Advocates working to end the AIDS epidemic fear they may lose ground under the Trump administration after coming within reach of ending the disease’s siege in the U.S. and abroad.
While former Presidents Obama and George W. Bush made fighting AIDS one of their administrations’ top priorities, President TrumpDonald TrumpJan. 6 committee chair says panel will issue a 'good number' of additional subpoenas Overnight Defense & National Security — Presented by AM General — Pentagon officials prepare for grilling Biden nominates head of Africa CDC to lead global AIDS response MORE has proposed massive cuts to prevention programs, failed to fill key positions that advise the administration on the issue, and has at times made disparaging remarks about countries suffering from the epidemic.
“The last year has been an incredibly challenging one with respect to the politics surrounding HIV and AIDS, domestically and internationally,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition (AVAC), a group that advocates for HIV prevention to end AIDS.
“The backdrop to all of this is it’s coming at a time of the most remarkable progress in the fight against HIV and AIDS that we’ve had in 35 years. We have tipped toward success and we could tip back in a moment with reduced resources with reduced political commitment.”
One big indicator of Trump’s lack of commitment to ending AIDS, advocates say, is his failure to appoint someone to lead the White House Office of National AIDS Policy (ONAP) more than a year into his presidency.
ONAP, created under former President Clinton in 1993, is intended to coordinate the federal government’s response to HIV/AIDS across numerous agencies while advising and updating the president on the epidemic.
But the office appears to be defunct under Trump, with no signs he intends to appoint a leader.
A White House spokesperson did not answer questions about whether Trump would appoint an ONAP director or whether the office was defunct, instead stating Trump has hired Katy Talento, a former Capitol Hill staffer with HIV/AIDS expertise, to be the health policy lead on the Domestic Policy Council.
Advocates note that Talento works on all health issues for the administration, not just HIV and AIDS.
“We don’t have that dedicated staff at the White House now,” said Carl Schmid, deputy executive director of the AIDS Institute.
“We miss that leadership, that central leadership,” Schmid said, though he added, “there are people in the administration that care very much about these issues.”
Last summer, six members resigned from the Presidential Advisory Council on HIV and AIDS, claiming Trump didn’t care about fighting the epidemic. The administration also hasn’t replaced the members who were fired in December. The council has now been vacant for two months, and an administration official had no update on when members would be replaced.
“It’s part of this administration’s overall view that anything Obama touched should be discarded or reversed,” said Scott Schoettes, one of the council members who resigned last summer and HIV project director at Lambda Legal, a civil rights organization that focuses on LGBT communities.
“The fact is we were working and seeing progress, and now it’s unclear what leadership we’re going to get from the federal government on a national AIDS strategy.”
Obama and Bush both created new programs to address AIDS.
Bush created the President’s Emergency Plan for AIDS Relief, an initiative to address HIV/AIDS worldwide that both parties have credited with making a difference to this day.
Obama went a step further and brought a focus to the domestic AIDS epidemic the country hadn’t seen before, with a focus on marginalized communities most at risk, such as gay black men and transgender people.
Obama, for the first time in the country’s history, ordered the creation of a National HIV/AIDS Strategy, a plan to end the epidemic in the U.S., and pushed for more funding for AIDS programs.
Both presidents were outspoken and drove attention to the epidemic, particularly in State of the Union addresses.
But Trump didn’t take that opportunity when he delivered his first State of the Union address last month.
“If I were to compare, I would say that we were on a trajectory moving forward under the Bush and Obama administrations and moving toward ending the epidemic,” said Murray Penner, executive director of the National Alliance of State and Territorial AIDS Directors, a nonprofit association that represents public officials who administer HIV and hepatitis programs.
“Now it feels as though we are coming to a halt, if we are truly looking at restricting access to health care and cutting back in terms of the services and opportunities that we provide for people living with HIV and AIDS.”
While other presidents used the power of their office to elevate the issue to a national stage, advocates say Trump has not personally met with them or even mentioned HIV/AIDS publicly, aside from a few written statements.
Advocates have pointed out that statements he did make didn’t mention people with HIV/AIDS who are LGBT.
Trump has been more hands-on in discussions about other health-care issues. Aides and lawmakers said he was a driving force in the ObamaCare repeal debates last year, and he often met with what the White House called “victims of ObamaCare.”
But on the discussion of HIV/AIDS, Trump is noticeably absent.
“I think there is a lack of commitment and awareness at the highest level of the office, including the president,” said David Stacy, director of government affairs at the Human Rights Campaign.
“I don’t think this is a priority for them.”
For advocates, what they view as the administration backing away from HIV/AIDS could not come at a worse time.
While strides have been made in preventing and treating HIV since it was recognized as a health condition in the 1980s, there is still no cure.
About 1.1 million people in the U.S. were living with HIV at the end of 2015, according to the Centers for Disease Control and Prevention, with nearly 40,000 new infections and 6,700 deaths in 2014. The opioid epidemic in the U.S. could also bring new infections. Globally, about 37 million people live with HIV.
The use of antiretroviral therapy has helped those with HIV live longer, healthier lives by, in most cases, stopping the virus from progressing to AIDS.
But that doesn’t mean the U.S. should stop trying to end the epidemic, advocates say.
“Taking our foot off the gas now when the possibility to, if not fully end the epidemic, really come close to victory, is a huge mistake. It’s going to really hurt people. It’s going to make a huge difference in outcomes and hurt people’s lives,” Stacy said.
“The potential here to really make headway has never been brighter. We can’t pull back when we should be moving forward with greater energy, greater vigor, greater resources.”
Instead, Congress has flat funded AIDS programs for years, and the Trump administration has proposed cuts in his budget requests.
The White House budget proposal introduced earlier this month would cut more than $1 billion from global AIDS efforts.
His proposal also recommends millions of dollars in cuts to domestic AIDS efforts, including $40 million from the Center for Disease Control and Prevention’s HIV/AIDS prevention program, $26 million from federal housing program for people with AIDS and $58 million from the Ryan White HIV/AIDS program.
Congress rejected similar cuts in Trump’s first budget proposal.
“The president’s budget, while Congress may or may not act on it, it’s still a statement of priorities and the values of an administration,” said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation.
“It does send the message these certain areas are not as important as others.”
Advocates note that Trump’s legacy could be one of ending the epidemic, if he decides to commit himself to building on the work of previous administrations.
“You could be the president who helps end an epidemic,” said AVAC’s Warren.
“You could also be the president who squanders the opportunity of ending this epidemic. It’s your choice.”