The historic 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 health care, and protecting the environment. As I witnessed legions of women, men, and children take to the streets to make an indelible mark on history, 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 and 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 and 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 virus 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 1980s gave rise to a civil rights movement where defiant and 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 and AIDS.
Today, guided by the National HIV/AIDS Strategy established in 2010 and aided by the Affordable Care Act — which significantly expanded access to treatment and care for millions — we are armed, 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 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), the daily dosage of a pill that has been shown to reduce the risk of acquiring HIV by nearly 100 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 and AIDS.
But as we continue efforts to reverse the epidemic’s course, a new administration and Congress debating U.S. health care 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. In observance of National Women and Girls HIV/AIDS Awareness Day on March 10, let’s underscore women’s — and men’s — right to health care and let’s defend this vision so that all people living with HIV or 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 toward an AIDS-free America in the years ahead.
REAR ADMIRAL SUSAN J. BLUMENTHAL, MD, MPA (ret.), is senior policy and medical advisor for amfAR, the Foundation for AIDS Research. Dr. Blumenthal has been a leading U.S. government health expert and spokesperson for more than 20 years. She served as assistant surgeon general of the U.S.; the first-ever deputy assistant secretary for women’s health; senior global health advisor in the U.S. Department of Health and Human Services; chief of the Behavioral Medicine and Basic Prevention Research branch at the National Institute of Mental Health, NIH; and as a White House adviser on health issues.