The Immigration Debate and HIV/AIDS: Public Health Watch

Even as new treatments for the virus become available, access may be an issue thanks to budget re-shuffling in Washington.

“Build the wall!”

“Reunite the families!”

Regardless of where you stand on the immigration debate, it’s likely you hope that the issue doesn’t seep into other aspects of American life and impact the well-being of our most vulnerable. Unfortunately, it seems it has.

According to a report in the Washington Post, the federal government has spent approximately $500 million to shelter and care for the children in its custody at the border. It has been well documented that Immigration and Customs Enforcement (ICE) officials for several months beginning last spring detained parents and their children separately after they were arrested for attempting to enter the country illegally. Although that policy was discontinued, the Post reports that some 200 children remain in federal custody.

The money to provide basic care and services to these children has to come from somewhere. Among the sources is $266 million previously budgeted to treat individuals with HIV/AIDS and $180 million of discretionary public health funding under the Affordable Care Act, according to Department of Health and Human Services (DHHS) Secretary Alex Azar, as quoted by the Post.

How these decisions will impact those for whom the funds were originally earmarked remains to be seen; however, the news comes at a time when questions are already being raised about the care individuals with HIV/AIDS are receiving in the United States. As Contagion® reported on August 21, although the United States has made significant inroads toward having 90% of individuals living with the HIV achieve viral suppression—the stated aim identified by the Joint United Nations Programme on HIV/AIDS—there is still much work left to be done, as indicated by a study published on September 18 in the journal Annals of Internal Medicine.

Indeed, although the study investigators found that 51% of Americans living with HIV/AIDS have achieved viral suppression through treatment, disparities in outcomes based on age and race remain. Similarly, the authors on a commentary published on September 19 by the New England Journal of Medicine noted that of the approximately 40,000 new cases of HIV diagnosed annually, nearly half were “in black or Latino men who have sex with men.” Sadly, in these populations, and in others, pre-exposure prophylaxis (PrEP) remains “an underused tool for reducing this alarming imbalance,” the authors lament.

Although it remains unclear how, if at all, the funding changes at DHHS will affect distribution of PrEP and other approaches to those who need them, advocacy organization AIDS United has suggested that “more than $9.5 million in federal HIV spending from the AIDS Drug Assistance Program, US Centers for Disease Control and Prevention HIV prevention and surveillance, the Secretary’s Minority AIDS Initiative Fund, and other programs” will be lost.

“DHHS is utilizing the Secretary’s transfer and reprograming authorities to provide additional funds for the care of unaccompanied alien children," DHHS Deputy Secretary Eric Hargan said in an email to Contagion®. "In 2012, 2013, 2014 and 2017 these authorities were also used for the UAC program, and the funding will now likewise be used for increases in caseloads and unexpected surges in children needing care from our program. Unfortunately, the need for additional funds has grown since FY 2011, due to the continual increase of unaccompanied alien children at the border. These transfers are only a temporary solution to the sad consequence of a broken immigration system. Based on the current growth pattern, and increased length of time needed to thoroughly vet appropriate sponsors for the ensured safety of unaccompanied alien children, DHHS is preparing for the possibility of heightened capacity to continue so it can meet its responsibility, by law, to provide shelter for those referred to our care by the US Department of Homeland Security.”

If true, though, these funding changes may mean that not all those living with HIV/AIDS in the United States will have access to state-of-the-art treatments, even as the virus becomes more treatable, thanks to the advent of novel approaches. Investigators at Rockefeller University, for example, recently published their findings in a Phase Ib clinical trial of immunotherapy—essentially a combination of 2 anti-HIV antibodies called broadly neurtralizing antibodies (bNAbs): 3BNC117 and 10-1074—which demonstrated that the new treatments were both safe and more effective than any previously tested antibody therapy. The results were published in Nature and Nature Medicine.

Notably, participants in the trial discontinued antiretroviral therapy and subsequently received 3 infusions of the 2 bNAbs over the course of 6 weeks. The combination approach suppressed HIV for an average of 21 weeks, and participants experienced no major side effects.

“These 2 antibodies are not going to work for everyone,” study co-author Marina Caskey, MD, Associate Professor, Clinical Innovation, Rockefeller University said in a statement released by the school in conjunction with the study’s publication. “But if we start to combine this therapy with other antibodies or with antiretroviral drugs, it could be effective in more people—and that’s something we hope to look at in future studies.”

Of course, treatments such as these only benefit those who need them if they can get access to them. And, sadly, it seems that will require an end to the gridlock in Washington over immigration.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.