S.F. AIDS Treatment Pioneer Cautious — But Hopeful — on Trump's Plan to End HIV Transmission

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Bottles of the antiretroviral drug Truvada. (Justin Sullivan/Getty Images)

President Trump is launching a campaign to end the HIV epidemic in the U.S. by 2030, targeting areas where new infections happen and getting highly effective drugs to people most at risk.

A San Francisco doctor who pioneered the treatment of HIV/AIDS is cautiously optimistic about the plan.

"The idea of targeting does make a lot of sense. Go to those places where there's a lot of transmission. Try to do a better job of getting those people into care," said Dr. Paul Volberding.

Volberding opened the first HIV/AIDS clinic at San Francisco General Hospital in 1983. Back then he never imagined AIDS would be treatable. But now he says antiretroviral medications have made HIV — the virus that can lead to AIDS — into a survivable disease, and new daily medications can prevent its spread.

Paul Volberding (Courtesy of UCSF)

The fact that doctors have the tools to stop the spread of the disease is precisely what makes Volberding and others hopeful about the president's plan.

"I think having this kind of a goal makes a lot of sense, because we do have the tools now. Treatment works. Treatment works as prevention as well," Volberding said.

Health and Human Services Secretary Alex Azar and senior public health officials said the effort will target the 48 counties with the highest rates of transmission, as well as Puerto Rico, Washington, D.C., and seven states with at-risk rural residents.

"We've never had that kind of 'this is the target,' " said Dr. Anthony Fauci, the government's pre-eminent AIDS warrior and head of the National Institute of Allergy and Infectious Diseases. The government has "been trying to address HIV, but never in such a focused way."


Trump mentioned the initiative in his State of the Union speech on Tuesday.

"Together, we will defeat AIDS in America and beyond," Trump said in the speech, but he didn't say how much would be dedicated in funding in his upcoming budget.

"It's going to be expensive, but I think it's certainly worthwhile," said Volberding, noting there's been in increase in HIV infections in cities in the southeast.

However, health officials warn money can't be pulled from other existing programs without public health consequences. And anti-AIDS activists say they're ready to work with the White House, but are wary because of Trump's previous efforts to slash Medicaid health care for low-income people, and his administration's ongoing drive to roll back newly won acceptance for LGBTQ people.

"To date, this administration's actions speak louder than words and have moved us in the wrong direction," said AIDS United, which funds and advocates policies to combat AIDS.

While HHS Secretary Azar said significant new funding would be included in the president's budget, he also emphasized that the campaign is about making more efficient use of existing resources like the Ryan White HIV/AIDS Program, which provides medical care and support services.

"The tools are there," Azar said. "This is about execution."

That's where Volberding and other doctors agree. Today's HIV treatments work so well they not only can give people with the AIDS virus a near-normal life expectancy, they offer a double whammy — making those patients less likely to infect other people.

At the same time, a longtime HIV medication named Truvada can prevent infection if taken daily by healthy people who are at risk from their infected sexual partners, a strategy known as "pre-exposure prophylaxis" or PreP.

Azar said the administration's campaign would rely on public health workers to identify people at risk for HIV/AIDS, get them tested, and get them on medication. The 48 counties they're focusing on are mainly metro areas. The states are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.

The initial goal is to reduce new HIV infections by 75 percent in five years. There are about 40,000 new cases of HIV infections a year in the U.S. That's a dramatic reduction from the crisis years of the AIDS epidemic, but progress has stalled. More than 1 million Americans live with the disease.

Volberding has seen how the epidemic swept through the Bay Area in the 1980s and 90s, and how San Francisco responded with a coalition of public and private resources working to get infection rates down. "I think San Francisco really can be held up as a model," he said, for the rest of the country to now follow.

KQED's Raquel Maria Dillon and the Associated Press contributed to this report.