Despite his embrace of Ending the HIV Epidemic (EHE) by 2030, former President Trump frequently enacted decisions that hurt this mission. One of those self-inflicted wounds was disbanding the Office of National AIDS Policy (ONAP) in 2017, which under President Obama’s watch had been given unprecedented authority to carry out its mission.
With the newly inaugurated Biden and Harris administration, it is possible to return ONAP to prominence. Greg Millett, M.P.H., who served as the office’s senior policy advisor from 2009 to 2011 and is now vice president and director of public policy at amfAR, recently spoke with TheBody about why that will be an essential step in combating HIV.
COVID’s Financial Toll
According to Millett, the timeline to EHE will have to be pushed back due to the COVID-19 crisis. The Congressional Budget Office has estimated that the pandemic will cost the United States approximately $9 trillion dollars over the next 10 years, which goes beyond what any previous pandemic has ever cost. According to Larry Summers, the Obama White House’s national economic advisor, it may end up costing as much as $16 trillion dollars to resolve.
These astronomic figures mean that there will be a budgetary shortfall to redress any other issue in the coming years. That includes HIV—unless, Millett says, “the advocacy community really stands up to try and keep that from happening.”
He is currently worried that many service providers at every level are being consumed by COVID-19’s demands. The result is that people who are integral to EHE—from health department officials to doctors in local areas—are unavailable, and community-based organizations are struggling to survive because they’re not getting the economic funding that they require.
A big step in addressing EHE and other HIV-related issues will be for the Biden administration to reconstitute ONAP and, most importantly, to bring it back into the White House as quickly as possible.
A History of ONAP
ONAP was created under the Clinton administration to organize the U.S. government’s response to HIV. At that point, the office was stationed in a government building across the street from the White House. This placement kept the organization from interacting with senior White House officials directly or achieving many of its directives.
Under the George W. Bush administration, that became redundant, because ONAP lost its director and became an office that did nothing. It changed again during Obama’s stewardship because the HIV advocacy community successfully lobbied for increased funding, with assistance from Rep. Barbara Lee, and was moved onto the White House grounds. This meant that officials were able to meet with high-level White House staff to coordinate a national HIV and AIDS strategy.
Millett says, “We were definitely envied by other departments in the White House because we were able to have the president and vice president involved in our planning.” With Biden back in the White House, Millett believes that HIV will be taken seriously and given the attention that it deserves again.
Epidemic Failure of Trumpian Portions
“This administration has failed to address an infectious disease,” Millett says of the Trump era. “When you look at COVID-19, all of the mistakes that were made with HIV in the Reagan administration are essentially being made again by the Trump administration. Except that it’s happening at an even larger scale than what happened 30 years ago.”
“Trump has sometimes made statements indicating that he is interested in pulling the American public together, but he’s put together policies that have systematically disenfranchised people living with HIV while at the same time trying to launch a plan to end HIV.”
Though Biden is inheriting the greatest economic calamity that this country has faced since the Great Depression, Millett believes that he will actually get the work done and invest in ONAP’s mission to bring about change.
A Path Forward
For people who are interested in participating in transforming the world so that it represents their interests, Millett says, “With the political process, no office or issue is too small for us to deal with. Whether that means running for school council or Congress, that’s something that people living with HIV should do to make sure that our issues and our influence is made clear.
“I say that because even though Biden won, there’s been Republican gains not just in the House of Representatives but in governorships and other places down the ballot, and it’s clear that more needs to be done to move the ball forward on health equity and other issues that are important for people living with HIV. And as we stand on the precipice of the possibility of losing the Affordable Care Act in a Supreme Court decision, it is clearer that all of us need to be involved in this process to preserve our democracy and to make sure that the people who are most disenfranchised have access to basic health care and fundamental human rights that we need to move this country forward.”
Millett continues, “It’s incumbent on all of us to participate in that process. We saw that our voices matter as people living with HIV in the 1980s by forcing the FDA to approve and fast-track drugs and make treatments available that many people thought would never be available for people living with HIV; by radically transforming the way that providers interact with their patients; and making sure that our voices were heard as part of a powerful advocacy group. It’s really a testament to the will of people living with HIV—and I don’t think that we’ve lost it.”
Looking at ending both epidemics, Millett says, “We know that it’s an infectious disease that affects people everywhere geographically. We can’t end the epidemic if we’re just going to focus on ending it in large urban areas. It has to end everywhere. And I think that the plan that eventually gets put forward by the Biden administration is certainly going to place an emphasis on making sure that we end the epidemic among all communities.”
Trump ignored COVID-19 as it ravaged Black and Latinx communities, just as Reagan ignored HIV as it did the same. There is no way to contain either virus if that reality is allowed to reign again. Hopefully, whoever ends up leading ONAP will hold that truth at the core of its mission as it works with Biden to bring about the change we need to eliminate the threat of HIV.