The president who fired his HIV/AIDS advisory council a year ago and has no one working in the Office of National AIDS Policy pivoted on Tuesday night, pledging to focus fresh money and knowledge to eradicate the epidemic.
In his State of the Union address, President Trump went beyond the promises of any of his predecessors since AIDS appeared as a deadly scourge nearly four decades ago. He announced a strategy to stop the spread of HIV by 2030 by concentrating as-yet-unspecified resources on 48 counties and other “hot spots” where half the nation’s new infections occur.
“Scientific breakthroughs have brought a once-distant dream within reach,” the president said in the latter part of his annual agenda-setting speech to both chambers of Congress. “Together, we will defeat AIDS in America and beyond.”
The president did not identify how much additional money the government would devote to the effort, saying only that his budget “will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”
Health and Human Services Secretary Alex Azar said Tuesday that the sums requested by several of his top public health officials to accomplish this goal will be in the president’s budget next month. He, too, did not specify an amount.
The HIV/AIDS pledge was part of a smorgasbord of health policy issues that Trump wove briefly into a speech portrayed by the White House as an attempt to find ideological common ground amid a moment of bitter partisanship that led to the longest government shutdown in history — and a reopening only guaranteed to last until mid-month.
In a gesture to social conservatives key to his political base, Trump broached the perennially divisive issue of reproductive rights by challenging the legality of late-pregnancy abortions — an issue lately considered in the Virginia and New York legislatures.
“To defend the dignity of every person,” the president said, embracing the position of abortion opponents that life starts at conception, “I am asking the Congress to pass legislation to prohibit the late-term abortion of children who can feel pain in the mother’s womb.”
Such a proposal has almost no chance of passing a politically split Congress, but it delighted Trump’s ideological allies.
Compared with other presidents, Trump “has been more passionate in talking about the unborn, but he’s also been able to amass a record of backing that up,” said Tony Perkins, president of the Family Research Council, who said he was one of about a dozen conservative leaders invited to review the speech with the president and Vice President Pence on Monday night.
Leana Wen, president of Planned Parenthood Federation of America, said in a statement: “Tonight, we heard the president make inaccurate and deliberately misleading claims about safe, legal abortion and bills that are meant to protect women’s access if Roe v. Wade were to be overturned — something that is increasingly likely.”
The president also reiterated his determination to constrain the price of prescription drugs. He gave his administration credit for what he contended was the largest slowing of drug prices last year in nearly a half-century. In an allusion to an administration proposal last week to end the widespread practice of passing drug rebates to middlemen, Trump said that drug manufacturers, health insurers and hospitals should “disclose real prices to foster competition and bring costs way down.”
On the other contentious health-care issue that has dominated his attention, the Affordable Care Act, Trump devoted a single sentence. “We eliminated the very unpopular Obamacare individual mandate penalty,” he said, referring to Congress’s elimination of the federal fine for people who flout the ACA’s requirement that most Americans carry health insurance. That change took effect last month.
The president made no mention of several other parts of the health-care law that his administration has worked to undermine through executive powers.
Trump did not elaborate on his strategy to erase HIV. But Azar, the HHS secretary, said in an interview that the plan grew out of several months of work by a team of leaders. They include Anthony Fauci, director of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases and a pioneer in AIDS research, and Robert Redfield Jr., a longtime AIDS researcher in the military and in the University System of Maryland before he became director of the Centers for Disease Control and Prevention in March.
Azar said that he presented the idea to Trump, who recognized the goal of eliminating HIV infections as “one of the most important moments in public health in the United States,” as the secretary put it.
After the president disbanded the HIV/AIDS advisory council in late 2017, Azar announced in December the appointment of two new co-chairs, who are scheduled to start meeting next month and are the only members so far. HHS also is creating a hub of AIDS advisers.
Not all leaders in the fight against AIDS welcomed the initiative. “President Trump once again presented a broad strokes narrative that people with HIV and AIDS, including LGBTQ Americans, simply can’t trust,” Sarah Kate Ellis, president of the advocacy organization GLAAD, said in a tweet.
Longtime AIDS activist Carl Schmid, deputy executive director of the AIDS Institute and one of the two new co-chairs of the White House’s HIV/AIDS advisory council, called the administration’s plans “a bold initiative.” But, he added, “there is a lot of distrust in the HIV community, and rightly so. In the next couple of days and weeks, the administration will have to prove themselves that they are serious about this. . . . The additional resources will be needed.”
The administration’s plan follows a 2010 HIV/AIDS strategy that the Obama administration devised and updated five years later.
Fauci said Tuesday that the new plan is different in its geographic concentration and because of significant research developments from the past few years. Recent studies have shown that people at greater risk of infection — such as men who have sex with men — can lower their likelihood of contracting the virus markedly if they take daily pre-exposure HIV medicines known as PrEP. Other studies have documented that HIV-infected people whose viral load is reduced through medicine to undetectable levels have little risk of transmitting the infection.
Such developments have reduced new infections in the United States to about 40,000 per year, but that figure has plateaued, said Brett Giroir, HHS assistant secretary for health. “We really need to have a push.”
To do that, Azar and his colleagues said, researchers have studied the geography and demographics of HIV and found that new infections are concentrated in 48 counties, the District of Columbia, Puerto Rico and seven states — primarily across the South — where a large share of HIV cases are in rural areas. The new initiative will start by focusing on those places.
Teams of HIV health workers — CDC employees or working through CDC grants — will fan out into such communities, trying to encourage residents at risk of HIV to get tested and to start preventive medicine or, if they test positive, to go on drug regimens to lessen their chances of getting sick or spreading the virus. The goal is to reduce new HIV infections by 75 percent within five years and 90 percent over the coming decade.