Remember the director of the U.S. Office of National AIDS Policy (ONAP), otherwise known as the country’s “AIDS czar”? The role was conceived back in the pre-combo-therapy Clinton years as a way to centralize the coordination of all HIV/AIDS-related efforts within the U.S. federal government.
ONAP had 12 different directors in the ensuing decades—until the Trump era, that is. Nobody in the former president’s inner circle appears to have cared enough to fill the role. (They also never fully filled the seats that were left open on PACHA, the equally longstanding President’s Advisory Council on HIV/AIDS, after about a third of its members quit in mid-2017 and Trump fired the rest in late 2017. It wasn’t until 2019 that a handful of folks were added back to PACHA’s ranks.)
And yet, despite those failings, it was the Trump administration that in early 2019 announced its ambitious “Ending the HIV Epidemic” (EHE) plan, which aimed to reduce the rate of HIV infection in the U.S. by 90% by 2030. The Biden administration has even more ambitiously pushed that deadline up to 2025.
In the absence of an ONAP head honcho, it was a person by the name of Harold Phillips—a gay, Black, openly HIV-positive longtime public health official—who became the point person on implementing the EHE plan. From his perch within the Department of Health and Human Services (HHS), Phillips managed EHE through the challenges of the COVID-19 pandemic and a lack of sufficient funding to help targeted localities pull together their action plans.
On June 5, the Joe Biden White House announced that Phillips would fill the long-empty role of ONAP director, leaving his position at HHS for an even higher one that puts the White House’s power behind his ability to coordinate the EHE effort across many government agencies, including those overseeing issues like housing, transportation, and food security.
How Does Phillips See His New Role at ONAP?
It’s an expansive role that, depending on how it’s handled, could steer a strong, steady ship or unravel into busywork. It’s also the second time the AIDS czar has been someone representing one of the communities most affected by HIV in the U.S.: gay Black men. (The first time was Douglas Brooks, under President Barack Obama.)
“Harold brings decades of experience in the battle against HIV/AIDS, and we’re lucky to have him spearheading the Biden-Harris administration’s efforts to defeat this epidemic,” said White House domestic policy advisor Susan Rice in the announcement of Phillips’ appointment. “[President Biden] has called upon the nation to recommit ourselves to ending HIV/AIDS once and for all. I know Harold and ONAP will be instrumental to that effort.”
Despite the bravado in that statement, many in the HIV world have long seen ONAP as variably effective: At its best, it is a pulpit from which the power of the White House can be exerted onto HIV efforts; at its worst, it is a fig leaf that claims the president cares about HIV but fails to effectively mobilize agencies with the funding streams that can make real change happen.
In a brief call with TheBody, Phillips—who is warm, affable, and widely respected in the HIV community—said that he intends to maximize his new position across a wide array of agencies as a way of fulfilling EHE’s goal of addressing “drivers” of the HIV epidemic, such as housing and food insecurity. “We can’t do this with HHS [health agencies] alone,” Phillips said. By December 1 of this year, Phillips said, he intends on releasing a revamped EHE strategy that will incorporate the contributions of agencies like the Department of Education, Department of Transportation, and Housing and Urban Development.
“I’m trying to figure out a timetable to get input into that strategy, and that includes understanding the impact of COVID on our work,” he said. “[The pandemic] pointed out certain inequities among racial minorities, so we have to [take that into account] when developing our timetable. President Biden has called for us to accelerate [EHE] and be bold.”
Beyond 2021, he said, “We need to look at some policy issues, like HIV criminalization”—laws in about half of U.S. states that punish people with HIV who have sex without disclosing their status—“and discrimination. And we need to use the [ONAP] pulpit,” he said, to push for more schools to deliver comprehensive sex education, which includes LGBTQ content as well as science-proven HIV and STD prevention measures like PrEP (the HIV prevention drug) and condoms.
Phillips pushed back on the idea held by some HIV advocates that PACHA was mere window-dressing to make a president look good on HIV/AIDS. He said that, under Obama, PACHA “made many solid recommendations” on issues like crafting the first-ever national HIV plan and ending HIV criminalization. He said that once he fills gaps in the current PACHA to include more people who are living with HIV, including transgender people and young people, the group could play an impactful role again.
As Phillips Takes the Helm at ONAP, the HIV Community Is Watching
As long-admired as Phillips is in the HIV advocacy community—prior to serving many HIV-related roles within the government, he worked at NMAC (formerly the National Minority AIDS Council)—he’s still being closely watched to see how he leverages his new role to push forward EHE.
“With your new appointment, community needs you to deliver,” read an open letter from Paul Kawata, NMAC’s longtime head. “There are too many people living with HIV who have fallen out of care. There are too many people who need PrEP, but we can’t seem to reach them. While the solution to ending the HIV epidemic might be biomedical, it is not simple. That’s the problem with the previous administration’s strategy. They believed you just needed to make medications available. The reality is so much more complex and nuanced.”
