For the most part, President Trump’s second State of the Union speech met the expectations of his critics, with plenty of boasting, showboating, and many statements that only make sense given the worldview of Trump and his base.
During the speech, Trump proudly declared that “the United States is now the number one producer of oil and natural gas anywhere in the world,” despite the vast majority of scientists saying the nation needs to move away from fossil fuels to reduce carbon emissions and address climate change.
He also failed to address last month’s record-length government shutdown that led to the postponement of the address, and set back US science and research, wreaked havoc on national parks, interfered with pollution cleanup and food safety, and furloughed food safety workers.
But one new proposal deserves serious consideration regardless of the messenger. In his State of the Union, Trump set a new, worthwhile goal:
“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.”
He is not incorrect here. Since its peak in 1996, new HIV infections have declined 47 percent globally, according to a report from the Joint UN Programme on HIV/AIDS, which itself is now aiming to end the AIDS epidemic by 2030. Trump’s proposal is ambitious, yet indeed more feasible than ever before.
According to the US Department of Health and Human Services, most HIV infections in the US are concentrated in a few hotspots. In 2016 and 2017, over half of new diagnoses occurred in just 48 counties, as well as Washington D.C. and San Juan, Puerto Rico. According to the department, Trump’s plan will work to cut new infections 75 percent in the next five years, and 90 percent in the next decade, “averting more than 250,000 HIV infections in that span.”
Yet, the administrations other policies have offered little in the way of broader support. An honest and comprehensive effort to eliminate the epidemic would require reversals in several areas.
Trump’s support of US science has been sporadic at best, yet it’s the work of scientists and doctors that has made the new goal possible.
Antiretroviral drugs can now suppress the virus so effectively that it becomes undetectable in the bloodstream. At that point, passing it on to others becomes unlikely. A drug called PrEP is also available that protects those at risk from picking up the virus from others.
The first drug used to treat HIV infections, called azidothymidine (AZT), was developed by scientists funded by the National Institutes of Health (NIH), for which Trump has proposed massive budget cuts in past years. Instead, Trump and the Republican party should support the kind of research that helped lead to such breakthroughs.
The administration has also done little to support the groups most affected by the epidemic. Of the one million Americans with HIV, gay African-Americans and bisexual men are disproportionately affected. To really address the crisis, Trump should support these same communities when it comes to healthcare, education, and inequality.
According to Gregg Gonsalves, a former HIV/AIDS activist and professor of epidemiology at the Yale School of Public Health, the administration should support states in their attempts to expand Medicaid coverage. He notes that those which haven’t expanded coverage are often the same states hit hardest by HIV/AIDS in recent years.
Yet, the Trump administration spent the first half of its term trying to eliminate expanded Medicaid.
Since PrEP in particular is meant for people without HIV, there are few funding alternatives for those that are uninsured or underinsured.
“So if Trump was interested in ‘ending AIDS,’ he’d have to support Medicaid expansion and fix the flaws in the ACA [Affordable Care Act] rather than tearing it all down,” Gonsalves said, speaking to Vox.
And Dr. Oxiris Barbot, New York City Health Commissioner, said:
“A pathway exists for the President to end the HIV epidemic, but he cannot reach this goal by alienating the very communities most affected by it. Any legitimate plan must begin by righting these wrongs.”
Politically, Democrats and Trump’s detractors should be careful not to reflexively criticize the plan because it’s coming from the administration, and should instead actively support it. But at the same time, they should hold the president to his word and should call attention to the way the administration’s other policies are hindering his own admirable goal to end the epidemic.