The Trump administration has gained a reputation for repudiation of policies enacted during the Obama years, but has adopted the plan of the Obama White House in combatting the HIV/AIDS epidemic.
The Department of Health & Human Services’ Office of HIV/AIDS & Infectious Disease Policy issued a 69-page progress report indicating the Trump administration has “affirmed its support” for the 2010 National AIDS Strategy, which was issued during the Obama administration and enumerated gay and bisexual men as groups vulnerable to the disease.
“At the start of 2017 there was uncertainty about how the Trump administration would approach HIV and whether the NHAS would continue to guide our nation’s response to HIV,” the report says. “The Trump administration has affirmed its support of the NHAS and its goals, recognizing that adaptation and flexibility may be required. This is necessary in order to respond efficiently and effectively to scientific advances, changes in the needs of people living with and at-risk for HIV, and other factors that drive the response to HIV and AIDS.”
The report also indicates the Trump administration will issue either a new or updated report by 2020 that will reassess the epidemic domestically and make new goals in combatting it. According to the report, work on that updated strategy will begin this year.
“In 2018 we will begin work on a new or updated NHAS that carries forward the theme of a national plan developed with the input of individuals living with HIV and at risk for infection, community groups and national organizations, the faith community, providers from various disciplines, researchers, federal, state, and local governments, and so many others,” the report says. “The new or updated NHAS will also build upon existing knowledge and experiences, set new goals and targets and guide us beyond 2020 to the end of HIV in America.”
The report also includes a timeline of the Trump administration’s effort to combat HIV/AIDS. Starting with the inauguration of Trump in January 2017, the report notes milestones such as an executive order renewing the President’s Advisory Council on HIV/AIDS for another two years and new funding from the Centers for Disease Control for state health departments.
Carl Schmid, deputy executive director of the AIDS Institute, said his organization is on the whole “very pleased” the Trump administration has affirmed the Obama-era National AIDS Strategy.
“We’re pleased that they adopted this,” Schmid said. “We know it was approved by the secretary’s office and that they’re moving forward. Commitment to ending AIDS was in there, which is really important and that they want to also start the process of drafting a new strategy.”
Richard Wolitski, director of the Office of HIV/AIDS & Infectious Disease Policy at HHS, talked about the process that went into the 2010 report, which was updated in 2015, when asked the Trump administration decided to affirm it.
“It was grounded in the best available data and science; the accumulated experience of states, cities and communities responding to HIV; community consultation; and input from people living with HIV and other key stakeholders,” Wolitski said. “It continues to guide domestic HIV policies and programs. This administration is committed to improving the efficiency, effectiveness, and impact of our efforts to achieve the goals of the National HIV/AIDS Strategy.”
For the new strategy in 2020, Wolitski said he had limited information, but said it’s coming out in that year because that’s when the previous report was set to expire.
“The NHAS is updated on a five-year cycle,” Wolitski said “The first National HIV/AIDS Strategy was released in 2010, followed by the current plan which is operative from 2015-2020. We do not have any additional details to share with you at this point.”
The progress report itself enumerates gay and bisexual men among other groups as a population disproportionately affected by HIV/AIDS, as well as transgender women. While progress hasn’t been achieved reducing HIV among gay and bisexual men, the report says the goals have been met in reducing the viral loads for transgender women in HIV care.
• For the goal of reducing the percentage of gay and bisexual men who have engaged in HIV risk behaviors by 10 percent, the report found the number climbed from 34.1 percent in 2013 to 35.2 percent in 2015. The annual target was 33.3 percent.
• For the goal of reducing the disparities in the rate of new diagnoses by at least 15 percent among gay and bisexual men, the report found the disparity steadily climbed from 20.5 to 22.7 in 2015. The annual target was 19.7.
• For the goal of reducing the disparities in the rate for new diagnoses by at least 15 percent among gay and bisexual men, the report found the disparity escalated from 109.4 in 2010 to 118.5 in 2015. The annual target was 105.3.
• For the goal of increasing the percentage of transgender women in HIV medical care who virally suppressed to at least 90 percent, the report found that number steadily increased from 62.2 percent in 2010 to 73.9 percent in 2015. The annual target was 71.9 percent.
