What Would a Donald Trump Presidency Mean for People With HIV/AIDS?

Gage Skidmore [CC BY-SA 2.0], via Wikimedia Commons

Currently, the presumptive Republican nominee for president has no stated HIV/AIDS policy. Nothing concerning the disease is listed on Trump's website, nor has the candidate discussed how he would approach the HIV epidemic during any of his campaign appearances. At this point, any discussion of what a Trump presidency would specifically mean for people living with HIV in the United States and across the globe is primarily speculative. Those of us outside Trump's inner circle are forced to read the tea leaves to try and create a narrative for an HIV/AIDS policy that, in all likeliness, may not yet exist.

While we don't have any details on his HIV/AIDS-specific positions, the contents of Trump's overall health care platform doesn't appear to bode well for people living with HIV. As would be expected from the presumptive Republican presidential nominee, the focal point of Trump's health care policy is the complete repeal of the Affordable Care Act (ACA), for example.

All of the HIV/AIDS activists who spoke with TheBody.com acknowledged the possibility of a President Trump making good on his promises to reduce the cost of prescription drugs and encourage price transparency among health care providers. But even with their metaphorical rose-tinted glasses on, none of them could muster anything approaching optimism for HIV-positive individuals in Donald Trump's America.

"As someone living with HIV, I find the way that Trump models citizenry extremely problematic," said Andrew Spieldenner, co-secretary of the U.S. People Living With HIV Caucus. "When the leader models something, the people who work for them will normally take it further," he noted. "My gut tells me a Trump presidency would be bad for people living with HIV, especially globally," he said. "The nativism he's exhibited during his campaign doesn't seem to me to be good for PEPFAR [The President's Emergency Plan for AIDS Relief]."

Spieldenner did say during his interview with TheBody.com that there had been some interest from the Trump campaign in sitting down for a meeting with HIV/AIDS activists, as Clinton and Sanders did last month, but that nothing substantive had come from it so far. Regardless, Spieldenner seemed less concerned by the lack of direct engagement between Trump and HIV/AIDS groups than by the overall ideology and bearing of the campaign Trump is running.

What Trump would replace the ACA with is murky, although his proposals are mostly a hodgepodge of business-friendly measures aimed at reducing government spending and placing the onus for care on individuals, such as allowing interstate health insurance competition and block granting Medicaid to the states.

Trump claims that he will maintain the ban on insurance companies denying coverage to people with pre-existing conditions, but without an individual mandate or the provision of financial assistance similar to what it is now available through the health care marketplace, it would seem there's no chance of that happening. According to a report by the non-partisan Committee for a Responsible Budget, Trump's health care plan "would cause almost 21 million to lose their health insurance" and would wind up costing anywhere between $330 and $550 billion over a decade.

In addition, the Wall Street Journal reported that Trump would consider privatizing the Department of Veterans Affairs (VA) health care system, turning it into something more akin to a health insurance provider than a network of hospitals. This could have drastic implications; as the VA notes, it is "the largest single provider of medical care to people with HIV in the United States."

Hilary McQuie, director of U.S. policy and grassroots mobilization at Health GAP, emphasized that her organization would try to work with a Trump administration but was unsure what that would look like and was deeply concerned about Trump's positions on social issues and immigration.

"There's no telling what he would do," McQuie said, adding that the xenophobia, racism and sexism exhibited in Trump's campaign would be terrible for preventative care and treatment efforts, as well as basic human rights.

George Ayala, who serves as the executive director of The Global Forum on MSM & HIV (MSMGF), shared similar concerns. "I'm not aware of anything Trump's said about HIV, which is a problem right there." Ayala said. "At this point we can only speculate based on behavior, but I think gay men -- especially gay men of color -- wouldn't have great access to the White House, and that spells trouble."

Like the HIV/AIDS activists who were interviewed for this article, Gregory Angelo, president of the Log Cabin Republicans, said that he didn't want to speculate about what Trump's HIV/AIDS policy might be. While the head of the gay Republican group was much more encouraging about the prospect of a Trump presidency, he still had his reservations.

"I am on record as having said that Donald Trump is the most pro-gay Republican presidential nomination in history," Angelo told TheBody.com. "If you look at the statements he's made, there's reason to believe that he at least might do no harm and may possibly be an ally. However, I want to be crystal clear on this: The Log Cabin Republicans have not endorsed Donald Trump and I am not a Trump apologist."

More than any candidate in recent memory, Trump has hitched his campaign's success, not to putting forward concrete or feasible solutions, but instead to capturing his followers' nativist anger and sense of betrayal. As a consequence, instead of having a more fully formed vision of what sorts of policies to expect from a Trump presidency, we find ourselves left with an ever-growing collection of macho posturing and xenophobic pronouncements.

Given that speculation and rhetoric are all we have to go on at the moment, it may behoove HIV/AIDS activists to prepare for the best as well as the worst with regard to a Trump presidency, even if an antagonistic relationship seems to be the more likely outcome. It remains to be seen exactly how far those who work for and follow Donald Trump would take his particular brand of jingoistic aggression if he were to win the White House. But it seems that most HIV/AIDS activists would be more than content if they never had to find out.