With the goal of beating HIV by 2025 domestically and a pledge for a renewed effort to fight the disease globally, President Biden has put in place officials charged with making that happen.

The White House kicked off the week with the announcement that John Nkengasong, who has served as a top official on global health at the Centers for Disease Control, would be nominated as ambassador-at-large and coordinator of U.S. government activities to combat HIV/AIDS globally at the State Department.

Meanwhile, leadership within the Presidential Advisory Council on HIV/AIDS, otherwise known as PACHA, was restructured in August as the Biden administration has continued the Ending the HIV Epidemic plan health officials started in the Trump administration.

Carl Schmid, who served as co-chair of PACHA during the Trump years, no longer holds that position, and has been replaced by Marlene McNeese, a woman of color and deputy assistant director of the Houston Health Department. John Wiesman, former secretary of health for Washington State, will continue to serve as co-chair.

McNeese is among eight new members of PACHA. The others are:

• Guillermo Chacón, president of the Latino Commission on AIDS;
• Tori Cooper, director of community engagement for the Transgender Justice Initiative at the Human Rights Campaign;
• Raniyah Copeland, CEO of the Black AIDS Institute;
• Leo Moore, medical director for clinic services at the Los Angeles County Department of Public Health;
• Kayla Quimbley, national youth HIV and AIDS Awareness Day ambassador for Advocates for Youth;
• Adrian Shanker, founder and executive director of Bradbury-Sullivan LGBT Community Center; and
• Darrell Wheeler, senior vice president for academic affairs at Iona College in New Rochelle, N.Y.

The changes underscore the new approach to HIV/AIDS Biden promised during his presidential campaign. Among them is beating HIV/AIDS domestically by 2025, which is five years earlier than the plan under the Ending the HIV Epidemic initiative that began in the Trump administration. Whether or not Biden will meet that ambitious goal remains to be seen.

Winnie Byanyima, executive director of UNAIDS, hailed the nomination of Nkengasong to the global AIDS position upon news of the announcement.

“John Nkengasong’s vast experience in combatting HIV, combined with his position as Africa’s leading disease expert fighting Ebola, COVID-19 and more, position him extremely well to guide the United States’ global contribution towards ending the AIDS pandemic,” Byanyima said. “Today, the HIV and COVID-19 pandemics are colliding in communities throughout the world, and the threat of a resurgent AIDS pandemic is very real. We need the kind of bold thinking and commitment he has brought throughout his career.”

While the global AIDS appointment will have a role in international programs, such as PEPFAR and U.S. participation in the Global Fund to Fight AIDS, Tuberculosis & Malaria, the PACHA appointments will focus on both domestic and global perspectives.

Schmid, executive director of the HIV+Hepatitis Policy Institute, said despite the change in leadership he will maintain his role as head of the subcommittee on the Ending the HIV Epidemic initiative.

“It’s good,” Schmid said.”They appointed a lot of African-American community, Latino community [members] and they said they’ll rotate co-chairs,” Schmid said. “I think it’s good that they put on new blood, and new leadership.”

Schmid has been a vocal skeptic about Biden being able to meet his goal to beat HIV by 2025 — as opposed to the 2030 target set by the previous administration — but said the realignment in PACHA was “not at all” related to that.

“I think I was replaced because the Biden administration wanted the leadership of PACHA to be more representative of the current epidemic in the United States,” Schmid said.

Schmid, however, refused to back down from his prediction that Biden won’t be able to make his 2025 goal a reality.

“I think you will find wide agreement within the HIV community that it is not feasible to end HIV by 2025,” Schmid said. “There is just too much work to do and change to happen.”

The new appointments will add to the cadre of Biden appointees engaged on HIV/AIDS, including Harold Phillips, who was appointed in June to lead the White House Office of National AIDS Policy after that position remained vacant for the entirety of the Trump administration.

‘Too early’ to gauge effort to beat HIV domestically

The focus of the appointees on the domestic front will be the Ending the HIV Epidemic initiative, a plan heavily focused on PrEP as a means of preventing HIV in an effort to reduce new incidents of infections by 90 percent within 10 years. The program was launched in 2019.

Although Congress has appropriated money for the initiative, and just last week, the Department of Health & Human Services distributed $48 million to HRSA centers as part of the effort, experts say not enough data is available to tell to whether or not the program has been effective.

Jennifer Kates, senior vice president and director of global health & HIV policy at Kaiser Family Foundation, said data isn’t yet available on whether new incidents of HIV are reduced because the latest data is from fiscal year 2019.

“From the perspective of the timeline of the goals of the initiative, it’s too early, we wouldn’t know that anyway, but just even given the context and what’s happened since it started, I just don’t know how you’d evaluate it,” Kates said. “What I do believe is important though, is the idea of dedicated new funding. It was the first new funding provided to HIV for years that’s been channeled to local jurisdictions [and] has the potential to catalyze new and better responses, but we don’t know yet that’s happened.”

The coronavirus pandemic, which has been the top priority for health officials around the world, is also obfuscating any potential assessment of the Ending the HIV Epidemic initiative.

Daniel Bruner, senior director of policy at the D.C.-based Whitman-Walker Institute, said the coronavirus has “dramatically impacted medical care,” including HIV/AIDS efforts.

“The pandemic has also necessitated substantial shifts in federal, state, and local resources into COVID prevention, diagnosis and treatment,” Bruner said. “Therefore, it is premature to draw any conclusions about the EHE initiative’s effectiveness. The federal government has emphasized its continuing commitment to the EHE initiative, and Whitman-Walker also remains committed to that work.”