The NMAC letter laid out several goals it said Phillips needed to meet, including writing more racial equity into the original EHE plan; rebooting PACHA; caring for aging folks living with HIV; counting transgender women’s HIV data as separate from gay men’s (which has often not been the case); and weaving HIV care into broader health care needs.
“To be honest, his new role in the past has been mostly ceremonial,” Kawata told TheBody. But with EHE, “There’s a deadline now, and there have to be actionable results.” Kawata wants to see improved coordination and communication: “Right now, HIV is broken down into all these little fiefdoms [of government agencies] that may talk to each other, but I don’t know if they really collaborate,” he said. “We need clear, measurable goals that include getting all the people with HIV who’ve fallen out of care back into care.” According to federal statistics, just two-thirds of people living with HIV in the U.S. receive some form of care, and only half are retained in that care.
Kawata said he wants Phillips to finalize the creation of a national online dashboard that breaks down rates of who’s diagnosed, who’s in care, and who’s undetectable by state and locality. “That’ll give the feds the capacity to target regions” with lagging results, he said. “We’re going to have to pour money into those communities and analyze why their outcomes are different.”
Kawata added that, by the first quarter of 2022, he wants to see Phillips convene a high-level White House summit on EHE “that will get this administration on the record with some very specific deadlines and steps. That’ll be the moment when they tell us how we’re ending the epidemic in a real fashion.”
Other advocates concurred—and expressed hope that Phillips would create real federal-level movement in the domestic fight against HIV. At AIDS United, president and CEO Jesse Milan Jr. credited Phillips, in his prior HHS role, for giving support to a series of special projects targeting people in recovery or coming out of prison. “He understands how government funding mechanisms work and how to use them strategically,” said Milan, “plus he knows, across the bureaucracies, who to go to to ask the right questions and make something happen.”
According to Milan, Phillips needs to engage traditionally non-HIV-engaged agencies such as the Department of Education and Department of Labor—the latter of which, said Milan, can play an important role in informing and educating the workforce about HIV. Milan also expressed a hope that the ONAP staff, traditionally about half a dozen people, would be expanded to between eight and 12.
Kenyon Farrow, a longtime HIV advocate and journalist who is now the managing director of advocacy and organizing for PrEP4All, said that he hoped Phillips would use a rebooted PACHA to “pull together some meetings about what a national PrEP program could look like. How do we provide PrEP care for folks in places who are still uninsured because their state has not yet expanded Medicaid? Do we create a Ryan White–like national program for PrEP, in which people can use public dollars to pay for their ACA [Obamacare] plans? ONAP can really play a role in spelling out the technical details.”
How Will Phillips Direct Where the HIV Money Goes?
Then there’s the question of how Phillips might influence use of the $267 million increase in domestic HIV funding that President Biden has called for in his budget—should Congress be able to pass a final budget containing a comparable amount of money, that is. Raniyah Copeland, who leads the Black AIDS Institute (which recently honored Phillips as one of its “Heroes in the Struggle”), said she wants Phillips to help push much of that money to minority-led HIV organizations.
“We’ve invested a great deal in HIV biomedical tools [such as medication and PrEP], but not a lot for the communities most impacted who are not virally suppressed or on PrEP,” said Copeland. “Most of the EHE money so far has gone to health departments and federally qualified health centers to disburse, with very little going directly to community-based organizations that support behavioral outreach efforts. Any new increase in funding should go directly to such groups.”
But Copeland also stressed that she thinks Phillips is excellent for the job. “He has the ear of the community and knows where some of the pain points are via all the listening sessions he’s done,” she said. “So if something is not going right in Birmingham [Alabama], they can call or text him about it, because he has relationships with all the jurisdictions.”
Dafina Ward, who heads the Southern AIDS Coalition, also expressed hope with Phillips taking over as AIDS czar. “I’ve never seen him be defensive when the community has been critical of HHS,” she said, “so I think he’ll be OK with being held accountable.”
Then she mused aloud: “I wonder what ONAP can do to hold [HIV and PrEP] providers in the South accountable in terms of reducing stigma around HIV, which is a driver of HIV here in the South.”
Ward said that when it comes to metrics and accountability on EHE goals, she wants Phillips to be a stern taskmaster. “I can see him set a new tone that’s not just window dressing,” she said. “He’s well positioned to help directors of other agencies understand why the heck they should even care about HIV—because it’s a byproduct of other issues like poverty, lack of access, and racism.”
OK, Harold, got all that? On a call with TheBody on June 11, Phillips laughed. “Thank you,” he said, “for acknowledging this is only my sixth day on the job.”