Lancet series highlights a vicious circle of inequities hobbling efforts to end disease spread

Steeped in inequities that include formidable barriers to basic health services for multitudes of its most vulnerable, marginalized and neglected people, the country leading global HIV responses, continues to fall far short of attainable goals to control its epidemic at home, a Lancet series of articles by leading HIV researchers released today shows.

While the Affordable Care Act addressed significant obstacles to health care for millions of Americans, erosion of its provisions over the last four years have reversed those gains and set back the improved access to testing, prevention, and treatment critical to ending HIV transmissions in the United States, authors note.

The challenges facing women, men who have sex with men, people, caught in the nation's opioid crisis, who inject drugs, and the once again rising numbers of people without health insurance, call for a comprehensive domestic version of the U.S. flagship global President's Emergency Plan for AIDS Relief -- such a plan as the federal Ending the HIV Epidemic initiative was meant to be, the authors note. But the authors also note that initiative, already challenged by bias, discrimination and funding restrictions hindering harm reduction measures that include sterile syringe provision, as well as reproductive health care, has been further challenged by the impacts of COVID-19 across the nation. And the papers show, the structural obstacles to health and failures in equitable health care access that have made the United States the wealthiest country with the largest HIV epidemic have now also fueled the spread of the novel coronavirus in numbers and impacts exceeding those of other high-income countries.

The answers lie in focused responses, the authors show, but also in lasting and committed structural systemic change.