By Joseph Jones
During his State of the Union address, President Donald Trump vowed to end the HIV transmissions by 2030, an ambitious promise that was met with thunderous applause. The “once-in-a-generation” plan drafted by the U.S. Department of Health and Human Services (HHS) will focus on communities in 20 states with the highest number of HIV infections. The plan has four key strategies: Diagnose, treat, protect, and respond.
The HHS will introduce “programs to increase adherence to HIV medication, help people get back into HIV medical care, and research innovative products that will make it easier for patients to access HIV medication.” They will also “implement routine testing during key healthcare encounters and increase access to and options for HIV testing.” Additionally, they will “implement extensive provider training, patient awareness and efforts to expand access to PrEP.” Finally, they will also work to “ensure that states and communities have the technological and personnel resources to investigate all related HIV cases to stop chains of transmission.”
Another element of the plan will be the establishing of a “HIV Healthforce” that will be “a boots-on-the-ground workforce of culturally competent and committed public health professionals that will carry out HIV elimination efforts in HIV hot spots.” All of these strategies will play a pivotal role in reaching HHS’ goal of reducing new infections of HIV by 75% in five years and at least 90% reduction in 10 years.
This bold proposal has serious potential in fighting an epidemic that desperately needs addressing. The CDC estimates that approximately 1.1. million people in the U.S. were living with HIV at the end of 2015. Data from the organization found that 15%, or roughly 1 in 7 people were unaware of their status. However, HIV advocates are skeptical about how strong of a commitment the President has to ending the epidemic, due to past actions which spurred ire within communities and organizations already working to fight HIV/AIDS.
In May 2017, the Trump administration announced a budget proposal which would cut funding for HIV programs such as PEPFAR (President's Emergency Plan for AIDS Relief), the Ryan White Program, and the Global Fund. Since then, in December of 2018 Trump signed the PEPFAR Extension Act of 2018, which provides additional funding for PEPFAR for the next five years.
In June 2017, six members of the Presidential Advisory Council on HIV/AIDS resigned, due to what they perceive a lack of commitment on the part of the President. One of the members that resigned, Scott Schoettes, the HIV Project director at Lambda Legal, wrote in a statement, "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." In December 2017, Trump fired all of the 16 remaining members of the council, with no explanation given, and their replacements were not sworn in until late January.
The Human Rights Campaign was also highly critical of the Trump administration sudden interest in tackling the issue of HIV. In a press release, the HRC includes a statement from David Stacy, HRC Director of Government Affairs. Stacy says, “If this administration wants to combat the spread of HIV, they need to immediately end their efforts to cut Medicaid funding, undermine the Affordable Care Act and license discrimination against the most at-risk communities when they seek healthcare. 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. The American public deserves a real commitment from their government to end the HIV epidemic.”
GLAAD was similarly unimpressed with the announcement. Sarah Kate Ellis, president and CEO of GLAAD said in a statement “Unfortunately, President Trump’s announcement has already been undermined by his own Administration’s record and rhetoric, and there is no reason for LGBTQ Americans or anyone else to see this as anything more than empty rhetoric designed to distract from what’s really happening behind the scenes every day.”
Because of countless examples of the Trump administration undermining efforts to fight the HIV epidemic, the HIV/AIDS activist organization ACT UP NY, offered a laundry list of radical actions that must be taken.
The list includes:
· Stopping the criminalization of those living with HIV (29 states have HIV-specific criminalization laws)
· Abolishing ICE (13 HIV+ immigrants have died in ICE detention since 2002)
· Increasing housing protections and HOPWA (Housing Opportunities for Persons With AIDS) funding for people living with HIV
· Having the administration repeal SESTA/FOSTA
· Increased protections of sex workers, increasing employment protections for individuals living with HIV,
· Having the U.S. expand healthcare for all including Medicare and Medicaid expansion
· A universal plan to rollout PrEP and PEP access
· A federal rollout of U=U (Undetectable = Untransmittable) education and funding.
One blockage to rolling out access to PrEP is due to one of the manufacturers use of patents to maintain control of the market for their medication. Gilead Sciences currently owns the patents on four AIDS treatments and also makes a large effort to prevent generic versions of their drugs from entering the market. Specifically, Truvada, Gilead’s brand name pre-exposure prophylaxis, also known as PrEP, that when taken daily, is up to 99 percent effective in preventing HIV infection. Gilead has inflated the price of Truvada by more than 25, 000%. An article from NBC News says, “When Truvada was approved as PrEP in 2012, a month’s supply costs roughly $1,200. The price has inched up in the six years since, and today, the average retail price in a U.S. pharmacy is about $2,000 a month, according to GoodRx.”
According to PrEP4ALL, an activist organization part of the #BreakThePatent moment, say that the drug costs less than $6 a month to produce, and in other countries, generic Truvada costs less than $100 a month. While some people, like myself, receive PrEP for free through their insurance and co-pay assistance cards, this option is not available for everyone. Because of the high cost of PrEP, many of the at-risk populations for contracting HIV, such as people of color, the LGBTQ community, HIV-negative people in sexual relationships with HIV-positive partners, and injection drug users are unable to afford PrEP and therefore continue to put themselves at risk of being infected with the virus.
PrEP4ALL estimates that less than 10% of these populations are currently taking the potentially life saving medication. The Centers for Disease Control and Prevention (CDC) estimated 1.1 million Americans are “at substantial risk for HIV and should be offered PrEP.” Despite this extremely high number of people at risk, Gilead Sciences estimates just 167,000 people are currently taking the drug.
PrEP4ALL have identified a specific act which gives the government the authority to break the stranglehold grip Gilead currently has on the patent for Truvada. The Bayh-Dole Act of 1980, also known as the Patent and Trademark Law Amendments Act, grants the government “March-in rights” to force a patent holder “to grant a nonexclusive, partially exclusive, or exclusive license in any field of use to a responsible applicant or applicants” if “such action is necessary to alleviate health or safety needs which are not reasonably satisfied” by the patent holder. PrEP4ALL argues that HIV/AIDS is a public health crisis that Gilead has failed to properly address by owning the patent for Truvada and increasing the price by more than 25,000%. If the Trump administration and the FDA were to “March-in” with the power of the Bayh-Dole Act, they could break the patent for Truvada and allow other manufacturers to create generic PrEP, significantly lowering the price for consumers, and allowing millions to have access to the medication.
Trump is a wild card who has flip flopped on so many different positions, with the HIV epidemic being no exception. While there are many indications that Trump has no vested interest in properly addressing the epidemic, the recent pledge to reduce HIV transmissions perhaps is a sign that Trump is turning over a new leaf. Is Trump ready to actively make ending the HIV epidemic a top priority of his Presidency? Only time will tell if Trump will adopt effective long- term solutions this public health crisis. Hopefully, the administration will seek the consultation of advocates and organizations who have a long history of working tirelessly on behalf of those living with HIV and to try and end the epidemic.
The way the administration approaches this issue will be a major part of Trump’s legacy, and so far, his track record is very poor. The LGBTQ community has a long history with the HIV/AIDS crisis, and governments and health agencies who failed to properly handle the epidemic. Because of this history, the community are uncomfortable with putting their trust in the hands of Trump, a President who has been no ally to the community, despite campaign promises to do so. If the President says he wishes to end new HIV transmissions by 2030, then we must hold the administration accountable every step of the way to ensure that this goal is feasible. We cannot allow this to be yet another empty campaign promise that the President has made to the LGBTQ community. The ACT UP slogan “silence=death” was starkly true when the epidemic was at its peak in the 1980’s, and it still rings true today in 2019.