Wednesday, February 6, 2019

Trump's Ten-Year AIDS Plan: just more bait-and-switch



In his State of the Union Address for 2019, the president read this paragraph:
No force in history has done more to advance the human condition than American freedom.  In recent years we have made remarkable progress in the fight against HIV and AIDS.  Scientific breakthroughs have brought a once-distant dream within reach.  My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.  Together, we will defeat AIDS in America.
I thought it would be interesting to collect the record of the president and his administration on HIV/Aids issues, to give his call some context.

The first thing to surprise me was that in all the tens of thousands of tweets gathered at the Trump Twitter Archive, out of the thousands of issues the president has bloviated on, AIDS got his attention exactly once:


Since he became president, his administration has veered between inaction, indifference, tone-deaf insults, and flurries of makework around World AIDS Day. Here's the record:


Scott A. Schoetes, "TRUMP DOESN’T CARE ABOUT HIV. WE’RE OUTTA HERE," Newsweek, June 6, 2017:
Five of my colleagues and I resigned this week from the Presidential Advisory Council on HIV/AIDS (PACHA).
As advocates for people living with HIV, we have dedicated our lives to combating this disease and no longer feel we can do so effectively within the confines of an advisory body to a president who simply does not care.
The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and—most concerning—pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease.
White House press release, October 2, 2017:  President Trump Continues PACHA
NBC News: "Trump's World AIDS Day proclamation leaves out LGBTQ people," December 1, 2017

"With American Leadership, We Are on the Brink of Controlling AIDS," December 1, 2017 press release on the PEPFAR program in Africa.

Press release, Department of Health and Human Services, "HHS Seeks Nominees for the Presidential Advisory Council on HIV/AIDS," December 1, 2017

Michael Shear and Julie Hirschfeld Davis, "Stoking Fears, Trump Defied Bureaucracy to Advance Immigration Agenda," The New York Times, December 23, 2017:
According to six officials who attended or were briefed about the meeting, Mr. Trump then began reading aloud from the document, which his domestic policy adviser, Stephen Miller, had given him just before the meeting. The document listed how many immigrants had received visas to enter the United States in 2017.
More than 2,500 were from Afghanistan, a terrorist haven, the president complained.
Haiti had sent 15,000 people. They “all have AIDS,” he grumbled, according to one person who attended the meeting and another person who was briefed about it by a different person who was there...While the White House did not deny the overall description of the meeting, officials strenuously insisted that Mr. Trump never used the words “AIDS” or “huts” to describe people from any country. Several participants in the meeting told Times reporters that they did not recall the president using those words and did not think he had, but the two officials who described the comments found them so noteworthy that they related them to others at the time. 
Ben Guarino, "Trump administration fires all members of HIV/AIDS advisory council,"  The Washington Post, December 29, 2017:
The remaining members of the Presidential Advisory Council on HIV/AIDS were fired en masse this week.
Months after a half-dozen members resigned in protest of the Trump administration's position on health policies, the White House dismissed the rest through a form letter.
The notice “thanked me for my past service and said that my appointment was terminated, effective immediately,” said Patrick Sullivan, an epidemiologist at Emory University who works on HIV testing programs. He was appointed to a four-year term in May 2016.
The council, known by the acronym PACHA, has advised the White House on HIV/AIDS policies since its founding in 1995. Members, who are not paid, offer recommendations on the National HIV/AIDS Strategy, a five-year plan responding to the epidemic.
The group is designed to include “doctors, members of industry, members of the community and, very importantly, people living with HIV,” said Scott Schoettes, a lawyer with the LGBT rights organization Lambda Legal. “Without it, you lose the community voice in policymaking.”
Schoettes was among those who quit in June, and he went out with a fiery commentary in Newsweek. “The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and — most concerning — pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease,” he wrote in the column.
“We tried to stick it out,” Schoettes told The Washington Post on Friday. “The fact is you’re dealing with a public health issue. It’s not partisan at all.”
But the “writing was on the wall,” he continued. The Office of National AIDS Policy, established in 1993 during the Clinton administration, has not had a director since Donald Trump took office. “The tipping point for me was the president's approach to the Affordable Care Act,” Schoettes said. “It is of great importance for people living with HIV like myself.”
The council's executive director, Kaye Hayes, confirmed in a statement that all remaining 10 council members had received letters Wednesday “informing them that the administration was terminating their appointments.”
She did not address when the administration might begin to make new appointments to the council, which can number up to 25 members. Its most recent meeting took place in August, Sullivan said, and by November, an archived version of PACHA’s website shows the group was down to 10 members and two staffers.
The website, which says it was updated Thursday, showed two staffers and no council members Friday...
David Smith, "Bill Gates: Trump twice asked me the difference between HIV and HPV," The Guardian, May 18, 2018

Jesse Milan, Jr, "Trump To Reallocate HIV Funds To Pay for Family Separation," Plus Magazine, July 11, 2018

President Trump, Proclamation of World Aids Day, November 30, 2018: still no mention of LGBT Americans.

