste to get President Trump’s program off the ground, the input of community organizations who serve the Black community has been overlooked and ignored. But while there is a dire need for urgency, if the most impacted communities and individuals are not intentionally centered in the planning and execution of the plan, this opportunity will be squandered.
Among others, Black community leadership, HIV/AIDS activists and advocates, health departments, and other stakeholders must be convened across and within the targeted jurisdictions to develop and assure that the administration understands the implications of this plan. We are mobilizing and engaging Black communities across the country to build our power to ensure that we not only have a seat at the table, but that it’s OUR table. Because this is an issue of equity and racial justice, and we are going to hold the Trump Administration accountable.
We are here to end the epidemic in the only way possible: by recognizing and addressing the structures that drive the epidemic, uniquely and unapologetically.
Raniyah Copeland is president of the Black AIDS Institute. BAI is the only national HIV/AIDS think tank focused exclusively on Black people. To stay connected with their work go to www.BlackAIDS.org and follow them on social media.