Trump's Plan to End HIV Is Admirable But Inconsistent With His Own Agenda
During his 2019 State of the Union address, President Donald Trump declared that he would fund a plan to end new HIV infections in the U.S. by 2030. The President’s commitment to this goal was followed by a blog post on HIV.gov by Health and Human Service Secretary Alex Azar that provided more details on the plan, titled Ending the HIV Epidemic: A Plan for America. While I applaud the president and Secretary Azar for highlighting this critical public health issue and pledging federal support to improve HIV treatment and prevention in the U.S., the administration’s policy record conflicts with these admirable goals.
According to the CDC, there are approximately 1.1 million people living with HIV in the U.S., and approximately 39,000 are newly infected each year. As Secretary Azar points out, the number of new infections has reached a historical low, but certain segments of the U.S. population are still greatly affected by the epidemic. Gay, bisexual, and other men who have sex with men (MSM), especially those who also identify as Hispanic/Latino, Black/African-American or indigenous, continue to be disproportionately impacted by HIV. For example, although HIV diagnoses dropped by 8 percent among heterosexuals between 2012-2016, they increased by 12 percent in Hispanic/Latino MSM during the same time period. Accordingly, the Plan for America, as described by Azar, will direct resources towards these communities that continue to be most impacted by HIV, as well as geographic regions with the highest rates of infection, such as the southern U.S.
Though a number of science-based elements comprise the Plan for America, other policies pursued and enacted by the Trump administration create substantial barriers to effective HIV treatment and prevention, especially for those communities most impacted by the disease. For instance, the Trump administration has worked to roll back Medicaid expansion and undo elements of the Affordable Care Act, both of which have increased access to health care for vulnerable communities. Medicaid funds a significant portion of HIV-related medical care in the U.S., which the National Institutes of Health have recently confirmed is an important component of ending the HIV epidemic. According to the NIH, studies have demonstrated that individuals who are on HIV medication and are able to achieve an undetectable viral load cannot transmit the virus to others. Cuts to Medicaid would undoubtedly lead to gaps in medical care for those living with HIV, including loss of access to medication that enables people with HIV to maintain undetectable viral loads. Additionally, Medicaid funds cover the costs of necessary quarterly labs for those on PrEP, a pill used to prevent HIV acquisition. In order to be effective, the Plan for America would need to protect and expand, not reduce, access to health care for those living with and at risk for HIV.
Trump’s policy record with sexual and gender minorities is also in stark contrast to the goals outlined in the Plan for America. Last month, the U.S. Department of Health and Human Services announced that it will likely soon implement a conscience protection rule that would allow health care professionals to refuse to provide care that conflicts with their religious or moral beliefs. In practice, this means that providers could refuse HIV care or prevention services to MSM or transgender individuals, the groups most disproportionately affected by HIV, if they object to their sexuality or gender identity on religious or moral grounds. Such a policy would fuel the mistrust of the medical system many sexual and gender minority individuals feel, and ultimately impede access to medical services that would help to reduce HIV infections in the U.S.
Ending HIV in the United States is a noble goal that should be applauded. However, to successfully accomplish this goal we must ensure that policies are designed to reduce barriers to and increase inclusion in health care so that those most affected by HIV are able to receive needed medical treatment and prevention services.
Donny Gerke, PhD, MSW is an assistant professor in Graduate School of Social Work at the University of Denver.
