If Donald Trump really wants to end the US HIV epidemic by 2030, as he’s expected to announce in tonight’s State of the Union speech, he will have to stop stigmatizing immigrants and trans people, according to health care experts.
About 1.2 million people nationwide have HIV, and every year another 40,000 are infected. On Tuesday, Trump will pledge to end the epidemic by first targeting the 20 states with the highest infection rates, according to Politico, and advance comments from counselor to the president Kellyanne Conway.
Such a plan is very doable, HIV prevention experts told Angle News, applauding recent speeches by HHS secretary Alex Azar advocating wider use of drugs that prevent HIV transmission. But groups with highest rates of the virus include gay, trans, black, and Latino men, drug users, and people living in southern states without public health care — constituencies not exactly embraced by the Trump administration, which is trying to build a wall on the Mexico border and kick trans people out of the military, and disbanded its Office of National AIDS Policy in 2017.
“Ending the HIV epidemic matches the scientific reality — we can do this,” Treatment Action Group project director Jeremiah Johnson told Angle News. “But it doesn’t match the political reality of our era.”
In January, National Institute of Allergy and Infectious Disease officials released study results confirming that antiretroviral treatments that drive the virus to undetectable levels in the bloodstream prevent people from transmitting the disease to their partners. What’s more, a daily preventive drug, taken by people who haven’t been infected, reduces their risk of acquiring HIV through sex by 90%.
Such advances have driven “roadmap” plans by public health experts to reduce HIV infections nationwide in the next decade, saving some $57 billion in longterm health care costs. But experts worry that the Trump administration’s hostility toward trans people and immigrants, in particular, could do more harm than good.
“Many recent immigrants are afraid to access HIV prevention and medical care, out of fear of deportation,” a 2018 AIDS United report noted. “These barriers have the potential to drive dramatic increases in new HIV cases among Latinx gay and bisexual foreign-born men.”
Saying it would be a “pleasant surprise,” Journal of the Association of Nurses in AIDS Care editor Lucy Bradley-Springer told Angle News that Trump “would be an unlikely messenger for ending the stigma toward people with HIV.” Bradley-Springer was one of six experts who resigned from a presidential advisory committee on HIV policy before it was disbanded by the Trump administration. They wrote a scathing letter at the time saying the administration’s policies harmed people with HIV.
The administration’s attacks on the Affordable Care Act and Medicare expansion also hurts people with HIV, prevention expert David Holtgrave of the University at Albany State University of New York told Angle News. About 85% of people infected with HIV in the US now are eventually diagnosed. Of those who go on to get treatment, almost all see the virus drop to undetectable blood levels. But only about half of those diagnosed get treatment, largely because they don’t have insurance and can’t afford or access it. (About 56% of people with HIV have federal health care coverage such as Medicare, while 30% have private insurance and 14% are uninsured.)
“People who are homeless need stable housing,” he said. “People in the rural south who don’t have a doctor nearby need telemedicine.”
Another contradiction in the Trump administration’s new goal of HIV elimination is Vice President Mike Pence’s history of only reluctantly allowing needle exchanges in Indiana after an HIV outbreak among drug users became rampant in 2015. Similarly, the Justice Department has not supported safe injection sites, places where drug users could be tested for HIV and receive treatment.
Azar, though, has called for both the widespread use of the HIV preventive drug, PrEP, and for lowering drug prices, which could make for a good combination, TAG’s Johnson added. The list price for PrEP is around $18,000 a year. “That’s an expensive drug by anyone’s measure,” he said.
A precedent does exist for a president making a perhaps unexpected and useful pitch for treating HIV, some noted. In 2003, then-president George W. Bush called for the creation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which has provided HIV treatment to 14 million people in more than 50 countries worldwide. Last year, the Trump administration proposed a $1 billion cut to PEPFAR’s budget and a $425 million cut to the Global Fund to Fight AIDS, TB, and Malaria.
“We’ll have to see just what, and if, he says on Tuesday,” said Holtgrave. “The question is, will it be the right policies that create a less stigmatizing environment for these people living with HIV?”