Here’s the big lie behind Trump’s reported plan to end the spread of HIV

Here’s the big lie behind Trump’s reported plan to end the spread of HIV
White House

At Tuesday's State of the Union, President Donald Trump intends to announce his administration's goal of ending transmission of HIV in the United States by 2030, according to Politico.

The report explained:

The strategy has been championed by top health officials, including HHS Secretary Alex Azar and CDC Director Robert Redfield.

While Trump’s plans for the address remain fluid — and one official cautioned that the speech is not finalized — HHS has pressed the White House to ensure the HIV strategy is highlighted on Tuesday night, said two individuals. The agency is also planning a broader rollout this week.

While it may sound bold, experts believe it's an achievable end — if politicians actually follow through. Treatment to reduce HIV transmission has flourished in recent years, and public health advocacy has been successful in curtailing the virus's spread. Vox's Julia Belluz spoke to five experts about the possibility of stopping HIV, and they argued that we already have the tools necessary for the task — we just need to use them. The World Health Organization has similarly pledged to end AIDS, the devastating disease caused by HIV, by 2030, though it says that it is not yet on pace to meet that goal.  President Barack Obama had said that an "AIDS-free generation" was within reach in 2014.

“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, told the health news outlet STAT in a September article. “We’ve invested in it. Let’s put it into action.‘’

But Trump is a known liar, so any of his promises should be met with skepticism. And on this front, there is good reason to doubt the administration's commitment to public health.

One is Vice President Mike Pence. When an outbreak of HIV hit Indiana during his time as governor, Pence was originally deeply resistant to a needle-exchange program that could fight injection drug-related transmissions. Eventually, he relented and agreed to allow the program to move forward, and it effectively ended the outbreak. But Pence made clear that he had strong moral objections to the policy and only agreed given the acute nature of the crisis. It's not obvious, should he ever become president, that he would be committed to the long-term policies needed to fight HIV.

More importantly, though, the Republican agenda is fundamentally at odds with one of the key strategies for ending HIV transmission: expanding health care coverage. Under Trump, the number of uninsured people has risen by 7 million people, according to Gallup, due in part to his war on Obamacare. And the party is committed to fighting the expansion of Medicaid, the program best suited to reach many members of vulnerable populations who might not otherwise get preventative care or treatment for HIV, which is key to reducing its prevalence.

Belluz explained:

People need access to the health system to reap the rewards of these discoveries and to drive down infection rates. There’s one simple way to do that, HIV and public health experts say: expand access to Medicaid.

“New infections are concentrated in the southern US,” Jeffrey Crowley, Georgetown Law professor and a former director of the White House Office of National AIDS Policy, pointed out. “And it’s the part of the country that’s least likely to expand Medicaid.”

The details of Trump’s HIV plan are still murky. Broadly, the administration is expected to take a “treatment is prevention” approach by calling for greater use of HIV medications that reduce the risk of spreading the virus. They’re also expected to focus on communities in about 20 states with the most widespread HIV transmission.

But, said Gonsalves, “If Trump was interested in ‘ending AIDS,’ he’d have to support Medicaid expansion and fix the flaws in the ACA rather than tearing it all down.”

Using the State of the Union to announce bold public health objectives can be a wise political move, and it would be a boon for the country generally if politicians cared more about fighting disease and providing access to medical care. But like the administration's putative efforts to fight the opioid epidemic, any plan to actually tackle the problem of HIV needs to extend health coverage to more people, not fewer. This is fundamentally in tension with a key pillar of the GOP's ideology.

And despite Trump's promise to deliver a health care plan that would provide cheaper, better coverage to every American, he never had any intention of actually achieving this goal. Like the Republican Party as a whole, he has no interest in making health care more accessible. So any claim to have a serious desire to reduce AIDS, or overdose deaths, or any other health crisis in the United States, is at its core a lie.


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