During the eight years of Barack Obama's presidency, great progress on HIV and hepatitis C occurred as a result of his vigorous, compassionate, and competent leadership. Obama established the National HIV/AIDS Strategy, or NHAS, which has focused government, medical providers, and community-based organizations on a key set of activities that are significantly increasing the percentage of HIV-positive people aware of their status, increasing the number of diagnosed people linked to care and treatment, increasing viral suppression, and reducing new infections. Similarly, Obama established the National Viral Hepatitis Action Plan, or NVHAP, which placed much-needed emphasis on this huge but under-addressed epidemic, and established important goals for diagnosis, treatment, prevention and reductions in health disparities among people with hepatitis C.
As importantly, of course, Obama and a Democratic-led Congress achieved the passage of the Affordable Care Act, which made it possible to meet the goals of the NHAS and NVHAP by extending health care coverage to millions more individuals, particularly those at middle and low incomes. The ACA has been directly responsible for gains in diagnosis and treatment of both HIV and hepatitis C, as well as for making biomedical prevention options such as pre-exposure prophylaxis, or PrEP, available to prevent new infections.
During the 2016 campaign, candidate Donald Trump did not respond to questionnaires regarding his position on HIV or hepatitis C issues. Upon his election as president, national advocacy groups prepared detailed documents for Trump's transition team and reached out to key health staffers to discuss the potential that, with strong leadership, both epidemics could be effectively halted during the new administration's tenure. Nevertheless, he proposed, and Congress agreed to, $43 million in cuts to the $2 billion Ryan White Treatment Modernization Act. In January, Trump dismissed all of the members of the President's Advisory Council on HIV/AIDS who had not already resigned in disgust with him. And he has made no moves to staff the previously very important White House Office of National AIDS Policy. Of course, given the damaging appointments he would no doubt make to these positions, HIV advocates might count their blessings.
In a bit of mixed news, on February 9 after a brief government shutdown, Congress passed a two-year budget deal (which requires a final vote in one month) to lift spending caps by roughly $300 billion in the next two years, with $131 billion of that reserved for domestic programs. Many issues that have been championed by HIV advocates over the past several months were addressed in the deal, which should assure protection of the Ryan White program and other essential HIV-related programs for the time being. However, all of this increased funding failed to win the votes of most House Democrats, who were rightfully outraged over Republicans' refusal to resolve the standoff over 700,000 Dreamers in the U.S.
No sooner had Congress agreed to protect, and even increase, domestic spending than Trump unveiled a proposed budget for 2018 that would increase defense spending while viciously cutting safety net programs, including further destruction of the Affordable Care Act, Medicaid, and cuts to HIV programs. Fortunately, there is no chance that the Trump budget will be approved, especially in light of the current direction of Congress to increase domestic spending. His budget is, however, further evidence of Trump's contempt for those in need of government funded health and social services programs.
With the recent passage of the Republican tax reduction bill, the stage may have been set for an eventual, massive roll-back not just of the ACA, but of the entire long-standing social safety net, as well. The bill's elimination of the individual mandate to have health coverage is expected to reduce the number of insured by 13 million, and the bill includes immediate cuts to Medicare and Medicaid. But it is the $1.5 trillion revenue reduction this alarming fiscal experiment will produce that sets up the conditions under which Republicans may finally get their wish to gut Social Security, Medicare, Medicaid, the Child Health Insurance Program, financial assistance for low-income people - and many other programs upon which people depend for life's necessities through no fault of their own.
HIV advocacy groups like Project Inform and our great partner the San Francisco AIDS Foundation will continue our hard work to protect and expand HIV and hepatitis C services. Community members who want to share in that work are encouraged to contact us at mailto:[email protected].
Dana Van Gorder is the executive director of Project Inform. For more information, visit http://www.projectinform.org.