HIV Advocates Should Work With the Trump Administration to End the HIV Epidemic on Our Terms
It is difficult to describe the feeling that came over me on Tuesday night as I watched President Trump pledge to "defeat AIDS in America" during his State of the Union address. Certainly, there was some degree of shock that President Trump -- a man who has shown no demonstrable interest in the lives and well-being of people living with HIV in this or any country -- would devote time in his highest profile speech of the year to talk about ending the HIV epidemic, but that wasn't it. Nor was it anger at the hypocrisy of a man who had devoted his first two years in office to dismantling our nation's health care safety net and slashing HIV spending in his annual budget requests having the audacity to talk about the progress "we have made" in preventing and treating HIV.
No, the main sentiment that washed over me as I watched the State of the Union was one of resolve and determination. For years, the tireless efforts of HIV advocates to end the HIV epidemic in the United States had been ignored by broad swaths of the political establishment in Washington, with only a handful of doggedly determined champions in Congress to make sure that funding for HIV programming wasn't cut and to fight back against the discrimination, criminalization, and stigmatization of people living with HIV. And now, the legitimate prospect of ending the HIV epidemic in the next 10 years was being put forth on national television by a president who hadn't named a director of the Office of National AIDS Policy halfway through his term and had been so dismissive of his own Presidential Advisory Council on HIV/AIDS that a good number of them resigned in protest. The announcement was eerie and surreal, but once the absurdity of this president asking Congress "to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years" sank in, the reality of the opportunity at hand became clearer.
The details around funding for the president's ending the epidemic plan are still murky, but the overall shape of what the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and other federal agencies are planning has already started coming into focus. In a blog post released in concert with the State of the Union, HHS Secretary Alex Azar outlined the administration's plan to end the HIV epidemic, which will mirror its plan for combatting the opioid epidemic by providing targeted investment and resources for the 48 U.S. counties (along with Washington, D.C. and San Juan, Puerto Rico) that contain more than half of newly diagnosed HIV cases, along with seven states where the epidemic is heavily impacting rural areas. Ultimately, the administration's goal is to see a 75% reduction of new HIV infections in five years and a 90% reduction in 10 years. No specific funding figures have been provided yet, but HHS Assistant Secretary for Health Brett Giroir, M.D., has said that new funding would be included for the plan, as opposed to funding reallocated from other vital health care programs.
Ultimately, the biggest question that emerges from this plan isn't whether or not it would be effective in providing care for people living with HIV and preventing new infections if properly implemented, but whether or not the HIV community can trust the Trump administration at its word. The short answer is, no, HIV advocates should not trust the Trump administration. Nothing that it has done in the past two years should lead anyone living with or affected by HIV to believe that administration officials will do right by them of their own accord.
It's worth remembering that this is the same administration that has dedicated itself to advancing policies that strip people living with HIV of their health care and their basic human rights. Whether it's rolling back Medicaid expansion, dismantling the Affordable Care Act protections for people living with pre-existing conditions, banning people living with HIV from serving in the military or the Peace Corps, trying to take away access to HIV medications for seniors on Medicare, changing the Public Charge rule to impose a de facto HIV ban and financial litmus test on immigrants coming to the United States, or any of the numerous discriminatory actions taken against LGBTQ people living in the country, the Trump administration has shown over and over again that it is not our friend and is not to be trusted.
And yet, I believe we should work with the Trump administration on its plan to end the HIV epidemic. Based on what we have seen so far, it seems as if a good deal of the administration's plan is reflective of the community-driven roadmap to end the HIV epidemic in the U.S. by 2025 that was developed by AIDS United and the Act Now: End AIDS coalition and endorsed by over 250 HIV service organizations late last year. This is not an accident, but the result of the hard work of HIV advocates who saw an opportunity to influence the designs of those in power in a way that would benefit people living with HIV. Sure, HHS Secretary Alex Azar and CDC Director Robert Redfield, M.D., aren't the selections that many in the HIV community would have made for those crucial presidential appointments, but they both have extensive backgrounds in HIV research, prevention, and treatment and see addressing the HIV epidemic as a significant priority. As HIV advocates, it is our job to influence their decisions as much as possible with the limited access we have.
To be clear, none of this means that we should change our approach to dealing with the Trump administration's myriad attacks on people living with HIV outside of this plan. No amount of funding included in this plan can offset the harm done by a domestic agenda that centers abstinence-based sex education, criminalizes abortion, demonizes immigrants, and promotes white nationalism. We owe the Trump administration nothing but our passionate and sustained opposition to its predominantly hateful policies. But we also should not reject a plan to end the HIV epidemic by 2030 because of where it originated from, and those of us who are able to should do everything we can to mold this plan in our image at the same time we continue to fight back against the Trump administration on so many other fronts.
[Editor's Note: While Drew Gibson is an employee of AIDS United, the statements in this article reflect his views alone.]
Drew Gibson is a freelance writer and a policy associate at AIDS United in Washington, D.C. You can follow him on Twitter at @SuppressThis or visit his blog "Virally Suppressed," which covers a multitude of issues related to public health and social justice.