As people around the globe mark the 28th annual World AIDS Day, public health officials and advocates say they are nervous about what the Trump administration will mean for prevention and treatment of the disease in the United States.
About 1.2 million Americans live with HIV, according to the Centers for Disease Control and Prevention. Trump’s platform on health care has no mention of the issue and he has said almost nothing about it publicly.
The one time he came close was over a year ago, in October 2015, when he was asked during a press conference whether he supported the president’s Emergency Fund for AIDS Relief, the government program funding the global HIV/AIDS response effort.
“Well, I like commiting to all of those things. Those are great things,” Trump responded. “Alzheimer’s, AIDS, so many different — you now, we are close on some of them… But the answer is yes. I believe so strongly in that. And we are going to lead the way.” Trump has also said he would “stop sending foreign aid to countries that hate us,” so it’s not entirely clear where he lands. A request for comment to his spokesperson Thursday was not immediately returned.
Moreover, the policy records of two key members of his administration — Vice President-elect Mike Pence and Trump’s choice for health secretary, Republican congressman Tom Price — have health advocates worried.
As governor of Indiana, Pence was at the center of the worst HIV outbreak in the state’s history. The outbreak, in spring 2015, was linked to the heroin epidemic but made worse by Pence’s initial refusal to lift the state’s ban on needle exchanges and his previous efforts to slash funding for HIV testing facilities in the state. Pence had led the charge in Indiana to defund Planned Parenthood, which is often a key provider of HIV testing in rural areas.
Researchers at the Centers for Disease Control later called the outbreak preventable, and some public health officials blamed Pence’s policies for facilitating the rapid spread of the disease and the governor himself for not acting faster to mitigate the outbreak. The self-described Christain conservative’s initial response to the outbreak was to go home and pray about it.
Studies have shown needle exchange programs reduce the spread of HIV, but Pence has long opposed needle exchanges “as an anti-drug policy.” Two months after the outbreak began, he begrudgingly allowed some needle exchanges to operate in the state.
Pence holds conservative views on HIV/AIDS and LGBT issues that stretch back to the beginning of his political career. When he first ran for Congress in 2000, he said Congress should only reauthorize the federal funding program for HIV/AIDS relief if it could “ensure that federal dollars were no longer being given to organizations that celebrate and encourage the types of behaviors that facilitate the spreading of the HIV virus.”
Price, Trump’s pick for health secretary, would be in charge of the federal programs responsible for conducting HIV/AIDS research, education, treatment, and prevention for millions of Americans. Most importantly, the Department of Health and Human Services oversees the National HIV/AIDS Strategy, which is tasked with developing policy to combat HIV nationally.
Price belongs to a fringe medical organization called the Association of American Physicians and Surgeons that holds some extreme views about medicine, including questioning whether HIV causes AIDS. A request to Price’s office asking whether he shares that view was not immediately returned.
Price has been a virulent critic of the Affordable Care Act, or Obamacare, and has introduced legislation to replace the health care law every year since it was passed. He also wants to slash funding to Medicaid and to privatize Medicare. Obamacare expanded coverage for expensive anti-retroviral drugs, which had previously been covered by the federal AIDS Drug Assistance Program.
Price also opposes expanding Medicaid, which serves many of those living with HIV/AIDS. “One of the most important things that happened with Medicaid expansion is that people were able to move off of ADAP and not just get HIV drugs but full [health] insurance,” Matt Kavanaugh, an HIV/AIDS health policy activist with the Global Health Access Project, told PBS. “If that rolls back, it’s likely we will see huge problems with ADAP.”
Kavanaugh is one of many HIV/AIDS activists worried about what Price’s plans would mean for low-income and uninsured people who rely on these health services and social programs.
“It’s an agenda that destroys the national health safety net,” he said. “We have a lot of people with HIV who depend on these programs.”
Follow Olivia Becker on Twitter: @oliviaLbecker