Donald Trump met the end of 2017 with one last act of destruction. He fired 16 advisors on HIV/AIDS, leaving the administration with no expert guidance on the issue. But that’s far from the only attack that Republicans launched on people with HIV in 2017. Aided by political cronies, Trump spent his first year in office decimating public health programs in America and around the world.
The firing of the HIV advisors is a major setback in addressing the epidemic. But by far, the most damaging proposal yet was Trump’s outlandish proposed federal budget.
Federal policy had made significant progress under Clinton and Obama, after suffering from the callous indifference of Reagan and the absurd abstinence-only approach of Bush. While President Obama was in office, infection rates dropped by 18%, thanks in part of PrEP treatment (which almost completely prevents infection) and new rules for insurance companies that previously withheld care.
Under Trump, however, the White House proposed eliminating over a billion dollars’ worth of HIV programs around the world. The Centers for Disease Control faced a 20% cut to its HIV program, housing programs for people with HIV faced $26 million in reduction and there were even further reductions to programs that train HIV health providers. Experts predicted those cuts could lead to a million deaths.
Trump’s cuts would, of course, disproportionately affect low-income Americans, for whom care was unobtainable before Obamacare. Republicans in Congress seemed ready to go along with that plan, suggesting an reduction of of $5 billion less than last year. Congressional Republicans suggested cuts to programs that address disproportionate infection among people of color, to STD prevention and to family clinics.
What’s more, the Republican attempts to dismantle Obamacare means that fewer people will be able to afford insurance — which means dooming them to a life without health care.
The advisory council that Trump disbanded was only able to meet twice all year, with no sign that the administration was paying any attention. In fact, numerous members had already quit, citing officials’ disinterest in their work. Trump never bothered to name a director for the Office of National AIDS Policy, and the administration has been re-allocating funding away from science-based programs and into proven failures like abstinence-only.
This comes at a particularly dangerous time, as the opioid epidemic — fueled by drug companies that push doctors to prescribe unnecessary painkillers — could trigger a rise in injection-based HIV transmission. Trump has claimed that he plans to address the opioid crisis, but so far his only action has been declaring an emergency, which sets aside a negligible amount of funding.
So what happens now? Although the government has invited people to apply for posts on the advisory council, there’s no reason to believe those posts will be filled. The administration has systematically eliminated funding for HIV programs, and no legitimate expert would support Republicans’ anti-science policies on sexual health. This could mark the first time since the deadly Reagan era when the federal government has no expert advice on AIDS.
For his part, Trump has only fleetingly addressed the epidemic. In one 2017 meeting, according to The New York Times, he pushed to restrict immigration from Haiti, claiming that Haitians “all have AIDS.”