On March 8 and 9, the President’s Advisory Council on HIV/AIDS (PACHA) had its first (obviously, virtual) meeting of the Biden-Harris era. The body was first founded in 1995 by the Clinton Administration to offer advice to the president on HIV issues, although its similar predecessor from 1987 to 1993 was called the National Commission on AIDS.
The panel is currently made up of 14 people (10 seats sit empty) appointed by the Trump administration after it fired everyone from the Obama administration—not an unprecedented thing to do, as presidential administrations go. After all, the Obama administration sacked all the George W. Bush holdovers.
The Trump firings occurred, in fact, after six of the Obama holdovers had already resigned in 2017, to protest the Trump administration essentially shuttering the Office of National AIDS Policy (ONAP) by not bothering to appoint a new director for it. “Trump Doesn’t Care About HIV. We’re Outta Here,” read their farewell op-ed in Newsweek.
They would be proven at least partially incorrect. In 2019, the Trump administration actually launched an ambitious plan to end the HIV epidemic in the U.S. by 2030—a goal that President Biden, when he was campaigning for president, promised to get to by 2025. But HIV advocates correctly pointed out that many of the things the Trump administration was doing, such as trying to roll back both health care access and LGBTQ protections (especially for transgender people), were antithetical to the very things necessary to end the HIV epidemic. Still, in fairness, to the extent that Ending the Epidemic (ETE) succeeds, it will be remembered as a Trump-launched initiative.
All this formed the background for the early March meeting, much of which was set aside for topic panels with outside guests including Tori Cooper, the Black transgender director of community engagement for the Human Rights Campaign’s Transgender Justice Initiative; Niasha Fray, M.A., M.S.P.H., program director of the Duke Office of Community Affairs in North Carolina; AIDS United CEO Jesse Milan Jr., J.D.; and Hawaii’s Carolyn Kuali’i, of the National Native HIV Network.
“Equity”—largely meaning equal power and access for BIPOC (Black, Indigenous, and people of color) people living with and/or working in the field of HIV/AIDS—was the oft-mentioned keyword at the meeting, which concluded with PACHA voting to pass a Resolution on Ensuring Equity and Justice in Ending the HIV Epidemic.
Yet the summit, six hours total, was short on specifics and substance, save perhaps for when Laura Cheever, M.D., Sc.M., the longtime administrator of HIV programs at the government’s HRSA agency, presented data showing that, even amid COVID last year, Ryan White–funded agencies nationwide still managed to deliver services to 6,300 people living with or at risk for HIV, reengage in services 3,600 of them, test for HIV more than 573,000 people, and prescribe PrEP to nearly 50,000. Of those tested for HIV, 2,260 received a positive result and were linked to care within 30 days.
Those were impressive numbers for the middle of a brand-new pandemic. Many in the meeting pointed out that the silver lining of COVID was that it had cemented telehealth as an effective means of bringing, keeping, and even reengaging people in care.
But Really, What Is the Point of PACHA?
Still, such substantive moments were few and far between, which perhaps reflects the current up-in-the-air status of PACHA, whose status has always been somewhat tenuous. According to Paul Kawata, who heads the national HIV/AIDS advocacy group NMAC but is not on PACHA, recent talks he has had with persons in the Biden-Harris White House indicate that the new administration absolutely plans to revive the Office of National AIDS Policy (ONAP), appointing a new head, and to appoint a new PACHA.
But at the moment, he was told, COVID is their all-consuming priority.
In the meantime, that leaves PACHA members—many if not all of whom may soon be swept away—as 14 advisors in search of an advisee. “They have no one to report to,” says Treatment Action Group head Mark Harrington, who has never served on PACHA.
“It’s never been clear what the role of PACHA was,” he continues, “and now that there’s no ONAP, it’s really not clear. We’re eagerly awaiting what the new administration does to revitalize ONAP and the ETE strategy,” he says.
He adds that activists are also waiting to see who the administration nominates to put before the Senate as the new head of the Office of the Global AIDS Coordinator (OGAC), now that Deborah Birx, M.D., has retired in the wake of her disastrous role of White House COVID coordinator under Trump.
Is it really true that PACHA, which has only advisory power, has never had a meaningful role? Certainly that did not seem the case back in the 1980s, under Reagan, when PACHA's earlier edition, the National Commission on AIDS—led by the late Rear Admiral James D. Watkins, a straight white HIV-negative military man—boldly called out the Reagan administration for its “sluggishness” toward the new epidemic, and, defying the conservatism of the time, called for anti-discrimination legislation, comprehensive K-12 health education, and a big jump in federal funds. Reagan did not act on those recommendations.
