If We Really Want to End HIV by 2030, the Trump Administration Needs to Change Its Ways

Photo: Getty Images / FrankvandenBergh
While tonight's 2019 State of the Union speech included lots of border-wall chat—with, of course, a few nods to the 35-day government shutdown that's now inextricably linked with that project—President Donald Trump touched on a topic that most of us probably weren't expecting. He made a commitment (and asked Congress to do the same) to eliminate HIV and AIDS in the United States within 10 years.

"Together we will defeat AIDS in America and beyond," he said in his address.

It's not yet clear exactly what the Trump administration's anti-HIV strategy will be, but according to Politico, it's likely to focus on the states where new HIV infection rates are highest. In general, rates of diagnosis are highest in the southern U.S. (about 17 diagnoses per 100,000 people), where they're happening at nearly double the rate of the midwest (about 8 diagnoses per 100,000 people).

You may be thinking, like I initially did, that this goal is totally outside the realm of possibility. There are 1.1 million people living with HIV in the U.S., and the latest numbers showed that 38,500 of them became infected in 2015 alone. But there is some cause for optimism here. HIV patients now have access to advanced antiretroviral meds that can prevent them from spreading the virus to others. Since 2012, a new drug called PrEP, sold under the name Truvada, has been used to prevent people from contracting HIV. These advances have helped reduce HIV infection rates in the U.S.—from 2010-2015, the number of new infections dropped by 8 percent, according to the CDC. Sadly, not everyone has access to these lifesaving treatments, as they're often out of reach for the poor and uninsured.

Health experts agree that this ambitious timeline is certainly possible. Several who spoke to Vox about what would need to be done recommended the following solutions: expand access to PrEP, support state expansion of Medicaid, increase public health funding, and target at-risk communities with treatment and prevention strategies while also building trust with those communities.

Promising as this may all sound, it's leaving many people puzzled. Up to this point, the Trump administration hasn't exactly been a major ally in the fight against HIV and AIDS. For one thing, President Trump fired all 16 members of the country's HIV/AIDS Advisory Council, in December 2017 (after six members had resigned in June of that year), and new members weren't appointed until the following December. Further, the Office of National AIDS policy has been without a director for two years. (The former one stepped down when Trump entered office.)

The Trump administration has worked to undermine many programs that are vital to HIV-prevention efforts. The president has previously expressed a desire to cut funding not just for Medicaid and Planned Parenthood—two entities that play a significant role in HIV treatment and prevention—but also the President's Emergency Plan for AIDS Relief (PEPFAR), which came about during the George W. Bush presidency. (However, in a turnaround, Trump did sign a five-year PEPFAR extension in December 2018.) The administration, along with the Republican-controlled Congress, has attempted to repeal the Affordable Care Act, which would potentially leave HIV patients vulnerable to skyrocketing costs (or losing coverage altogether). The Centers for Medicare and Medicaid Services (part of the Trump administration's purview) last month proposed to take away protections for certain classes of medications, including antiretroviral medications, which could make them more expensive or inaccessible for certain members of the population. Oh, and let's not forget that last year, the government took money from the Ryan White HIV/AIDS program and used it to fund child detainment at the border.

The current administration also hasn't traditionally been supportive of the populations most vulnerable to HIV. The bulk of new diagnoses occur among gay and bisexual men—a demographic group that accounted for 67 percent of all HIV diagnoses in 2016, per the CDC. Black and hispanic men and women are disproportionally impacted across the board. When you think about the horrific treatment of immigrant families at the border and the administration's repeated efforts to roll back LGBTQ anti-discrimination policies—including those related to health care—it's not surprising that this news is causing cognitive dissonance for some.

Naturally, many experts are skeptical of the motives behind the plan. “Unfortunately, President Trump’s announcement has already been undermined by his own administration’s record and rhetoric, and there is no reason for LGBTQ Americans or anyone else to see this as anything more than empty rhetoric designed to distract from what’s really happening behind the scenes every day,” said Sarah Kate Ellis, president and CEO at GLAAD, in a statement.

“If this administration wants to combat the spread of HIV, they need to immediately end their efforts to cut Medicaid funding, undermine the Affordable Care Act, and license discrimination against the most at-risk communities when they seek healthcare,” said David Stacy, director of government affairs at the Human Rights Campaign, in a statement. “This administration simply cannot achieve this goal while, at the same time, charging forward with attacks on health care for the communities most impacted by HIV. The American public deserves a real commitment from their government to end the HIV epidemic.”

Another cause for realism? Past presidents have typically fallen short of ambitious, disease-related goals like this one. President Obama's "Cancer Moonshot" program of 2016 sought to find a cure for cancer, which clearly didn't pan out before he left office.

Hopefully, the new wave of congresspeople committed to improving health care will help keep the administration accountable, while we can all use our voices to do the same. With HIV, any progress we make toward eradication is a victory.

If tonight's State of the Union leaves you feeling stressed, visit these soothing social media feeds—or learn how to channel your rage into a superpower.  

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