Biden Administration's Efforts to End HIV/AIDS At Home and Abroad

On World AIDS Day, we reflect on all those lost globally and in the U.S. from AIDS-related illnesses, honor the more than 38 million individuals living with HIV, and celebrate the remarkable gains we have made battling this disease. The Biden-Harris Administration remains committed to implementing the updated National HIV/AIDS Strategy (NHAS) announced last year and achieving the bipartisan goal of ending the HIV epidemic at home and abroad. The Administration is also releasing a new strategy to guide the President's Emergency Plan for AIDS Relief (PEPFAR) globally. Over the past year, the Administration has taken action to:

Accelerate our Domestic HIV Efforts

• Launching the NHAS Federal Implementation Plan. In August 2022, the White House Office of National AIDS Policy (ONAP) released the NHAS Federal Implementation Plan, detailing more than 380 actions agencies are implementing to meet NHAS goals.
• Implementing the Ending the HIV Epidemic (EHE) in the U.S. initiative. The U.S. Department of Health and Human Services (HHS) initiated EHE in 2019 to provide a targeted infusion of funds and resources to populations and regions with the greatest need. EHE advances innovative, community-driven solutions that leverage scientific advances in HIV prevention, diagnosis, treatment, and outbreak. It also works to address racial, ethnic, and geographic disparities. As part of EHE implementation, federal agencies have been awarded funding to support equitable access to HIV services for people with and at risk of HIV.
• Requesting unprecedented investments to end the HIV epidemic. In his FY2023 budget proposal, President Biden requested $850 million to aggressively reduce new HIV cases by increasing access to HIV prevention and care programs and ensuring equitable access to support services. The budget also proposed the creation of a 10-year $9.8 billion National PrEP Program to guarantee PrEP at no cost for all uninsured and underinsured individuals, provide essential wrap-around services through states and localities, and establish a network of community providers to reach underserved areas and populations.

Respond to HIV/AIDS Globally

Over the last 20 years, PEPFAR has saved 25 million lives and helped pave a brighter future for people living with HIV/AIDS. The Administration has taken action over the past year to build on that impact, including:

• Releasing a new five-year strategy. Ahead of its 20^th anniversary in 2023, PEPFAR is releasing a new five-year strategy to reinvigorate the U.S. global HIV/AIDS response. The strategy, Fulfilling America's Promise to End the HIV/AIDS Pandemic by 2030, will focus on enhancing collaboration and partnership to confront the challenge of fighting HIV/AIDS as a security threat in the wake of other emerging health threats.
• Leading the largest ever Global Fund Replenishment. President Biden led an historic seventh replenishment for the Global Fund to Fight AIDS, Tuberculosis and Malaria, raising $15.7 billion in donor pledges to date. Those resources will be used to get the world back on track toward ending HIV, tuberculosis, and malaria by 2030 and building more resilient health systems around the world.
• Leveraging PEPFAR to support public health and fight COVID-19 and mpox. PEPFAR platforms are helping countries and communities protect and advance global HIV/AIDS gains while building more resilient health systems and supporting the global COVID-19 and mpox responses. These investments have: supported more than 70,000 facilities and community health clinics, including 3,000 laboratories; trained nearly 340,000 healthcare workers; enhanced disease surveillance, supply chain, health and laboratory information systems; built community capabilities; and applied routine and rapid analysis of data for decision making.

