Progress and stumbles one year into Trump’s plan to end HIV

A year ago, President Trump announced a groundbreaking initiative to end HIV transmission in the United States by 2030. This forward-thinking and ambitious goal is achievable because of several significant developments such as President Obama’s National HIV/AIDS Strategy (the first for the U.S., released in 2010 and updated in 2015), which identified a limited number of evidence-based actions to make the most significant impact on the domestic HIV epidemic; unprecedented scientific advances in HIV prevention and treatment; and community-based leadership in reducing HIV transmission in key localities nationwide. 

Although fighting HIV is a truly bipartisan issue with champions on both sides of the aisle, President Trump recently claimed at a New Jersey rally that Obama “chose not to” end AIDS. I worked in the Obama White House and helped write and implement President Obama’s National HIV/AIDS Strategy. 

President Trump’s rhetoric is not helpful. His comments overshadow real steps that his administration has made to combat the domestic epidemic in terms of funding and scaling up effective HIV prevention interventions.

More importantly, the President’s statement highlights a blind spot: the biggest threat to achieving the goal of ending HIV is none other than the administration itself.

Various policies of the Trump Administration undermine this goal by targeting communities at the highest risk for HIV. For instance, cuts to Title X-funded providers affect the availability of basic health care, reproductive, and HIV services for low-income women.

The public charge rule discourages non-citizens from seeking government assistance (including health services) at a time when HIV rates are increasing among a segment of the Latino population. And anti-immigrant rhetoric and crackdowns only exacerbate HIV transmission when fearful undocumented immigrants delay seeking health care. 

The administration has actively sought to permit discrimination against transgender populations in health care settings, supports workplace bias against LGBT people (note: many Americans are insured through their jobs), and wants to allow health care workers to object to providing care to LGBT individuals morally.

The administration also fired gay and HIV-positive U.S. Air Force airmen because of their HIV status, only to be rebuffed by the Fourth Circuit Court of Appeals that said the administration’s policy is ‘at odds with current science.’ None of these actions help to engender trust with communities at risk for HIV.

Access to health care remains fundamental to eliminating HIV. Following the implementation of the Affordable Care Act (ACA), a large proportion of people living with HIV in the U.S. gained access to comprehensive health insurance.

Medicaid expansion has enabled more people with HIV to obtain coverage. People living with HIV who are insured are less likely to transmit the virus, which explains why HIV diagnoses in Louisiana fell to the lowest level in a decade two years after the state expanded Medicaid. 

Yet, unlike President Obama, the percentage of uninsured Americans has increased under President Trump. Although President Trump claims that he has saved Americans with pre-existing conditions from being denied health care, ample evidence suggests otherwise.

The administration downplays the impact of these policies on the President’s goal of ending HIV transmission, but these issues demonstrably undermine the realization of the President’s HIV initiative. Even the Centers for Disease Control and Prevention recently published a study showing that states with greater overall levels of health care coverage and LGBT anti-discrimination laws had lower mortality rates among adults living with HIV (aged 34-54).

Bold goals matter, but ending an epidemic remains hard work, we need things like:

1. A long-term commitment that will require an increase in investments in subsequent years

2. Public-private partnerships to help fill gaps in access to services and medicines

3. Supplementing sparse health services and health personnel in rural settings

4. Expeditious and affordable access to new HIV prevention and treatment innovations as they become available

5. A concerted effort to find an effective vaccine and ultimately a cure for HIV

6. Recognition that funding for HIV research has benefited and led to scientific advances for other chronic health conditions. 

I want President Trump’s initiative to succeed and am encouraged by those people in the administration who are working in good faith to realize its goal. But it remains to be seen whether the administration and its policies will stop undermining their worthy objective.  

Greg Millett is Director of Public Policy at amfAR, The Foundation for AIDS Research, a former scientist at the Centers for Disease Control and Prevention, and an architect of President Obama’s National HIV/AIDS Strategy.