Similarly, as Esther Kaplan wrote in a 2002 POZ magazine feature, PACHAs in the George H.W. Bush and Clinton administrations were not afraid to push their presidents to work harder on HIV/AIDS.
A preview of the Trump era occurred, however, under George W. Bush, whose PACHA was stacked with religious evangelicals not likely to push back on that administration’s fondness for abstinence-only sex ed and extreme aversion to discussing condoms, clean needles, gay Black men, transgender people, and drug users in the HIV prevention equation.
Then, under Obama, PACHA became filled with some of the most respected longtime HIV advocates in the U.S., including Cornelius Baker, Dawn Averitt Bridge, Humberto Cruz, Kathie Hiers, and Phill Wilson. If in a sense they were merely echoing and applauding the administration’s vision of a science-driven national AIDS strategy that finally centered the groups most affected, many of them had also been pushing for that very vision for years before Obama.
Of a full council of 24, at least five of them were living openly with HIV, according to Google searches, and 15 of them were BIPOC. Fourteen came from the HIV advocacy and service community rather than from the highest ranks of research or Big Pharma, and at least one, Ejay Jack, was transgender.
Among the 14 current Trump holdovers, only two appear to be living openly with HIV (based on their official PACHA bios and Google searches), seven are BIPOC, six appear to be coming out of the advocacy/service community, and three are from Big Pharma. Based on their PACHA bios, none identify as transgender or gender nonconforming, despite that community’s high HIV rates, especially among Black and Latinx transgender women.
Taking Offense to Dismissals of Trump’s PACHA
According to Carl Schmid, M.B.A., executive director of the HIV + Hepatitis Policy Institute and cochair of the current PACHA, the Trump administration tried to make the council more diverse, community-based, and reflective of lived HIV and transgender experience.
“But people did not want to be a part of it, to engage with that administration,” he says. “Maybe later, when they saw Trump was focusing on HIV, they felt different. When I accepted the offer, I knew that the administration was going to do [ETE] with a budget of hundreds of millions of dollars. I felt I needed to be there, even if, of course, I was against many Trump policies.”
Schmid, whose PACHA term ends in January 2022, also refutes the idea that PACHA under Trump was useless. “We did an awful lot of work,” he says. “We helped shape the ETE initiative. We brought the voice of the community to them. We took administration officials, including assistant secretary for health Admiral Brett Giroir, to HIV clinics in Florida and Mississippi so they could see firsthand the work they were doing there, so they would understand the importance of ancillary services when they were creating funding announcements, and so they would understand the role of [coexisting epidemics] like hepatitis and STIs. And we gave them a lot of input on PrEP.”
Importantly, he says, PACHA spoke out against the Trump administration’s attempts to strip LGBTQ protections from the Affordable Care Act. “We had a meeting with Roger Severino, who headed the Office of Civil Rights, and said, ‘This is perpetuating stigma, allowing providers to discriminate based on sexual orientation or gender identity.’ We made that case very strongly, passed a resolution against it.”
He concludes, “I’m proud of what we did. I think we have established a great foundation for the future.”
And What Might the Future Hold?
Going forward, PACHA’s impact may be only as great as the Biden-Harris administration allows it to be—assuming that the administration follows through on Biden’s campaign promise to prioritize the ETE campaign.
“We need for President Biden to publicly reiterate his commitment to ending the HIV epidemic,” says Kawata. “We want to make sure that he says it again.”
He says he finds it slightly worrisome that he heard that the new administration was not even aware that this most recent PACHA meeting was taking place. Of course, that may be because the administration considers the current PACHA a bunch of irrelevant Trump holdovers who will soon be swept out.
But, according to Harrington, PACHA shouldn’t be high on a list of priorities when it comes to ending the HIV epidemic. What matters, Harrington adds, is that the administration takes radical steps on drug and housing policy—in which case, he says, “PACHA could then be a useful forum for bringing communities together.”
That’s if the next PACHA members are willing to boldly push back on the very administration that would honor and stroke them by appointing them in the first place. “It’s part of the dynamics of federal power,” says Harrington, “that when people get appointed to things, they’re so thrilled that they become domesticated.”
And that’s a dynamic that has often led to PACHA becoming what one top HIV advocate, who asked to remain anonymous on this point for fear of backlash, called part of an administration’s “window dressing” or “frosting.” Said this advocate: “PACHA appointments are often a way for the administration to reward someone who worked on the campaign.”
Or, says this advocate, they serve as a way for an administration to check diversity boxes without following through on commitments.
Will that be the case under Biden-Harris? Only time will tell. Meanwhile, for the current Trump-appointed PACHA, a band of folks currently reporting to the assistant secretary for health for lack of anyone better, “equity” remains a seductive word to bandy about among one another at meetings—even if, as PACHA members, they currently have none themselves.