Could the National HIV Strategy Help Guide the Covid Fight?

We’re now 6 months or 9 months into the Covid-19 pandemic, depending on whether you count from the recognition of the first cases in China in January or the decision to begin locking down the United States in March. More than 200,000 Americans have died—nearly 25 percent of the deaths worldwide—and almost 7 million others have either tested positive or fallen ill and recovered.In that time, parts of the US health establishment have published guidelines for how to prevent the disease and treat it, along with some documents—though not many—about how the White House has been tracking the illness. But one thing is still missing from the US coronavirus response: a comprehensive national strategy for how to combat Covid-19.This is unusual. In the past, the US government has produced thorough plans for handling epidemics, both for outbreaks we were already in the middle of and for ones we could envision arriving, such as pandemic flu. Now a group of HIV researchers, impatient with the delay, has proposed taking one of those plans, the National HIV/AIDS Strategy, as the basis of a comprehensive Covid-19 response, one that would define what it means to beat back this disease, and set out the steps to get there.

It’s an innovative idea, and public health people not involved in this specific proposal agree a plan is desperately needed. But no one, including the proposers, can figure out how to counter a critical flaw: the Trump White House’s refusal to engage with the things that are needed to end the pandemic. It’s hard to figure out how to have a national plan if the leadership of the nation it addresses declines to take a role.

“Given the severity of the epidemic, we thought there's a real need for a truly comprehensive plan as urgently as possible,” says David Holtgrave, dean of the public health school at the University at Albany, State University of New York, who was the first author on the proposal (published in the journal AIDS and Behavior). “We felt that where we are now is similar in circumstance to HIV: Before the national strategy was written, different federal agencies had handled elements of a plan, but nothing had pulled them together. It's bringing it all together in one comprehensive place that we're calling for.”
The earliest US cases of HIV were recorded in 1981, but it took until 2010 for the then-new Obama administration to write a strategy for countering the disease. By that point, the virus had already been identified (in 1984), the first versions of the drug cocktails that kept AIDS from being rapidly fatal had been announced (in 1996), and the Food and Drug Administration had approved the first rapid diagnostic test for the virus (in 2002).But before 2010, no entity had set goals for what HIV testing and treatment of infections were intended to achieve. The innovation in the original national strategy (it was updated in 2015) was to set numeric targets, such as lowering new infections by 25 percent, raising the number of people getting into care within three months of diagnosis to 85 percent, and setting specific objectives for HIV treatment among members of marginalized groups. Then, starting from those goals, the plan’s authors worked backward to specify the steps that federal agencies, state and urban governments, and nongovernmental organizations would have to take to meet them. It also, touchingly, started with a statement of intent: “The United States will become a place where new HIV infections are rare.”