In his State of the Union speech last night, Donald Trump made a bold promise to end HIV in the US by 2030. Not much is known about his strategy, but a plan to spend the first five years focusing on communities in the 20 states with the most HIV infections is being floated around.
“In recent years we have made remarkable progress in the fight against HIV and AIDS,” Trump said in his speech. “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.”
The goal is ambitious but it is achievable if sufficient work is put in. However, many are skeptical about whether the efforts and money needed to take on the challenge will actually be put forward. It could just turn out to be more empty rhetoric from Trump's administration, another lie to add to the over 8,400 lies Trump has told since he took office two years ago.
Activists, researchers, and people living with HIV have many reasons not to trust Trump and his administration when it comes to HIV. Trump defunded HIV research, after all. Last February, Trump fired his 16-person HIV/AIDS advisory panel for no reason. The new co-chairs were only sworn in last week and the first meeting won’t be until mid-March. Recently the Fenway Institute published a report lambasting the administration, showing how they constantly, carelessly, and callously failed the most vulnerable LGBTQ+ people living with HIV.
“In 2018 the Trump Administration continued to advance discriminatory policies that undermine the ability of LGBT people to access health care and other services,” the report states. “The Trump Administration promoted religion-based discrimination against LGBT people, eliminated critical nondiscrimination protections, and appointed federal judges who oppose LGBT equality.”
There is also no reason to believe that Vice-President Mike Pence actually has a genuine interest in fighting HIV. While governor of Indiana in 2015, he oversaw cuts to public health funding that led to the state’s worst HIV outbreak ever. He also argued for abstinence-only sex education (not-so-fun fact, it doesn't work!) and has previously supported federal funding for conversion therapy.
In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) proposed the 90-90-90 target. They hope that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people diagnosed with an HIV infection will receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression. This is key to end HIV and, as cities like London have demonstrated, it is achievable.
In the US, it is estimated that only half of people living with HIV are virally suppressed. And this is not good. People on antiretroviral drugs whose viral load is undetectable cannot transmit the virus. U=U, undetectable is equal to untransmittable. So it is important to consider that while the goal is achievable, given that access to antiviral drugs, preventative drugs like PrEP (pre-exposure prophylaxis), and even condoms are not equal in the US, there may still be many hurdles to overcome.
Stigma, racial, homophobic, biphobic, and transphobic discriminations continue to stop people from accessing life-saving drugs. It is no surprise that HIV thrives in the poorest and most marginalized communities. Trump's administration has proposed and championed discriminatory and racist policies and gutting the Affordable Care Act. If they truly want to end HIV they need to expand Medicaid, making PrEP widely available and cheaper, invest in local health clinics, and financially support community organizations, especially the ones focusing on intersectional identities. And it goes without saying that there should be continued support for research into better treatments, cures, and even potential vaccines.
We sincerely hope that the administration truly intends to achieve this goal, but we are not willing to give preemptive kudos without evidence of concrete commitment.
