President Trump announced a new plan to end the HIV epidemic in America by 2030 in his State of the Union address Tuesday. Ohio is one major target of the initiative.
Further details released Wednesday from the Department of Health and Human Services (HHS) show Franklin, Hamilton and Cuyahoga counties are among 48 hotspot counties slated to receive extra resources under the new plan. Those counties cover the cities of Columbus, Cincinnati and Cleveland.
According to the HHS factsheet, the 48 counties identified in the plan are areas with higher levels of HIV transmission. More than 50 percent of new HIV diagnoses occur in those counties, as well as Washington, D.C., and San Juan, Puerto Rico.
The roll-out of the plan locally will include an increased effort for more diagnoses and testing, treatment, and greater access to PrEP (pre-exposure prophylaxis), a drug that helps prevent HIV infections. The plan will also establish an "HIV HealthForce" in each county, described by HHS as "local teams committed to the success of the Initiative in each jurisdiction."
Dr. Carlos Malvestutto, who works in the Infectious Diseases Division of the Ohio State Wener Medical Center, applauds the effort - with some qualifications.
“What concerns me is that to be able to achieve this goal, we have to make sure that we use the tools and that they are targeted to all the vulnerable populations affected by HIV," Malvestutto says.
Cleveland Clinic's Dr. Kristin Englund echoed those concerns.
"Hopefully there will not only be funding coming into these 48 counties of which we are one, but also boots on the ground to implement these programs," Englund says.
Challenges remain in reaching the 2030 goal in Cuyahoga County, said Englund, and many have not been addressed in the initial proposal. Englund cites the high cost of medications for under-insured patients, lack of access to transportation for patients to get treatment, the opioid crisis, and mental health issues, as potential barriers to reducing transmission rates.
"If those barriers can be addressed, then certainly there is hope we could be able to eliminate HIV infections, but there is still a lot of work that needs to be done," Englund said.
One of the biggest issues that needs to be addressed, according to Englund, is how to reach high-risk populations in Cuyahoga County, such as gay men, men of color, and young people.
Dr. Jonathan Karn, Director for the Center for AIDS Research at Case Western Reserve University School of Medicine, says Trump's 2030 goal is "ambitious" but "doable."
"There's nothing from a medical perspective to say that you can't do this," Karn said. "If it can't be achieved, it's because of failures we have in delivering health to people who are disadvantaged."
The plan aims to reduce 75 percent of new HIV infections within 5 years, and 90 percent within 10 years.