2019 State of the Union (Washington Blade photo by Michael Key)
President Trump took the opportunity of his second State of the Union address to call for an end to HIV transmission in the next 10 years — but that call was received with skepticism from advocates unhappy with his administration’s approach to the epidemic thus far.
Speaking Feb. 5 before a joint session of Congress, Trump talked about the United States having made “important strides” in combatting HIV/AIDS, but that the time has come to finish the job.
“In recent years we have made remarkable progress in the fight against HIV and AIDS,” Trump said. “Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. We have made incredible strides. Incredible. Together, we will defeat AIDS in America and beyond.”
The part of Trump’s remarks about “important strides” in combatting HIV/AIDS and defeating the disease not just in the United States but “beyond” were ad-libs from his prepared remarks.
Trump’s line about defeating HIV/AIDS was among those applauded by members of Congress on both sides of the aisle, including possible 2020 hopefuls Sens. Kamala Harris (D-Calif.), Bernie Sanders (I-Vt.), Kirsten Gillibrand (D-N.Y.), Cory Booker (D-N.J.), Elizabeth Warren (D-Mass.) and Sherrod Brown (D-Ohio).
The inclusion of the call to end HIV in the State of the Union address was expected. On Feb. 3, Politico reported health officials within the Trump administration were expecting that call to be a component of the speech. The Department of Health & Human Services is also expected to unveil a more detailed plan later this week.
Carl Schmid, deputy executive director of the AIDS Institute, said in a statement Trump is taking a “bold step” in the fight to end HIV/AIDS.
A co-chair of the Presidential Advisory Council on HIV/AIDS, Schmid said the remarks were part of a bold initiative to end the HIV epidemic by 2030.
“His proposal to increase access to antiretroviral medications for people living with HIV and for prevention in those communities with the highest rates of HIV and where additional resources are most needed will translate into fewer HIV infections,” Schmid said. “Under the president’s proposal, the number of new infections can eventually be reduced to zero.”
Trump’s call to end HIV transmission is consistent with the administration adopting Obama-era goals to combat the epidemic in a progress report issued last year on the 2010 National AIDS Strategy. The administration is set to produce an updated version of that strategy by 2020.
The announcement also follows Secretary of Health & Human Services Alex Azar’s pledge in December to fight HIV/AIDS in a speech that recognized its disproportionate impact on African-Americans, Latinos and gay men.
Among those commending Trump for including a call to end HIV and calling for additional detail was Michael Weinstein, president of the AIDS Healthcare Foundation.
“Many experts have stated over and over that we have the tools to end the epidemic. What we lack is the political will,” Weinstein said. “AHF looks forward to the details of the president’s plan and hopes it will address primary prevention of new HIV infections – including aggressive promotion of condoms and safer sex education, universal access to treatment for everyone living with HIV, strengthening the Ryan White HIV Program and protecting the 340B Drug Discount Program.”
But the general consensus among HIV/AIDS advocates was Trump — who defeated a Democratic nominee in 2016 who talked of an “AIDS-free generation” — wasn’t making enough commitments to pull off his stated goal.
Rep. Mark Takano (D-Calif.), who’s gay and one of the co-chairs of the LGBTQ Equality Caucus, told he Washington Blade on Capitol Hill after the State of the Union address he does “applaud” the pledge to end HIV, but said the commitment may fall by the wayside like so many others.
“The president made bold promises in the campaign about reducing the costs of prescription drugs and when it came really time to follow through on it, he didn’t do it,” Takano said. “The same thing about infrastructure. Democrats, all of us, are willing to work with him on a true infrastructure bill, but he’s got to follow up on it, so the words I can agree with, whether they are bold true words remain to be seen.
House Speaker Nancy Pelosi (D-Calif.) was also cautious about Trump’s commitment to end HIV in a statement after the speech.
“The president’s call for ending HIV transmission in America is interesting, but if he is serious about ending the HIV/AIDS crisis, he must end his assault on health care and the dignity of the LGBTQ community,” Pelosi said.
Stacey Long Simmons, director of advocacy and action at the National LGBTQ Task Force, also questioned whether Trump was serious about ending HIV transmission despite his words in the State of the Union address.
