Many of us were surprised last year when President Trump announced in the State of the Union address that he was committing the United States to ending the domestic HIV epidemic over the next decade, by which he meant that his Administration would work to cut annual new HIV diagnoses in half over the next five years and reduce them by 90% over the next decade. Some people may have expected me to criticize, but I applauded this commitment. I remain hopeful that we will notch real victories against HIV in the Trump era.
But, last night at a campaign event, the President made a statement that demands a correction. He said that President Obama could have ended HIV, but “chose not to”. President Obama’s achievements in addressing domestic HIV have reinvigorated the HIV response and are of historical significance. Listening to the demands of the HIV community, he promised and delivered our nation’s first comprehensive National HIV/AIDS Strategy for the United States. Most such blue-ribbon reports are released and soon forgotten, but this one has been a tool to drive change. Noted for its evidence-based recommendations, the plan was updated in 2015 to extend through this year and the Trump Administration is working on the next update. The Strategy remains the guiding force underpinning our collective efforts. Moreover, despite intense federal budget pressures, the Obama Administration oversaw the first consistent year-to-year increases in HIV prevention in well more than a decade. In response to state funding cuts at the height of the economic downturn, the Obama Administration took emergency action to find additional resources for the AIDS Drug Assistance Program (ADAP) to help remediate waiting lists for lifesaving HIV medications, and perhaps most importantly, President Obama signed into law the Affordable Care Act that led to very significant expansions in health coverage for people living with HIV both through Medicaid and the health insurance marketplaces.
Other significant policy changes included eliminating the HIV entry ban that allowed the International AIDS Conference to reconvene in the United States in 2012 after a 20-year boycott. When the Congress modified the ban on federal funding for syringe services, the Obama Administration issued guidance to permit funding of syringe services programs both domestically and globally. When the first research study demonstrated the effectiveness of pre-exposure prophylaxis (PrEP), the President applauded this outcome and re-oriented the Strategy to embrace PrEP in the 2015 update. When NIH-funded randomized trials proved that HIV treatment is highly effective at preventing HIV transmission, this also was embraced in the Strategy update.
Early in his Administration, President Obama said that he wanted to be remembered by the promises kept and not the lofty promises made. Indeed, from 2008 to 2014, annual new HIV diagnoses declined by 18% after remaining stubbornly stable for more than a decade. A research study of the major federal HIV treatment program, the Ryan White HIV/AIDS Program found that from 2010 to 2014, viral suppression was up in all groups examined and health disparities were reduced for Black people, adolescents, and people in the southern US, all groups disproportionately impacted by HIV.
Despite this progress, we need President Trump to make his mark and the HIV community will work with his team to be successful. But, history must know that, along with his other accomplishments, President Obama kept faith with people living with HIV and set the stage for further progress.
Jeffrey S. Crowley is a distinguished scholar and program director of Infectious Disease Initiatives at the O’Neill Institute for National and Global Health Law at Georgetown Law. From 2009-2011, he served as Director of the White House Office of National AIDS Policy and Senior Advisor on Disability Policy for President Barack Obama.
