“Ultimately, it became clear that the only way we could one day see a world free from HIV was if the United States led and heavily invested in the global response to HIV.”
“We must also apply the lessons of the fight against HIV to our current battle against the COVID-19 pandemic so we can begin saving lives and get the global economy back on track.”
WASHINGTON – U.S. Senator Ben Cardin (D-Md.), a senior member of the Senate Foreign Relations Committee, issued the following statement for the Congressional record marking World AIDS Day on December 1, 2020.
“Today, we mark the 32nd celebration of World AIDS Day, which gives us an opportunity to reflect on the lives lost to HIV/AIDS, how far we’ve come in the fight against this virus, and what we need to do to ensure an AIDS-free generation.
“Since the first cases of AIDS were reported domestically in June 1981, more than 700,000 Americans have tragically died due to AIDS-related complications. However, through significant scientific advances brought about by public and private partnerships, we have developed antiretroviral therapies (ARTs) that have proved instrumental in decreasing AIDS-related mortality rates by more than 80 percent since the peak in 1995. Investment in U.S. disease surveillance, prevention, and public education has similarly led to new incidence infection that notably declined 8 percent between 2010 and 2015. We are lucky to have premier scientific research institutes within my home state of Maryland working together to combat this deadly virus. The National Institutes of Health, the Walter Reed Army Institute of Research, and the Institute of Human Virology at the University of Maryland all lead U.S. and global research on developing treatments and a vaccine for HIV/AIDS.
“The world-class research institutions housed in Maryland have not only substantially led the scientific advancements around HIV/AIDS, but have also played a significant role in declining new cases among Marylanders. Across Maryland, more than 30,000 adults or adolescents were living with HIV at the end of 2017. Though my state ranks fifth among all U.S. states and territories in HIV diagnosis rates per 100,000 people, we are making great strides to prevent new infections. Last year saw the state record fewer than 1,000 new cases of HIV infection for the first time in three decades, the lowest level since 1986 and a significant decrease over the peak of 2,612 new HIV infections among Marylanders in 1991. Sixty percent of Maryland’s HIV patients were using some form of ART to suppress the virus, a testament to the state’s strong safety net programs like Medicaid. Public health initiatives implemented by the Maryland Department of Health have been similarly instrumental in reducing new infections, including programs like safe-sex education programs, condom distribution, access to prophylactic medication, and a statewide needle-exchange program for injection drug users.
“Today, more than 1 million Americans are living with HIV, and they are able to lead healthier and safer lives due to increased access to care brought about by the Patient Protection and Affordable Care Act (ACA). The ACA has led to increased patient protections like the prohibitions on rate setting tied to health status, the elimination of preexisting condition exclusions, and an end to lifetime and annual dollar limits. However, increasing prescription drug costs for ART regimens and health insurance benefit designs that shift out-of-pocket costs onto patients may negate recent domestic gains to end the HIV epidemic. Furthermore, Medicaid is the largest source of insurance coverage for people living with HIV. Yet, recent actions by Republican states to cut Medicaid spending and impose work requirements could hinder access to treatment or care for the HIV/AIDS population, as an estimated 42 percent of adults with HIV are covered under Medicaid. In the U.S. the fight against this disease also disproportionately affects communities of color, with Black- and Latino-Americans accounting for a disproportionate share of new HIV diagnoses and deaths.
“Internationally, through the incredible work of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. has invested more than $85 billion in the global HIV/AIDS response, saving more than 18 million lives, preventing millions from becoming infected, and achieving HIV/AIDS epidemic control in more than 50 countries. Since 2003, PEPFAR has changed the trajectory of the HIV epidemic around the globe by expanding access to HIV prevention, treatment, and care interventions. It is considered by many to be one of the most successful and cost-effective efforts in the history of American foreign assistance.
“Despite the progress we have made around the globe, there is still significant work to be done. Of the 38 million people living with HIV, 12.6 million are not accessing life-saving treatment. In 2019, there were 1.7 million people newly infected with HIV – more than three times the global target – and 690,000 people perished from this terrible disease. While we have made strides in combating HIV/AIDS in eastern and southern Africa, we have seen staggering increases in new infections in eastern Europe and central Asia, as well as in the Middle East and Latin America. Key populations and marginalized groups continue to be disproportionately affected by the epidemic, and stigma against those with the disease is still rampant around the globe.
“This World AIDS Day is unlike any other as the world contends with the COVID-19 pandemic that continues to rage here at home and around the globe. The global COVID-19 pandemic is impacting the global response to HIV and is threatening the decades of progress we have already made against this disease. In addition to disrupting HIV treatments and prevention services, lockdowns have cut off vulnerable populations from educational and social support services, and growing inequalities resulting from the economic downturn is likely to lead to increases in HIV risk behaviors and vulnerability.
“But this World AIDS Day also provides us with an opportunity to reflect and apply the lessons learned from the HIV epidemic to the fight against COVID-19.
“Ultimately, it became clear that the only way we could one day see a world free from HIV was if the United States led and heavily invested in the global response to HIV. From significant contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria to the creation of PEPFAR, U.S. global health leadership and international collaboration helped to turn the tide on the global epidemic.
“This is as true today as it was 32 years ago. International public health crises require international responses. President Trump’s retreat from historic U.S. global health leadership during the COVID-19 pandemic has not only hamstrung the international response, it has put U.S. lives at risk. President-elect Joe Biden recognizes that we are only as strong as the weakest health system, and he has already committed to rejoining the World Health Organization.
“One of the biggest tragedies of the HIV epidemic is that millions died around the world while waiting for treatment and once treatment became available in 1987, it was out-of-reach. At about $8,000 a year (more than $17,000 in today’s dollars) the first HIV drug was too expensive for populations who needed it most—low-income communities in the U.S. as well as low and middle-income countries. While Congress authorized $30 million in emergency funding to states to pay for low-income patients’ treatment, global access to the drug remained far behind. For example, when PEPFAR was created in 2003, only 50,000 people in Africa were accessing lifesaving HIV treatment.
“We cannot make the same mistake with COVID-19. While we wait for the development of COVID-19 vaccines and treatments, we know that wearing a mask and maintaining a distance of 6 feet while in public and avoiding indoor gatherings and large crowds are some of the strongest prevention tools we have at our disposal. We have seen incredibly positive news over the last few weeks, with three prominent vaccines showing promising effectiveness at preventing development of COVID-19 symptoms in late-stage clinical trials. It is an incredible testament to the biomedical enterprise domestically and internationally that a potentially viable vaccine, let alone multiple candidates, were developed in less than a year. However, we are only as strong as our weakest link, and COVID-19 does not respect borders. To protect our domestic health, we must ensure that our allies and low and middle-income countries around the world have affordable access to eventually approved COVID-19 vaccines, diagnostics, and therapeutics. This is why we must take part in COVAX, an initiative co-led by the World Health Organization with over 88 participating countries, to ensure that the domestic advances developed through public-private partnerships funded by the U.S. government aid the global response.
“While we celebrate the progress we have made in the fight against HIV/AIDS this week, we must recommit ourselves to continuing this fight, as success is within our grasps. Through international partnerships – supported by donor nations, civil society, people living with HIV, faith-based organizations, scientific research community and academia like Johns Hopkins University, the University of Maryland and the Walter Reed Army Institute of Infectious Disease Research, the private sector, foundations, and implementing organizations like Catholic Relief Services and Lutheran World Relief – we have been able to come so far. We must also apply the lessons of the fight against HIV to our current battle against the COVID-19 pandemic so we can begin saving lives and get the global economy back on track.”