In 1997, the same year that President Bill Clinton challenged the nation to develop a vaccine for HIV within a decade, Donald Trump, the real estate developer and fixture of New York’s tabloids, joked about a deterrent of his own.
“Hey, Lady Di, would you go to the doctor?” Stern joked, prompting Trump’s pretend directive. “Go back over to my Lexus, because I have a new doctor,” Trump said, acting out a dialogue with the recently deceased princess. “We wanna give you a little checkup.”
On Tuesday, the president is expected to issue a directive on the same topic. But it won’t be make-believe, and it will come from the speaker’s rostrum in the venerable House chamber.
In his second State of the Union address, Trump plans to announce a national commitment to ending the transmission of HIV in the United States by 2030.
The plans were welcomed by Cecilia Chung, co-director of policy and strategic projects at the Oakland-based Transgender Law Center. She previously sat on the Presidential Advisory Council on HIV/AIDS — a body that went unstaffed for a year, after all of its members finished their terms, resigned or were fired in 2017.
She also said she was surprised, as well as fearful, that the president was the wrong messenger, “because his administration’s policies and his prior comments point in the opposite direction.”
“I’m afraid that the promise will be in vain,” the legal and medical advocate said in an interview with The Washington Post.
Chung enumerated policies that she said ran counter to the safety of people living with the virus that causes AIDS, including changes to Medicare’s Part D prescription drug program allowing insurers to stop covering drugs that treat HIV; the quest to hobble the Affordable Care Act; and stepped-up immigration enforcement, which Chung said keeps at-risk and undocumented communities from seeking treatment.
Her skepticism was shared by the Human Rights Campaign, the nation’s largest LGBT rights organization, which criticized the Trump administration on Monday for spending two years “undermining advocates' efforts.”
“This administration simply cannot achieve this goal while, at the same time, charging forward with attacks on health care for the communities most impacted by HIV,” David Stacy, the organization’s director of government affairs, said in a statement. “The American public deserves a real commitment from their government to end the HIV epidemic.”
The White House didn’t respond to a request for comment late Monday. Trump has not appointed a director of the Office of National AIDS Policy, and his administration has no website for the leaderless domestic policy unit, which is meant to work with the presidential advisory council. Archived sites remain from the Obama administration, from George W. Bush’s time in office and from the Clinton years.
Trump has not displayed a high level of understanding of HIV, even though he reportedly used to require women to take a test for the virus before he took them out on the town. The demand didn’t just apply to a hypothetical dalliance with Princess Diana. “I have been known to say that to women,” he told the Associated Press in June 1991, shortly after reaching a settlement in his divorce proceedings with his first wife, Ivana.
In more recent years, he twice asked Bill Gates, the Microsoft executive and co-founder of the Bill & Melinda Gates Foundation, what distinguished HIV from HPV, as the philanthropist told foundation staff in video footage obtained by MSNBC last spring. In a brief clip, Gates can be seen recounting two meetings with Trump following his election, one with the president-elect in December 2016 at Trump Tower and another in March 2017 at the White House.
“Both times he wanted to know if there was a difference between HIV and HPV, so I was able to explain that those are rarely confused with each other,” Gates said, his lips curling into a slight smile as the audience laughed. Human papillomavirus, or HPV, which is a common virus transmitted through intimate skin-to-skin contact and through sex, can cause genital warts and cancer when it does not go away on its own. There are effective vaccines. Human immunodeficiency virus, or HIV, which is spread through body fluids during sex or needle and syringe use, attacks the immune system. There is no cure, but the virus can be controlled using antiretroviral drugs.
Shortly after Trump reportedly inquired about the difference between the two viruses, his White House unveiled a budget proposal for the 2018 fiscal year that was rebuked by health groups for endangering both domestic and global HIV prevention efforts. Lawmakers minimized the fiscal blow, which would have included $149 million in prevention programs from the budget of the Centers for Disease Control and Prevention and an entire Health and Human Services initiative focusing on minority populations — groups that suffer from a disproportionate share of new diagnoses. The cuts appeared again in the budget proposal for 2019, again drawing condemnation and again mostly failing to materialize in the compromise that made it through Congress.
The Human Rights Campaign argued that Trump’s views on HIV appeared consistent with those held by other members of his administration. When he was governor of Indiana, Mike Pence, now vice president, presided over the state’s worst HIV outbreak in its history in 2015, which intensified as Pence delayed authorizing needle exchanges because of moral objections. The former Indiana congressman has also been at the forefront of GOP efforts to defund Planned Parenthood, access to which has been linked by public health researchers to fewer HIV diagnoses.
Critics of the administration also pointed to the record of Trump’s nominee for attorney general, William P. Barr. When he was the nation’s top law enforcement officer under President George H.W. Bush, he oversaw the detention of several hundred Haitian refugees in what a federal judge in New York described as an “HIV prison camp."
Barr defended his actions at his confirmation hearing last month. “We were sort of in a Catch-22,” Barr said, pointing to a restriction, lifted in 2010, that barred people living with HIV from entering the United States. The attorney presented himself as a more enthusiastic advocate for the practice in a 2001 interview with the University of Virginia’s Miller Center. He recalled how military and national security officials, including then-Joint Chiefs of Staff Chairman Colin Powell, had pressed him on the use of Guantanamo Bay.
“Their position was, Guantanamo is a military base, and why were all these people here, the HIV people, all these other people? How long are you going to be on our property with this unseemly business?” Barr said. “I’d say, ‘Until it’s over. But we’re not bringing these people into the United States. This is a very convenient base outside the United States, and it’s serving a good function.’ ”
In a 1995 article in the Catholic Lawyer, the attorney lamented that the government’s answer to “disease and illegitimacy” was “the distribution of condoms” rather than “sexual responsibility.”
As Barr was denouncing public health interventions and extolling the virtues of the two-parent family, the Presidential Advisory Council on HIV/AIDS was taking shape under Clinton, set up to advise the White House and HHS officials on their response to the AIDS crisis. The unpaid members, who serve terms of as many as four years, offer input on the National HIV/AIDS Strategy, which was last updated in 2015 and lasts through 2020.
An exodus of six members in the summer of 2017 depleted the council’s ranks.
“Trump doesn’t care about HIV. We’re outta here,” one of the departing members, Scott A. Schoettes, a Lambda Legal attorney living with the virus, wrote in a piece for Newsweek.
“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,” he wrote. “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.”
Chung’s term expired the same year, the transgender rights advocate said. By the end of 2017, the council was down to 10 members, who were dismissed en masse through a letter thanking them for their service.
For a year, the advisory board had zero members, as the administration remained mum about its plans.
In December 2018, HHS Secretary Alex Azar announced the appointment of two new co-chairs. In remarks at the National Ryan White Conference on HIV Care and Treatment, he spoke about plans to update the national strategy for 2020. The opioid crisis, he said, “has made injection drug use more common,” creating new challenges for arresting the spread of HIV and other infectious diseases.
HHS also announced that a meeting of the council would take place March 14 and 15 — less than six weeks after the State of the Union address. The public meeting would tackle recommendations, according to an agenda, with the lofty ambition of “prevention, treatment and cure of HIV disease and AIDS.”
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