“HIV advocates all agree that ending transmission is an important goal,” Simmons said. “Based on Trump’s repeatedly broken promises, we have cause to question his commitment until we see the necessary funding flowing to strategies that will actually end transmission.”
Trump has disappointed advocates fighting HIV/AIDS before. For starters, Trump — in an action first reported by the Washington Blade — fired all members of the Presidential Advisory Council on HIV/AIDS in late 2017 via a letter without explanation. Those terminations occurred after six members of the council resigned on their own in protest over the administration’s inaction on the epidemic.
Only in December 2018 did the Trump administration finally announce new members of the council, but those members were two co-chairs, Schmid and John Wiesman. No other replacements have been named.
Trump has also made repealing the Affordable Care Act a main goal of his administration, although efforts seemed to have fizzled out after failed attempts in his first year in the White House. Nonetheless, Trump succeeded in repealing the individual mandate in Obamacare under the 2017 tax reform law and allowed states to implement work requirements under the Medicaid expansions.
According to the Henry Kaiser Family Foundation, Medicaid is the largest source of insurance coverage for people with HIV. An estimated 40 percent of people with HIV receive care under the program.
Also of concern are the “religious freedom” actions instituted within the Department of Health & Human Services under Roger Severino, a former Heritage Foundation scholar and now director of the HHS Office for Civil Rights.
Those actions include the creation of a Conscience & Religious Freedom Division. Critics say the division enables the denial of medical services in the name of religious freedom to LGBT people, including gender reassignment surgery for transgender people, as well as people with HIV.
David Stacy, director of government affairs for the Human Rights Campaign, said the Trump administration’s efforts disproportionately affect people with HIV and inhibit efforts to confront the epidemic.
“If this administration wants to combat the spread of HIV, they need to immediately end their efforts to cut Medicaid funding, undermine the Affordable Care Act and license discrimination against the most at-risk communities when they seek healthcare,” Stacy said. “This administration simply cannot achieve this goal while, at the same time, charging forward with attacks on health care for the communities most impacted by HIV. The American public deserves a real commitment from their government to end the HIV epidemic.”
A budget proposal with increased funds for HIV/AIDS would be a change for Trump. His first two budget requests to Congress have also requested funding cuts for both domestic HIV programs, chiefly the Ryan White Care Act, and programs designed to fight the global epidemic, such as PEPFAR. Although the cuts to domestic programs were diminished in the second budget, the cuts to global programs were still considered draconian.
Despite Trump’s request to cut those programs, the Republican-controlled Congress continued appropriating funds for those programs at the same level.
Simmons warned those who heard Trump’s pledge in the State of the Union address not to give him a pass on his administration’s neglect on HIV/AIDS.
“If Trump was serious about HIV, he wouldn’t have proposed HIV funding cuts in his first two budgets,” Simmons said. “If Trump was serious about helping those with HIV and reducing the transmission of HIV, he wouldn’t have abruptly dismissed the presidential council on HIV and left the council vacant for nearly a year. If Trump was serious about reducing the transmission of HIV, he wouldn’t have selected a vice president that gutted funding for health clinics, leading to an HIV outbreak in rural Indiana.”
The Department of Health & Human Services is also pursuing a controversial rule change to Medicare Part D, which affords seniors prescription drug coverage. The administration says the policy is intended to lower drug costs, but many advocates fighting HIV/AIDS said it would have the opposite effect.
Asia Russell, executive director of the New York-based Health GAP, said the Trump administration thus far has been a “nightmare” for people with HIV in the United States and around the world.
“Tonight’s announcement will not wake us up from this nightmare unless it immediately reverses these harmful political decisions,” Russell said. “To end the HIV epidemics at home and globally, a real leader must call for: At least $1 billion in additional funding for global AIDS for fiscal year 2020, a permanent repeal of the Global Gag Rule, Medicare for All to ensure access to quality health care in the United States, evidence-based policies such as harm reduction for people who use drugs, and truly progressive proposals to slash the cost of medicines in the U.S. and globally.”
