By Susan J. Blumenthal, M.D., M.P.A.
This piece was adapted from an article first published on The Advocate for National Women and Girls HIV/AIDS Awareness Day on March 10, 2017.
The landmark Women’s March in January brought millions of people in America and around the world together in support of women’s rights, equality, expanding access to healthcare, and protecting the environment. As I witnessed legions of women, men, and children take to the street to make an indelible mark during Women’s History Month, I was reminded of the remarkable progress we have made over the past two decades in advancing women’s health because we raised our voices and fought for changes in the way research was conducted, services were delivered, and public policies were constructed. There are important lessons for HIV/AIDS.
In the early days of the AIDS epidemic, the scientific and medical communities failed to recognize women as a target population for research. As a consequence, women were excluded from clinical trials of HIV/AIDS medications and preventive interventions. The omission proved to be a major public health oversight, and led to a rapid rise in the number of HIV cases among women, who contracted the disease primarily through heterosexual sex. As a result, today women represent 50 percent of the 37 million people living with HIV worldwide, and one in four of the 1.2 million living with HIV in the U.S.
The AIDS crisis in the 80s gave rise to a civil rights movement where defiant, powerful voices were heard in marches around the country, calling for a national response to fight this devastating disease. Ultimately, increased investments were made in scientific research, leading to the discovery of lifesaving medications as well as the implementation of programs and other interventions to treat and prevent HIV/AIDS.
Today, guided by the National HIV/AIDS Strategy established in 2010 and aided by the Affordable Care Act (ACA) – which significantly expanded access to treatment and care for millions – we are armed, now more than ever, with an effective arsenal of tools and resources to prevent HIV and reduce its transmission to others. As a result, new HIV infection rates are significantly declining.
Last month, the Centers for Disease Control and Prevention (CDC) reported that overall annual HIV infection rates in the U.S. fell 18 percent from 2008 to 2014, from an estimated 45,700 to 37,600. Among women, HIV rates declined 40 percent between 2005 and 2014, with the largest drop – 42 percent – seen in black women.
While black women continue to be disproportionately affected by the disease (accounting for 61 percent of HIV diagnoses among women in 2015), another CDC analysis suggests that racial disparities among women in the U.S. may be shrinking. The report found that the difference in HIV diagnosis rates between black women and white women (the group with the lowest rates) decreased by almost 25 percent from 2010 to 2014.
This progress is no small feat, considering the fact that women had not been the focus of HIV treatment and prevention efforts at the emergence of the epidemic.
High-impact HIV prevention strategies targeting women and other key populations have been implemented since to help reduce HIV prevalence in America. These interventions include routine, free HIV screening and testing under the ACA; access to lifesaving antiretroviral treatment and medical care under the Ryan White HIV/AIDS program and through health insurance; syringe exchange programs for injecting drug users; and for women at increased risk of HIV, increased access to pre-exposure prophylaxis (PrEP), a daily pill, which has been shown to reduce the risk of acquiring HIV by 90 percent if taken as prescribed. Additionally, mother-to-child transmission of HIV has been virtually eliminated in the United States. Our national strategy is working, and we are truly at a tipping point in the fight against HIV/AIDS.
But as we continue efforts to reverse the epidemic’s course, a new Administration and Congress debating U.S. healthcare policy endangers the progress made thus far.
Most women with HIV rely on federal and state health programs, like Medicaid and Ryan White, for their care and coverage. Evidence shows that Medicaid expansion under the ACA played a significant role in increasing insurance coverage for people with HIV. In states that expanded Medicaid under the health reform legislation, the proportion of people receiving HIV drugs rose from 39 percent in 2012 to 51 percent in 2014, and the proportion of uninsured women with HIV dropped to 6 percent from 11 percent during this same time frame.
Nationwide, the number of people with HIV in care relying on the Ryan White program rose from 42 percent in 2012 to 48 percent in 2014. What’s more, a new study found that the number of Ryan White program participants who achieved viral suppression rose 12 percent from 2010 to 2014. When people with HIV are virally suppressed as the result of effective, consistent therapy, transmission of HIV to others can be reduced by as much as 96 percent.
Given this significant progress, it’s of great concern that the current debate about repealing the ACA and limiting access to health care could result in a potential resurgence of HIV infection in our country. It would have a devastating impact on the health of women, jeopardize the lives of people with HIV, and reverse the strides that have been made to effectively prevent and treat the disease.
When the National HIV/AIDS Strategy was released, it articulated a clear vision: “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”
Women play a critical role in fighting the HIV epidemic in our country, and our collective voices are vital in the battle to end AIDS in the United States. Let’s remember the history lessons for HIV/AIDS in our country including the vital importance of fighting for women’s – and men’s – right to health care. Let’s make sure that research data is analyzed for sex, racial and age differences so that critical population groups are not left behind. Let’s work together to ensure that all people living with HIV/AIDS have access to quality care and lifesaving medications, stigma and discrimination are eliminated, and research investments are increased to discover a cure and a vaccine. Let’s take these steps now so that we can accelerate the march forward towards an HIV/AIDS free America in the years ahead.
Rear Admiral Susan J. Blumenthal, M.D., M.P.A. (ret.), is the Public Health Editor of the Huffington Post. She is also Senior Policy and Medical Advisor for amfAR, The Foundation for AIDS Research and a Clinical Professor at Tufts and Georgetown Schools of Medicine. Admiral Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women’s Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House Advisor on health. She convened the first NIH conference on Women and AIDS and established and chaired an HHS Women and AIDS Task Force with membership of more than 60 organizations. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health (NIH). She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Rosalind Franklin Centennial Life in Discovery Award. Her work has included a focus on HIV/AIDS since the beginning of the epidemic in the United States in the early 1980’s.