In his 2019 State of the Union address, President Donald Trump announced that he plans to usher in a new era of health. He claims that by 2030, there will be no more new HIV transmissions in the United States. The plan would include a 75% reduction in HIV infections by 2024 and a 90% reduction in infections by 2029.

Sounds great, right?

But scientists, researchers, and doctors of all types have been working, studying, and testing ways to eliminate HIV for years. How will this newly proclaimed initiative be any different? While Trump asserts that complete elimination of HIV/AIDS in the United States is possible, is that enough? What will it really take to make this dream a reality?

The plan

The United States Department of Health and Human Services has determined that the majority of new HIV cases in the country stem from a couple of primary hot spots, and this is one of the first major elements to Trump’s plan. In 2016 and 2017, over 50% of all new HIV cases were in the District of Columbia, Puerto Rico, and in 48 specific counties across the country.

His plan will begin by targeting these hot spots: funding programs that track the spread of HIV and compile data about said spread. This, in combination with local programs focused on treatment and HIV prevention, will hopefully help bring down the number of HIV sufferers in these hardest-hit areas.

The director of the US National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, is positive about this new approach to the HIV epidemic. This plan will bring in experts, opinions, and resources from a variety of agencies; Fauci compares this current plan to what the UN has been doing in recent years to combat HIV. The Joint UN Programme on HIV/AIDS also has a goal to end HIV transmissions by 2030: recent reports show that new HIV infections have dropped 46% since 1996, so any similarities to that program are likely positive.

Additionally, this plan focuses on identification, treatment, and education. Program coordinators and key players emphasize the importance of treating people who are currently infected with HIV in order to stem the tide of newly infected people.

The conflicts

But what will it take to actually get this program off the ground? Although many people (politicians as well as scientists) have praised the announcement and projected plan, there are plenty of people who remain skeptical.

Trump has not been particularly generous in the past with allocating financial resources to the HIV/AIDS community or to HIV/AIDS researchers. He moved millions of dollars away from prevention programs in 2018, has made access to affordable health care difficult, and has gotten rid of funds for HIV research. Although the Assistant Secretary for Health at the US Department of Health and Human Services remains hopeful that the budget allocation for this plan will be sufficient, no official financial numbers have been released. 

The hope

Professionals worldwide have seen the positive impact of increased early identification of HIV. The underlying understanding that early detection is better has been around for years, but it wasn’t until scientific data was published at the AIDS conference in Vancouver in 2015 that the numbers were there to back it up.

In the UK, approximately 92% of people living with HIV have been identified, and of that group, 98% are undergoing treatment. Even more incredible is the fact that of those whose HIV has been diagnosed and are getting proper treatment, 97% have reached the point in treatment where HIV is undetectable in their blood.

If the United States is able to successfully follow the UK’s example and focus their energies on identification, treatment, and prevention, it is possible that a similar status will follow. In the United States in 2015, around 1.1 million people had HIV, according to the US Centers for Disease Control and Prevention. About 15% of those people did not know that they were infected, so the country has a ways to go before seeing the numbers of the UK.

World AIDS Day, a campaign to fight against HIV/AIDS and support people who are suffering, also cites early identification as one of the most important things governments federal and local can do to stem the rate of HIV transmission

Bill Gates, however, has a different take. Instead of focusing his energies on identification and prevention only, he has been working to develop a vaccine. He believes that the vaccine, in conjunction with other hard-hitting drugs, could eliminate new infections of the virus.

The International AIDS Vaccine Initiative, backed by the Gates Foundation, started its first clinical trial of the new potential vaccine in October 2018. The trial, which is taking place in Seattle, Washington and in Washington, D.C., will test the newest candidate in the vaccine race: eOD-GT8 60mer. The vaccine is supposed to encourage the immune system to create proteins that could potentially protect infected people against AIDS. The study is ongoing, and the Initiative hopes to have results by late 2019. 

Despite the past and politics, this plan is promising. Given adequate funding and support, it could drastically reduce new HIV transmission rates, especially if it is working in conjunction with the Gates Foundation and other organizations that are working to develop a vaccine.

While we’re not out of the woods yet, the future of HIV prevention is close— and maybe we’ll even see it by 2030.