HIV continues to impact millions of people, and efforts to end the HIV epidemic have been greatly affected by the Covid pandemic. In response, the White House Office of National AIDS Policy (ONAP) released the National HIV/AIDS Strategy (NHAS) Federal Implementation Plan last year to refocus efforts to end the HIV epidemic in the United States by 2030. With 2023 underway, I want to look back on the progress made toward this goal.
I’ve spent the last decade working at Gilead Sciences, a leader in anti-viral medicines development, with a strong focus on HIV treatment and prevention. I have been privileged to live through amazing developments in the science around HIV both treatment and prevention, but I’ve also seen that there is much that needs to be done beyond the science. I’ve had the opportunity to connect with people across the world and in the US, either living with HIV or impacted by it through their communities and loved ones, in an effort to understand how Gilead can continue to support initiatives and research to help end the epidemic. I’ve seen how, in the US, HIV disproportionately impacts those communities who experience other health inequities even despite programs to provide free care to those living with HIV. This underscores the intersectionality of all health inequity: we cannot think simply in terms of access to medicines or access to providers, but more broadly in terms of all the barriers that are placed in the way of engagement in care — ‘the bars before the bars’.
I’ve been amazed by the work of community organizations to address these barriers in thoughtful and culturally sensitive ways. From transportation services to childcare; from back doors to clinics, to wrap around services addressing housing and food insecurity; ensuring inclusive language and understanding of justifiable medical mistrust. We must keep these communities at the center of our health equity efforts, listening humbly to understand experiences; not solving issues on our own, but instead elevating the voices articulating these challenges and bringing forward solutions. I’m inspired by Gilead’s efforts to support organizations in communities hit hardest by HIV, increasing and accelerating their work to reduce disparities.
For many working in the field, the memories of HIV as a disease that tragically cut short so many young lives feels only too recent. However, there is also reason for great hope. Huge progress has been made both in treatment, prevention and in ‘treatment as prevention’. The NHAS Federal Implementation Plan outlines four focus areas:
Preventing new HIV infections
Advancing the science behind pre-exposure prophylaxis (PrEP) is fundamental in ending the epidemic. There are now three approved medicines in the US for HIV prevention, two of which were developed by Gilead. However, uptake of PrEP is very varied across groups, with those impacted by multiple health inequalities, particularly communities of color, less likely to be engaged in PrEP services. Increasing awareness of and access to HIV prevention among these communities requires both innovation and partnership.
At Gilead, we’re currently exploring the development of long-acting therapies with less frequent dosing with the potential to help meet the diverse range of unmet needs. But we can’t stop there. We must continue to forge collaborations to expand global access to prevention resources and actively work with expert stakeholders. Through educational programs, partnerships, and community outreach, we can better understand barriers and apply innovative approaches to improve outcomes.
Another critical factor in HIV prevention is an uptake of HIV treatment. People living with HIV (PLWH) who adhere to their treatment regimen and maintain an undetectable viral load will not transmit HIV via sex to their partners. Educating people that “Undetectable means Untransmittable” (U=U) is a crucial piece to reducing stigma and preventing new infections. By affirming U=U and expanding access to diverse treatment options for PLWH in consultation with their healthcare team, we can help end the HIV epidemic.
Aiming to Improve HIV-related health outcomes of people with HIV
PLWH are living longer by staying on treatment, presenting new, different challenges, and enforcing the need for optimal holistic care. While those who maintain treatment regimens recommended by their doctor can achieve viral suppression, there are still other health-related considerations to address. By 2030, up to 70% of PLWH will be over 50, with the majority living with age-related comorbidity. Additionally, health-related quality of life, stigma, and discrimination continue to impact PLWH.
However, scientific innovation is progressive, not definitive. We must optimize existing tools and continue innovating to bring new solutions to improve the care and experiences of PLWH. Putting people at the center as we develop new, more effective therapies is key as we strive to address unmet needs and support life-long health, while ultimately fighting to eliminate HIV.
Reducing HIV-related disparities and health inequities
The HIV epidemic is fueled by racial, gender, class, and sexual discrimination at the community and systemic levels. To help end the epidemic by 2030, we must address these.
The Covid-19 pandemic diverted many HIV-focused efforts, particularly among communities already disproportionately impacted by HIV, like those in the Southern U.S. (1, 2). To refocus on ending the epidemic by 2030, Gilead joined the HIV community in advocating for increased federal funding for HIV resources that reach underserved communities. We are pleased to see Congress provided an increased budget for the Minority HIV/AIDS Fund in the Fiscal Year 2023 omnibus appropriations bill, further prioritizing support of these communities.
Achieving integrated, coordinated efforts that address the HIV epidemic among all partners and stakeholders
We cannot end the epidemic alone. Gilead works with public health officials, advocates, and communities impacted by HIV to help ensure we tackle barriers to care. Gilead is the No. 1 overall philanthropic funder of HIV causes, based on a report published by Funders Concerned About AIDS. Also of note, Gilead designed our latest PrEP studies alongside the communities we serve, from conception to execution.
However, there is much work to do. At Gilead, we are committed to championing innovations, programs, and partnerships that support the wellness of all people impacted by HIV, including pursuing research that could, one day, lead to a cure, until the virus is eliminated.
We must forge partnerships and collaborations across industries, government, and community to strengthen efforts toward our shared goal of ending the epidemic for everyone.
About the Author:
Hilary Hutton-Squire, MChem, MSc
Hilary Hutton-Squire, Vice President HIV Treatment and Prevention, leads Gilead Science’s HIV business in the United States and Puerto Rico. She joined Gilead in 2013, after working at Novartis, IMS Health, and GlaxoSmithKline. At Gilead, she has held a number of international leadership positions across many therapy areas, including HIV, HCV, oncology, inflammation, and Covid-19. She was General Manager of Gilead’s U.K. and Ireland organization through the launch of a Gilead HIV treatment and Gilead’s CAR-T therapy, negotiating broad and rapid access to these medicines. She led Gilead through the U.K.’s exit from the European Union, and the early stages of the Covid-19 pandemic, working with the U.K. and Irish governments, to set up clinical trials and bring rapid access to Gilead’s Covid-19 medication. She previously led Gilead’s pricing and market access organization across Europe, the Middle East, and Australia, and led the Liver Business Units in the U.K. and the U.S.
She holds a Master’s in Chemistry from Oxford University and a Master’s in Information Management from Brunel University, London.
She has more than 20 years of leadership experience in the pharmaceutical industry. She was inspired to join Gilead by a commitment to reduce health inequalities by bringing treatment to patients who need them the most. She is a champion of diversity and inclusion, with global recognition for her support of women in the health and life sciences and for championing employee resource groups for Black and LGBTQ+ employees.