Pre-exposure prophylaxis, or PrEP, has been universally hailed as a major breakthrough in the fight against HIV/AIDS, yet many argue that this medication is far from a panacea, considering that in the US, one in every two Black men who engage in sex with men will become HIV positive. The reasons so many Black men are affected are manifold, and include economic challenges, a lack of access to health care and the stigma which is often associated with a HIV diagnosis. The fact is that HIV is likely to be a major health issue so long as employment, housing and health care for all remain a challenge in the US. Although Donald Trump has yet to publish his plans regarding HIV/AIDS funding, many fear that the rate of infection is bound to worsen during his regime.
Pence and Price: Views on HIV/AIDs Funding
Much of the concern expressed has to do with Trump’s choices for the posts of vice president (Mike Pence) and health and human services secretary (Tom Price). Pence was at the nucleus of one of the biggest HIV outbreaks in American history in the spring of 2015 when he was governor of Indiana. Pence espoused abstinence-only education, which has been found to be ineffective to quell the spread of AIDS. He was also anti-needle exchange programs, despite their proven efficiency and economic feasibility. Pence initially refused to lift Indiana’s prohibition of needle exchange, eventually allowing a few programs to operate in his state.
The Importance of Needle Exchange Programs
Needle exchange programs not only reduce the risk of contaminated needles being shared; they also lower the risk of law enforcement professionals being infected accidentally. Moreover, many needle exchange centers offer free HIV testing, and some programs assist those with substance abuse issues, informing them regarding where they can receive treatment and support. Needle exchange programs are also extremely cost-effective. As the Centers for Disease Control and Prevention (CDC) noted, “The cost [to prevent one] HIV infection by Syringe Exchange Programs (SEPs) has been calculated at $4,000 to $12,000, considerably less than the estimated $190,000 (listed in 1997 dollars) medical costs of treating a person infected with HIV.”
SEPs also help to lower the rate of Hepatitis C infections, which cost between $25,000 and $30,000 to treat (per person, annually).
A Documented Anti-LGBT Stance
In 2002, Pence claimed that Congress should support the reauthorization of the Ryan White Care Act (the main source of federal support for combatting HIV/AIDS) only after ensuring that no federal monies were given to groups which “celebrate and encourage the types of behaviors that facilitate the spreading of the HIV virus.”
Meanwhile, Health and Human Services Secretary Tom Price has voiced his support for a constitutional amendment against same-sex marriage. He is also against the Affordable Act, which has significantly helped patients with pre-existing conditions such as HIV. Price is also against the expansion of Medicaid. Global Health Access Project activist Mike Kavanaugh notes, “One of the most important things that happened with Medicaid expansion is that people were able to move off of [AIDS Drug Assistance Program] and not just get HIV drugs but full [health] insurance.” Like Pence, Price hails from Atlanta, an area which has been hard hit by HIV/AIDS. Despite the statistics, he has voted repeatedly to uphold a ban on federal funding for syringe exchange programs.
Trump and the Future of PEPFAR Funding
HIV/AIDS advocates are also concerned about the future of PEPFAR (the US President’s Emergency Plan for AIDS Relief). This emergency plan, created by President George W. Bush in 2003, has thus far dedicated $60 billion to fighting HIV/AIDS worldwide. As of September 2015, PEPFAR was supporting antiretroviral therapy treatment for almost 9.5 million people worldwide.
HIV/AIDS advocates note that statements by Trump (such as “Americanism, not globalism, will be our credo”), or the assertion that the US should “stop sending foreign aid to countries that hate us,” may lead to a cut in foreign spending, thereby reducing the amount of funding for HIV/AIDS prevention and treatment.
The good news is that PEPFAR has consistently received bipartisan support in Congress. Even during times of economic recession, a united front has made it possible to quell the spread of HIV/AIDS. PEPFAR supports vital programs, such as those which prevent the passing of the virus from mother to child. Other critical interventions made possible by the program include voluntary medical male circumcision, HIV counselling and testing, and viral load testing. The latter measures the amount of HIV contained in a blood sample. When HIV levels are high, it indicates that the immune system is not fighting HIV as well as it should be.
HIV/AIDS advocates such as ACRIA, the AIDS Policy Project and the AIDS Treatment Activists Coalition are waiting with bated breath to discover what the Trump administration has in store. It is hoped that the progress made over the past decade will not be halted by the mistaken belief that HIV/AIDS is anything less than a global threat.
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