Ending the HIV epidemic in Indian Country
Robert R. Redfield
Robert R. Redfield and Michael D. Weahkee
Communities and tribal nations across the U.S. are poised to end the HIV epidemic in America – and we encourage everyone to embrace this once-in-a-generation opportunity. An extraordinary confluence of scientific breakthroughs, focused leadership, community advocacy and the power of predictive data has the potential to take us from aspiration to reality.
Earlier this year, President Trump announced an ambitious and historic plan to end the HIV epidemic and prevent new cases of HIV in America. The Ending the HIV Epidemic: A Plan for America initiative, which has drawn bipartisan support, calls for infusing some of the communities hardest hit by HIV with the additional public health expertise, technology and resources needed to confront the HIV epidemic in their communities. As proposed in the FY 2020 President’s Budget, under the direction of the U.S. Department of Health and Human Services, the proposed initiative would achieve maximum impact by focusing efforts on these geographic hotspots. Several of these locations include tribal communities impacted by the epidemic.
An estimated 3,600 American Indians and Alaska Natives have HIV – and almost 20 percent have not received a diagnosis. More than half of those with HIV have not yet achieved viral suppression – meaning they are not yet benefiting from life-saving treatment that also prevents HIV transmission to others.
The HIV epidemic has cost our nation too much for too long, including 700,000 American lives lost since 1981. Assuming that current infection rates stay steady, we are at risk of another 400,000 Americans acquiring HIV over the next decade. We have the public health tools needed to end this epidemic and we must apply them.
As we meet with public health leaders and stakeholders in Phoenix this week, including tribal leaders, we are optimistic that, working together, we will be successful. Efforts will focus on four key strategies to meet these communities’ needs, as well as the needs of other states and communities where the most HIV diagnoses occur:
- Diagnose all people with HIV as early as possible .
- Treat people with HIV rapidly and effectively to reach sustained viral suppression.
- Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis, known as PrEP, and syringe services programs .
- Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.
To accomplish this, the Centers for Disease Control and Prevention would accelerate work with tribal, state and local health departments, and most importantly, the community. Funding for the initiative would be used to establish specialized local teams to support expansion of HIV prevention and treatment efforts in the community. This effort would include listening to tribal citizens living with HIV and learning from their experiences so that we can better reach those in greatest need and ensure local progress. And the Centers for Disease Control and Prevention will continue work to combat the stigma that is still associated with HIV — because stigma is the enemy of public health.
The Indian Health Service is a crucial part of this federal initiative. Efforts in Indian Country would build upon the success of pioneering programs such as the Cherokee Nation’s efforts to eliminate hepatitis C, and the Phoenix Indian Medical Center’s (PIMC) HIV Center of Excellence, which has been recognized two years in a row by the Ryan White HIV/AIDS Program Quality Award. As we move forward in this important work, the Indian Health Service will continue to collaborate with tribes, tribal organizations and urban Indian organizations and seek input on implementation and decisions that have an impact on the communities we serve.
In Arizona, American Indian and Alaska Native people with HIV have the highest viral suppression rates of all racial groups statewide – and can serve as a model of success as we work to end the HIV epidemic. Part of that success is due to Phoenix Indian Medical Center’s efforts to control the spread of HIV among local tribal communities. The HIV clinic serves more than 300 patients, providing a continuum of care that supports people with HIV from the moment of their initial diagnosis through medical treatment needed to stay healthy and keep the virus under control. As a result, Phoenix Indian Medical Center patients have achieved a 93 percent viral suppression rate with antiretroviral therapy. People with HIV who take medication as prescribed and stay virally suppressed can live long, healthy lives and have effectively no risk of sexually transmitting HIV to a partner. Every year, 80 percent of new HIV cases are due to viral transmission from people living with HIV who are not receiving HIV care and treatment.
Ending the HIV epidemic in America will require this type of commitment and focus nationwide. The Centers for Disease Control and Prevention’s latest data confirm that national progress reducing the number of new HIV infections has stalled in recent years. There are prevention and treatment gaps, particularly in rural areas and among disproportionately affected populations like American Indians and Alaska Natives. In addition, the ongoing opioid crisis continues to threaten progress; nearly one in 10 new HIV infections occur among people who inject drugs. Ongoing efforts to prevent and treat substance use disorder and curb the opioid epidemic will help us to address and tackle this aspect of HIV transmission.
We can put an end to the HIV epidemic, both in Indian Country and across the U.S. We have the tools, and communities have the leadership to do this. But we also need public engagement, and we must work together to support people living with HIV in their journey. This means clearing the path of stigma, delivering health care services in a way that meets cultural and community needs, and learning from individuals already in treatment so the path becomes easier for others who follow.
American Indian and Alaska Native communities have a long history of resilience. We now call to action that same level of cultural unity and community strength to help end the HIV epidemic throughout Indian Country.
Robert R. Redfield is the director for the Centers for Disease Control and Prevention and administrator for the Agency for Toxic Substances and Disease Registry.
Michael D. Weahkee, an enrolled member of the Zuni Tribe, is the principal deputy director for the Indian Health Service and an assistant surgeon general of the United States in the U.S. Public Health Service Commissioned Corps.