“Indicators measuring disparities in new HIV diagnoses did not meet the annual target among gay and bisexual men overall, young Black gay and bisexual men, and among persons living in the southern United States,” the report says. “In contrast to these results, new HIV diagnosis disparities were reduced among Black women and the annual target was met.”
The report indicates goals among gay and bisexual men aren’t met, while progress is made on other goals, such as increasing the number of people who know their HIV status and reducing the number of new diagnoses overall by at least 25 percent. The number of new diagnoses was 43,806 in 2010, but that number fell to 40,040 in 2015, according to preliminary data.
Wolitski said the Trump administration affirmed the strategy’s enumeration of gay and bisexual men because those groups are heavily affected by it.
“The National HIV/AIDS Strategy was drafted to address the HIV-related concerns of all Americans,” Wolitski said. “It is important, however, for the strategy to recognize that certain populations are disproportionally affected by HIV in the United States. As in past reports, this progress report highlights a number of measurable indicators to determine whether the strategy was achieving its objectives, including HIV outcomes related to gay and bisexual men.”
Wolitski also noted gay and bisexual men aren’t the only population enumerated in the report as disproportionately affected by HIV/AIDS.
“The strategy measures outcomes in a number of key groups that bear the greatest burdens of HIV or for whom key results are lagging,” Wolitski said. “Other groups specifically addressed in the 2017 Progress Report include: African-American women, transgender women, youth, people who inject drugs and people living in the southern United States.”
Despite the enumeration of this data, Schmid said the report wasn’t without faults, decrying how it excluded affirmation of the Affordable Care Act. Another absence was information on young gay Latinos, whom he said is another population where HIV/AIDS is “actually going up.”
Schmid also credited the Obama administration for laying the groundwork for the report. All the data, Schmid noted, goes until 2015, which was before Trump took office.
“The data is always lagging, so it doesn’t represent the actual work of progress under the Trump administration,” Schmid said. “They’re just reporting out on what occurred.”
Schmid said the report was expected on World AIDS Day on December 1, but it was only issued recently around Memorial Day. The report since that time has yet to receive significant attention in the media or elsewhere.
But it wasn’t a surprise the Trump administration affirmed the National AIDS Strategy. Assistant Secretary of Health Brett Giroir, Schmid said, informed Congress the Trump administration would continue the Obama-era plan during his confirmation hearing.
“We’ve been hearing positive things from the administration on HIV,” Schmid said. “So, I was obviously pleased…I think it’s important for the community to know that they are moving forward.”
The Trump administration adopts the Obama-era strategy against HIV/AIDS as much of the internal infrastructure against the disease found in the previous administration is not in place. For starters, Trump has yet to appoint a director of the White House Office of National AIDS Policy, which was a position consistently filled in the Obama years.
The President’s Advisory Council on HIV/AIDS, or PACHA, has gone without any members for nearly six months after Trump in December terminated the tenures of the Obama-era members, as first reported by the Washington Blade. Trump fired the remaining members of the council after six resigned in June 2017 over objections to the lack of an HIV strategy.
The most recent budget from the Trump administration for fiscal year 2019 also proposed modest cuts to domestic HIV programs, while making significant cuts to global programs. Congress is expected to unveil its own budget proposal in the coming days, which will address whether they’re affirmed or rejected.
Schmid said he’s heard from the Trump administration they intend to replace members of the President’s Advisory Council on HIV/AIDS “soon, soon, soon.”
“I hope it’s very soon because we need to have that check and that involvement with the community and the administration, and frankly, to keep the pressure on them,” Schmid said.
Wolitski said he had no update on when the administration would reappoint members of the President Advisory Council on HIV/AIDS.
“We don’t have any new information about PACHA appointments, but will share that information once we have it,” Wolitski said.
As for the appointment of a White House AIDS czar, Schmid said the Trump administration seems to have a general practice of decentralization to Cabinet departments.
“As long as the assistant secretary of health has the authority, has the leadership to implement these plans, to convene the different agencies, Cabinet agencies, we’re comfortable with that,” Schmid said.