Address HIV Stigma and Discrimination

• Affirming the U=U message. At the 2022 International AIDS Conference, the Administration joined global partners in affirming the evidence-based message that "undetectable=untransmittable" (U=U), meaning that people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load will not transmit HIV to their HIV-negative partners through sex. In addition, HHS launched "I am A Work of ART," a community-informed campaign to encourage people with HIV to seek care, stay in care, and achieve viral suppression through anti-retroviral therapy (ART).
• Hosting a White House forum on HIV criminalization. In 2022, ONAP brought prosecutors, public health officials, and legal and infectious disease experts to the White House to discuss the need to modernize HIV-specific criminal laws and their prosecution, ensuring they are supported by the latest scientific evidence.
• Safeguarding the rights of people with HIV. The Biden-Harris Administration has strengthened protections against discrimination based on HIV status. For example, the U.S. Department of Justice (DOJ) continues to vigorously enforce the Americans with Disabilities Act (ADA) to combat HIV discrimination, and the Department of Defense (DoD) has updated its policies on HIV-positive personnel serving within the military in light of significant advances in HIV diagnosis, prevention, and treatment. In addition, the Food and Drug Administration (FDA) has supported the Assessing Donor Variability And New Concepts in Eligibility (ADVANCE) study to evaluate alternatives to the FDA's blood donor deferral policy for men who have sex with men (MSM), ensuring any potential future policy is based in science, not stigma.

Ensure Equity

• Diversifying PACHA membership. President Biden added new members to the Presidential Advisory Council on HIV/AIDS (PACHA), representing the full diversity of the HIV epidemic, to share their knowledge and help further inform our HIV response.
• Engaging with the HIV community. PACHA held numerous "PACHA-to-the-People" community engagement sessions to hear from local communities. Federal leaders also visited EHE jurisdictions and participated in virtual town halls and discussions with people with lived experience of HIV, community-based organizations, state and local health departments, HIV advocates, and others.
• Advancing equity for marginalized and underserved Americans. On his first day in office, President Biden signed an executive order on advancing racial equity and support for underserved communities, and in February 2021, he signed a memorandum on advancing the human rights of LGBTQI+ individuals around the world. To mark Pride Month 2022, the President signed the most significant executive order on LGBTQI+ civil rights in history. Among other actions, this order strengthened federal coordination to improve health equity by protecting LGBTQI+ individuals' access to health services, addressing the risks of so-called conversion therapy, and driving better data collection on individuals' sexual orientation and gender identity (SOGI) to increase visibility of LGBTQI+ populations and better serve their needs.
• Promoting access to gender-affirming care. In June 2022, the Health Resources and Services Administration (HRSA) released a letter encouraging Ryan White HIV/AIDS Program (RWHAP) service providers to leverage their infrastructure to provide access to gender-affirming care and treatment services for transgender and gender-diverse people with HIV.
• Addressing violence against transgender women of color. The Administration launched the first-ever White House Interagency Working Group on Violence Against Transgender Americans, which released a federal report and blueprint of actions agencies are taking to address the root causes of violence against transgender women of color.

Support and Treat People At-risk for "Syndemic" Illnesses

• Supporting people affected by HIV during COVID-19 and mpox public health emergencies.Recognizing that infectious diseases don't exist in isolation, the Biden-Harris Administration has taken significant action to support and treat individuals affected by HIV and other interacting epidemics, or "syndemic" infections, such as COVID-19 and mpox. The Administration is: providing funding to prevent, prepare for, and respond to COVID-19, including resources specifically for organizations that serve people with HIV; updating CDC guidance regarding the use of HIV self-tests and PrEP; publishing new clinical guidelines on COVID-19 and people with HIV; and providing consumer information on COVID-19 and mpox for people with HIV. Led by the White House Mpox Response Team, the Administration has worked to make mpox tests, vaccines, and treatments equitably available to communities at-risk, including people with HIV. This work has included creating resource flexibilities so organizations that serve people affected by the HIV and mpox syndemic can test, treat, and vaccinate against mpox while they address HIV and sexually transmitted infections and support housing and mental health.

Advance New Research

• Releasing a multiyear HIV research plan. The National Institutes of Health's (NIH) Office on AIDS Research issued its five-year NIH Strategic Plan, which serves as the guiding framework to allocate funds that advance the NIH-wide HIV research agenda and ensures investment of resources in the highest priority areas of scientific opportunity.
• Using new technologies to develop an HIV vaccine. NIH's National Institute of Allergy and Infectious Diseases (NIAID) launched a Phase 1 clinical trial evaluating three experimental HIV vaccines based on a messenger RNA (mRNA) platform-a technology used in several approved COVID-19 vaccines.