This is War.
Late yesterday, media outlets began reporting that the Trump administration has fired all members of the Presidential Advisory Council on HIV/AIDS (PACHA), which advises the Department of Health and Human Services and the President on policies and programmatic priorities relevant to the domestic and global HIV epidemic. This news follows last week’s media accounts that alleged Trump had claimed Haitians bound for the U.S. “all have AIDS,” indicating that his understanding of HIV is likely racist, xenophobic, and stuck somewhere in the early 1980’s.
The dismantling of the current Council comes after six PACHA members publicly resigned in June, citing the administration’s repeated advancement of legislation harmful to communities affected by HIV and dedication to dismantling the Affordable Care Act, which significantly expanded access to lifesaving healthcare and medications for people living with HIV.
It’s not unusual for a sitting Administration to dismiss advisory body members appointed by a predecessor – in fact, I had the privilege of serving on President Obama’s PACHA for four years following his dismissal of members appointed by George W. Bush. During those years, from 2010-2014, the PACHA oversaw the creation and enactment of the first ever National HIV/AIDS Strategy, an ambitious plan to address the domestic HIV epidemic; helped create a federal interagency working group on the intersections between HIV and violence against women; and passed progressive resolutions, such as one which demanded that laws criminalizing people with HIV be addressed at the state level. That PACHA was diverse; comprised of stakeholders ranging from faith leaders to business representatives, policy experts and scientists, with relatively strong representation by people living with HIV, LGBTQ communities, and Black leaders. Despite the fact that this is not an unusual development, in the context of the Administration’s other actions, those of us living with HIV and working in communities most affected by HIV should be extremely concerned by the news that PACHA members have been dismissed.
HIV is still a crisis in the U.S. today, with over a million people currently living with HIV and Black Americans, gay and bisexual men, and transgender women especially affected by the epidemic. Yet the administration has failed to appoint anyone to fill vacancies in the Office of National AIDS Policy (ONAP) in its first year. During the Obama administration, the director of the White House Office of National AIDS Policy served on the Domestic Policy Council, overseeing disability and health policy issues for the nation, and ensuring that HIV issues were addressed at the very highest levels of government. That PACHA served as a direct liaison between the public and the ONAP Director, as well as the Secretary of Health and Human Services, bringing concerns raised in communities relevant to the HIV epidemic to the attention of federal agencies and the White House. The PACHA helped ONAP convene expert consultations on key populations and issues, including youth, people of trans experience, women, Black and Latinx Americans, men who have sex with men, employment opportunities for people living with HIV, and stigma and discrimination. These consultations were designed to advance HIV-related policies and programmatic priorities addressing specific concerns and communities.
Earlier this month, multiple sources reported that the administration appears to be pressuring federal agencies including the Centers for Disease Control (CDC) not to use language that is standard in federal grant requests by clinics and community based organizations serving populations affected by HIV, including the words “vulnerable”, “science-based”, “evidence-based”, “entitlement”, “transgender”, “fetus”, and “diversity”. An analysis conducted by Science Magazine of the four most recent budget requests by the President shows that this ban on words may already be in effect. But this is more than a language ban; it represents the Administration’s ban on ideas and their own set of ideological claims. In the absence of the use of the word “transgender”, for example, a gender binary is constructed where there are only two accepted genders. Republicans have long waged war on so-called “entitlement” programs, which guarantee a set of benefits to particular groups or segments of the U.S. population, and the recent passage of the GOP’s purported tax bill paved the way for Representative Paul Ryan’s longstanding attempt to gut Medicaid, Medicare, and Social Security spending. People with HIV are disproportionately low-income, and Medicaid is the largest source of health insurance for those living with HIV in the U.S. “Evidence-based” studies show us that comprehensive sex education is more effective than abstinence programs, and that clean needles save lives. Thus, these apparent changes to language use are downright dangerous and have real consequences for people’s lives.
PACHA plays a critical role in ensuring public accountability, transparency, and oversight on HIV-related matters, while making recommendations to strengthen the domestic response to the HIV epidemic. Currently, there is a Federal Register notice out seeking new PACHA nominees. The Trump administration is likely preparing to appoint new Council members and administration insiders who will propagate conservative ideological viewpoints on the HIV epidemic.
With his actions and inactions, Trump has declared war on people living with HIV. Anyone who cares about public health, social justice, and policies grounded in science should be paying close attention to these upcoming appointments and prepared to respond in full force.
Naina Khanna is the Executive Director of Positive Women’s Network – USA, served on President Obama’s Advisory Council on HIV/AIDS from 2010-2014, and is a Public Voices Fellow of the OpEd Project.