Last week, during the annual National Ryan White Conference on HIV Care and Treatment in National Harbor, Maryland, Health and Human Services (HHS) Secretary Alex Azar announced that after the terms of the remaining members of the Presidential Advisory Council on HIV/AIDS (PACHA) were prematurely eliminated just one year ago, HHS would reconvene with two new co-chairs: Carl Schmid, deputy executive director of The AIDS Institute, and John Wiesman, Dr.P.H., M.P.H., secretary of health for the state of Washington. In his remarks, Secretary Azar stated that PACHA would host its first meeting with all new members in March 2019, as one step in the process to developing a new strategy to update the National HIV/AIDS Strategy, as the most recent plan ends in 2020.
"As many of you know, this process has already begun, and it will include deep engagement with community leaders and those on the frontlines, which means all of you," he told the audience of attendees. "Developing the 2020 strategy will also involve the input of the President's Advisory Council on HIV/AIDS, the first meeting of which has now been scheduled for March." News of the PACHA announcement and the current administration's inertia on HIV was met with mixed reactions. Some congratulated the new co-chairs and see it as a way to move forward in working with an administration that has been difficult on health care.
The HIV, STD, and Hepatitis Policy Partnership (a policy advocacy coalition comprised of the National Coalition of STD Directors, National Alliance of State and Terrirorial AIDS Directors, NMAC, and Schmid's organization, The AIDS Institute) issued a statement celebrating Schmid's appointment and the reconstitution of PACHA, stating, "HIV is not a partisan issue and continues to be a public health threat that must have the right leadership and resources necessary to end new infections and ensure access to quality prevention and treatment for everyone who needs it."
Other HIV advocates were less than pleased, most expressing discomfort with a new PACHA in an administration that has attempted to overturn the Affordable Care Act (ACA), restrict legal status for immigrants if they access public services for health, housing, or food, and stop fetal tissue research, which caused an HIV cure study to shut down. Mark S. King, HIV activist and journalist, described the announcement as a joke: "From where I sit, bolt upright in my pontificating armchair, no advisory board is capable of offering counsel to leaders who have made it very clear they don't want it and who have, by the way, demonstrated again and again what their true intentions actually are. Reinstating PACHA is a cynical ploy."
When it comes to HIV and AIDS policy, President Trump's administration has been imbrued in discrimination and bigotry since the beginning. He may not have stated his disregard for the AIDS crisis in America, but he has made it clear that it's not a priority for him. From his refusal to appoint a director for the White House Office of National AIDS Policy to proposing a $59 million cut to the Ryan White HIV/AIDS Program shortly after inauguration to directing the Defense Department to ban people living with HIV from the military, Trump has readily exposed his hand.
In addition to questioning the point of a PACHA in an administration that has expressed disdain for people living with HIV and the communities most vulnerable to the virus, some raised questions about the lack of diversity represented by the new co-chairs Azar appointed to PACHA, given the disproportionate impact on communities of color, young people, and transgender people. Both of the newly named PACHA co-chairs have expertise in HIV prevention, treatment, and care policy. It's not a question of credentials per se. Wiesman started his public health career in Connecticut in 1986 and was in its first group trained to provide HIV counseling and testing services. Schmid has been at The AIDS Institute since 2004. He is a former chair of the HIV Prevention Action Coalition and the Ryan White Reauthorization Work Group. He was a member of the Presidential Advisory Council on HIV/AIDS from 2007 until 2009. Both Wiesman and Schmid are, however, gay white men.
"Many have chosen not to legitimize this administration's hateful actions towards communities living with and impacted by the HIV epidemic; that's why we saw the PACHA 6 resign last year," said Naina Khanna, executive director of Positive Women's Network USA (PWN). "It's also part of the reason why there has been a mass community call to relocate the International AIDS Conference proposed to take place in San Francisco in 2020. Ultimately though, the appointment of two white cisgender men to chair a council responding to the domestic and global HIV crisis, which mostly impacts black and brown people all over the world, is not surprising, given this administration's approach."
DeMarc Hickson, Ph.D., M.P.H., executive director of Us Helping Us, People Into Living in Washington, D.C. first congratulated both Schmid and Wiesman on their appointments, noting, "Carl Schmid is a long-time ally in the fight against HIV wherein The AIDS Institute was a founding member of the National Black Gay Men's Advocacy Coalition, and Dr. Wiesman has a long-standing history of developing and implementing innovative HIV prevention and care models that are the underpinning of many End the Epidemic state plans." Hickson went further to explain that while he recognizes the long-term contributions to HIV that both co-chairs have made, the communities most impacted still need to be at the forefront of any national work to address the epidemic.
"Black gay and transgender representation must be significant on PACHA, and if it is not, it will be a step backward," he said. "We have worked long and hard to get the attention of the federal government on the health issues, like HIV, that disproportionately affect black gay men and transgender women, and there needs to be a true commitment to lift up black gay men and transgender women into leadership positions, which do not truly exist in this administration."
The next PACHA meeting will commence in March 2019. For more information or to sign up for the email list, click here.