Trump’s Hypocrisy on HIV Treatment and Prevention
The President unveiled a plan to end HIV transmissions in the US by 2030 — but his efforts to stigmatize those most affected by the illness make that hard to believe.
By Gillian Branstetter
In between his dangerous lies about immigrants and his cowardly refusal to defend his proposed ban on transgender troops, President Donald Trump made a surprising promise in his State of the Union speech last week.
“In recent years we have made remarkable progress in the fight against HIV and AIDS,” he said. “Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”
The promise to end HIV transmissions in the US by 2030 is definitely possible, according to HIV researchers and advocates who have previously estimated the US could reach that goal by 2025. But Trump is a very unlikely messenger for this policy. He has spent his entire administration trying to limit health care access for those most at risk for HIV, and otherwise restricting the rights of groups like immigrants, people of color, and LGBTQ people.
Trump’s plan should be approached with skepticism by transgender people in particular. While many discuss HIV and AIDS in the past tense, transmission levels remain a crisis for many communities, including transgender people. Transgender people overall are five times as likely to be diagnosed with HIV as the general population, and estimates of the rate among Black transgender women range from one in five to an alarming one half of the population.
Prevention and treatment of HIV among transgender people remains a top priority among the medical world — including Robert Redfield, the HIV researcher and advocate Trump appointed to head the Centers for Disease Control and Prevention. Trump himself, however, has taken every step he can to limit the health care choices of transgender people, implementing policy changes that could have disastrous impact on those seeking to protect themselves against HIV or seek treatment for an existing diagnosis.
Consider the Trump administration’s all-out war on the Affordable Care Act. The ACA remains an important tool for fighting HIV, and our friends at AIDS United cite the law’s expansion of Medicaid coverage as a particular benefit. “One analysis found that if all states expanded their Medicaid programs,” writes the group, “nearly 47,000 people with HIV could gain new Medicaid coverage”
Medicaid is a foundational benefit for people with HIV — A study by the Kaiser Family Foundation found 56% of people living with HIV already rely on Medicaid for their health insurance. But the Trump administration continues to fight against the ACA — including its Medicaid expansion — in federal court.
In a frightening escalation of that fight, a federal judge in Texas recently sided with the administration and ruled the entire Affordable Care Act unconstitutional. That decision’s tortured logic is considered particularly extreme by legal experts of every political stripe, given the Supreme Court’s previous rulings upholding the ACA.
In another move to limit access to care for this vulnerable population, Trump’s Department of Health and Human Services is refusing to defend the rights of transgender people under the non-discrimination provision of the Affordable Care Act, known as the Health Care Rights Law. The repeal of this rule is likely to worsen the already awful situation faced by too many transgender people when accessing care, including the one in three who have been mistreated by a provider and the more than half that have refused to seek health care out of fear of mistreatment.
This is particularly true of those seeking HIV prevention or treatment. As one transgender man related in his response to our US Transgender Survey, they were rebuked when they went to get an HIV test:
“The nurse refused to give me HIV testing because she said those funds were reserved for men who have sex with men and I’m ‘not a real man.’ She told me I was born female and just needed to accept reality.”
Advocates and researchers alike agree ending HIV transmission will require more, not less, stigma and access in health care. CDC Director Redfield even responded to news of the Trump administration’s plan to write transgender people out of existence under federal law by noting “We need to understand that stigmatizing illnesses, stigmatizing people is not in the interest of public health.”
The steps taken by HHS and the administration to limit health care access will fall hardest on the poor and transgender communities that face HIV most frequently, meaning the Trump administration could potentially be working against itself if it hopes to end HIV. Trump’s self-contradiction is not limited to transgender people; Immigrants to the US likewise face an increased risk of HIV, yet are the most frequent target of Trump’s rhetorical and political attacks.
Consider the fate of those in the US with Temporary Protected Status (TPS) visas, many of whom are fleeing hostile and violent countries of origin. In his first year in office, Trump took the extreme step of revoking thousands of TPS visas, meaning many people who have lived in the US for years or decades could now face deportation to potentially dangerous conditions. As our friends at Planned Parenthood note, this means many people with TPS visas may be hesitant to seek health care for fear of being deported.
That same fear is spread throughout all immigrant communities under an administration that consistently uses them as xenophobic fodder. In a recent poll of the Migrants Clinicians Network — an organization representing health care providers in immigrant communities — two thirds of providers have noted a reluctance among their patients to seek care under this administration.
This means transgender immigrants are being pushed out of their health care on both fronts — a disturbing trend given undocumented transgender people are ten times as likely to contract HIV as other transgender people and even documented transgender immigrants remain twice as likely as other transgender people.
The Trump administration is built on a foundation of fear and prejudice. From their transphobic appointees to their mean-spirited policies to to their distortions of federal law, the administration has set it sights pushing some Americans to the margins and continues to work extensively towards that mission. Health care access has served as the center ring for those battles — whether it’s against transgender people or immigrants or transgender immigrants — making Trump’s sudden turn towards HIV as a top priority hard to believe.
The notion the Trump administration could effectively carry out an ambitious plan to end HIV — a disease that has always hit marginalized communities hardest — seems unlikely, especially since it’s at cross-purposes from so much of their agenda. As Director Redfield noted, you cannot separate stigma against an illness and stigma against the individuals most likely to be impacted by that illness. They are twin evils that fuel each other.
Trump will not be president through 2030, but the damage he’s doing today could severely hamper that goal and ruin the lives of people seeking treatment now. Treatment and prevention of HIV in the US has taken leaps and bounds since the 1980s, when thousands of LGBTQ people died each month and President Reagan (followed by the first President Bush) washed his hands of the matter. But the Trump administration should be a reminder of the frightening fragility of all progress, and his dangerous efforts to strip health care from millions is no different.
Promises are cheap. The Trump administration needs to be held accountable for fulfilling this unlikely promise, as well as for the countless attacks that leave advocates and patients skeptical at best.