Chris Johnson,  "For World AIDS Day, Pence praises HIV programs Trump sought to cut," LA Blade, December 4, 2018:
With World AIDS Day approaching, the White House recognized the occasion on Thursday with an event hosted by Vice President Mike Pence, who during his remarks praised HIV/AIDS programs Trump sought to cut during his administration.
Crediting President Trump with bringing a “renewed energy and focus” against HIV/AIDS, Pence made faith-based organizations’ work a cornerstone of his remarks, saying those efforts have made the United States “closer today than ever before to ending the AIDS crisis in our time.”
“Now, the credit for this achievement is widely shared, but faith-based organizations and faith communities like those represented here have played a preeminent role,” Pence added. “And the leaders in this room have inspired countless others to put hands and feet on their faith and bring hope and healing to literally millions of people around the world suffering with HIV/AIDS.”
Pence said the Trump administration will invest $100 million in new resources to expand our engagement with faith-based organizations and communities of faith “on the frontlines of the fight against HIV/AIDS.”
“This new investment of $100 million in faith-based organizations will increase the funding to those organizations by a full third,” Pence said. “And this will make a world of difference, we believe, in countless lives affected by this disease.”
Pence acknowledged HIV/AIDS has infected more than 77 million people worldwide and claimed no less than 35 million lives, devastating countless families and communities around the world.
“In response to this health crisis, the American people did as we always do: We mobilized the resources of the nation to fight this epidemic, not just in our own nation, in our communities, but ultimately in every corner of the world,” Pence said.
But no where during his speech did Pence mention the disproportionate impact of HIV/AIDS on LGBT people, even though the LGBT community has endured the brunt of the epidemic. In 2016, gay and bisexual men accounted for 67 percent of the 40,324 new HIV diagnoses in the United States, according to the Centers for Disease Control. Pence’s omission is similar to the lack of mention of LGBT people in Trump’s World AIDS Day statement last year.
Pence also touted the Ryan White CARE Act, a federal program that provides health coverage for low-income people with HIV/AIDS, asserting the program “continues to provide vital medical services to more than 1.1 million people in the United States living with HIV.”
The vice president also praised PEPFAR, a U.S. initiative that seeks to distribute antiviral drugs globally, primarily in Africa. Pence recalled his support in 2003 as U.S. House member for the program when then-President George W. Bush created the initiative.
“Thanks to the generosity of the American people and the efforts of the organizations that are so well represented here today, it’s humbling to think, in just 15 years, this American effort has helped save more than 17 million lives and prevented millions more from contracting HIV/AIDS to begin with,” Pence said. “And AIDS-related deaths have been cut in half since their peak in 2004.”
Touting the work of the Trump administration, Pence pointed out the State Department last year developed a PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control and said Trump would soon sign a bill reauthorizing the program in the aftermath of congressional approval this week.
“We’ve made great progress, but our work is far from over,” Pence said. “And as evidenced by the Congress’s action and the president’s renewed leadership, that work will continue until we end the scourge of HIV/AIDS once and for all.”
It should be noted Trump’s most recent budget proposal for fiscal year 2019 called for a drastic reduction of PEPFAR, down from $4.65 billion in FY-17 to $3.85 billion. That would have been a 17 percent reduction compared to existing funding levels. The budget request also sought a decrease of $2.26 billion in funds for the Ryan White Care Act, which is a 2 percent reduction compared to existing funding levels.
Federal Register, "Meeting of the Presidential Advisory Council on HIV/AIDS," December 7, 2018:
The Council meeting is scheduled to convene on March 14-15, 2019 from 9:00 a.m. to approximately 5:00 p.m. (ET) on March 14 and from 9:00 a.m. to 1:00 p.m. (ET) on March 15. Please note that on March 14, the meeting will include a closed session from 9:00 a.m. to 12:00 p.m. This portion of the meeting will be closed for administrative briefings to be presented to the new Council members. The meeting will be open to the public from 1:00 p.m. to 5:00 p.m. on March 14 and from 9:00 a.m.-1:00 p.m. (ET) on March 15.
HIV.gov page, PACHA Members & Staff, January 28, 2019, lists the commission's two new co-chairs but no commission members.

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