Marking the 33rd annual World AIDS Day on Wednesday, the Biden administration announced it would ramp up its domestic and international efforts to fight the HIV virus, which has killed 36 million people worldwide in four decades.
President Joe Biden also released Wednesday the domestic-focused National HIV-AIDS Strategy, which aims for a 90% reduction in new HIV cases in the U.S. over the next nine years. Currently, about 1.2 million Americans are thought to be living with the virus. The epidemic peaked in the U.S. in the 1980s.
The administration has said that racism that leads to unequal medical care is itself "a public health threat" that needs to be acknowledged in the battle against the virus.
The president offered two new measures aimed at ending the epidemic in the United States by 2030 and boosting U.S. efforts to end the spread of HIV, the virus that can progress to AIDS, around the world.
"Today, we once more raise a two-story-tall red ribbon from the North Portico of the White House to remember how far we have come," Biden told an audience of American activists, politicians and medical experts, including AIDS research pioneer Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "And the work we have left to finish, so we never forget the prices paid all along the way."
Internationally, where the bulk of new infections occur, the U.S. seeks to increase donor funding. On Wednesday, Biden said the U.S. would host the Global Fund to Fight AIDS replenishment conference next year. The U.S. is the fund's largest donor, contributing about $17 billion to it last year. That's in addition to a commitment Biden made earlier this year in which he sent $250 million of American Rescue Plan funding to the President's Emergency Plan for AIDS Relief (PEPFAR), a program established in 2003 by President George W. Bush to combat the disease internationally.
Historian Jeremi Suri, of the University of Texas at Austin, says that while these pronouncements may seem abstract: “presidents have enormous influence over global action on HIV/AIDS.”
“Presidents can mobilize attention and raise public consciousness, or they can distract, confuse, and repress,” he said. “Reagan did the latter for AIDS, contributing to widespread discrimination of the gay community and thousands of needless deaths. Clinton and GW Bush did the opposite, raising awareness and encouraging help for those who needed it. Bush went the farthest with a massive international commitment to AIDS prevention and treatment.”
Slow, unequal response
Still, it's not clear whether even that infusion of funds will right the ship. The United Nations' AIDS organization said Wednesday that the global goal to end the epidemic by 2030 has been derailed — and not just by the coronavirus pandemic that upended global health policy and practices.
"Even before the COVID-19 pandemic hit, many of the populations most at risk were not being reached with HIV testing, prevention and care services," said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization. "The pandemic has made things worse, with the disruption of essential health services and the increased vulnerability of people with HIV to COVID-19. Like COVID-19, we have all the tools to end the AIDS epidemic, if we use them well. This World AIDS Day, we renew our call on all countries to use every tool in the toolbox to narrow inequalities, prevent HIV infections, save lives and end the AIDS epidemic."
Tedros has warned that discrimination and inequality are at the root of the epidemic, and that inattention to these problems would lead to 7.7 million AIDS-related deaths in the next 10 years.
Other critics have knocked Biden for not moving fast enough on his promises to fight HIV. In August, the world's premier medical journal, The Lancet, published a critique of Biden's pace in nominating a new leader for PEPFAR. Biden announced his pick for the job, Cameroon-born John Nkengasong, a U.S. citizen who heads the Africa Centers for Disease Control and Prevention, in late September. The Senate received the nomination in mid-October and referred it to the Committee on Foreign Relations, where it remains.
"During his candidacy, U.S. President Joe Biden committed to prioritizing the global AIDS response," the authors — two American and two African activists — wrote in the medical publication. "This promise has been contradicted by a 6-month delay in nominating an ambassador-at-large to lead PEPFAR, which has functioned without a presidentially appointed health diplomat since Ambassador Deborah L. Birx was detailed to the White House Coronavirus Task Force in February 2020."
On Wednesday, as he recognized Nkengasong among the crowd gathered at the White House, Biden was hopeful.
"We can do this," he said. "We can eliminate HIV transmission. We can get the epidemic under control in the United States and in countries around the world. We have a scientific understanding. We have treatments. We have the tools we need. We're going to engage with people with lived experience with HIV and ensure that our efforts are appropriate and effective and centered around the needs of the HIV community."