Two years into the Trump presidency, HIV services have weathered some hits but remain under threat on multiple fronts. As Arneta Rogers, policy director at Positive Womena’s Network-USA, acknowledges, “We have had cause for alarm on many issues related both directly and indirectly to HIV since Trump took office.” For example, “attempts at repealing the Affordable Care Act and attacks on Medicaid and social services women living with HIV rely on.”
One of the biggest concerns is Trump’s war on science. As William McColl, AIDS United’s vice president for policy and advocacy says, this administration appears to be “guided by particular ideologies and that in some areas, such as climate change, has had a clear impact on released reports.” And Dr. Craig R. Cohen, a professor of obstetrics, gynecology, and reproductive sciences at University of California, San Francisco, recalls this isn’t the first time we’ve seen an administration politicize science in a way that has negatively impacted specific demographics.
“Under the G.W. Bush administration, research on certain topics including reproductive health were derailed and delayed,” Cohen recalls.
So, is Trump’s anti-science bias impacting the work of the Centers for Disease Control and Prevention and National Institutes of Health?
McColl doesn’t think so: “People working within the HIV field for the government have been strongly professional and generally have stayed on course no matter who is president. In meetings…high-level leadership of the administration — including the new Health and Human Services Secretary Alex Azar — is both knowledgeable about HIV and committed to ending the epidemic. It’s our job as AIDS Service Organizations and HIV advocates to ... keep holding them to a focus on ending the HIV epidemic.”
Cohen also believes we don’t need to worry. “Support for science by NIH and CDC remains intact,” he says. “We have an exemplary peer review system which helps to ensure that the highest quality science gets funded. In my particular area of research, HIV and reproductive health, I have not witnessed any significant effect stemming from the administration.”
“I think the administration’s war on science — at least at present — isn’t shared by the government more broadly,” Dr. Elvin Geng, associate professor in the Department of Medicine at UCSF argues. “Even the Republican-held Congress has utmost respect for and has funded CDC [and] NIH at historical levels, and will likely continue to do so. I still believe in today’s NIH- and CDC-funded science.”
But there’s still need for concern. “We are, however, not on safe territory at all,” adds Geng. “The real worry is that the insane tax cuts for the rich will eventually empty the federal government’s coffers, then there won’t be any money to spend on things like health and science.”
Other financial concerns revolve around the administration reallocating HIV-dedicated funds elsewhere: at least $5.7 billion was reportedly transferred from the Ryan White HIV/AIDS Program to house detained immigrant children earlier this year.
Whether due to funding cuts, reorganization, or the stress of their working conditions, a growing number of people have left government for greener pastures. McColl acknowledges hearing “about lower level folks leaving the administration. Moreover, career federal staff have lamented that the administration has often chosen to leave a position unfilled once staff leave.”
What impact does that kind of “brain drain” have on the work these agencies do? McColl says, “We have not been hearing that it is so prevalent as to significantly affect operations. Of course, any time someone leaves an administration, there is real concern about the impact on knowledge and ability to perform. Most notably, the administration has chosen not to fill the positions at the Office of National AIDS Policy, and although we are told that they will be filling the President’s Advisory Council on HIV/AIDS ‘soon,’ it has not happened as of now. These are positions that provide coordination, advice, and leadership — and their vacancy is worrying.”
Rogers says PWN-USA recognizes “there are still many career scientists, researchers, and officials within these institutions who have been dedicating their energy and talents to understanding HIV and finding the most effective ways of treating and preventing it.”
In a written statement, Bert Kelly from the CDC’s media office responded to concerns about the rumored staff shortages and funding issues, stating, “The CDC has the resources it needs to protect our nation’s health and security. Our mission remains: working 24/7 to keep America safe, healthy, and secure. CDC protects the health, safety, and security of Americans using the best available scientific data. We stand ready as part of the administration to work to protect and advance the health of Americans.”
The CDC declined to directly comment on Plus’s inquiry as to whether HIV research could be impacted by the Trump administration’s alleged antagonism toward science and towards some communities greatly impacted by HIV (e.g. people of color and transgender individuals).
“The administration’s staunch opposition to collecting data concerning sexual orientation and gender identity leaves room to speculate that the accuracy of overall surveillance data could be compromised,” notes Rogers. “And lack of that data will certainly frustrate efforts to target testing, treatment, and prevention efforts for the communities most impacted by HIV. Further, it stands to reason that when an administration is as openly hostile to communities of color and the LGBTQ community as this one is, and additionally questions and rejects established scientific consensus, [then] funding and support for HIV research and programs will likely be scrutinized and deprioritized.”
“Efforts to erase LGBTQ people and people of color are absolutely unacceptable,” McColl adds. “In fact, this administration actually should be focused on increasing inclusion of these populations in every study possible. We are especially concerned about transgender people, since inclusion of questions on trans identity and experience are both more recent and less entrenched than other disparately affected populations.” Earlier this year, AIDS United was joined by more than 130 organizations in signing a letter supporting the continuation of a program that provided the first federal data about transgender health in the United States. “Unfortunately, with an administration which seeks to undermine the accuracy of reporting, we are going to have to continue to review and scrutinize every report to make sure we aren’t seeing troubling buzzwords or other signs of bias creeping into them,” the McColl adds. “However, we do not think it is justified to automatically lose trust in the accuracy of these reports. Frankly, that plays into the goal of denying truth and reality, which would serve only President Trump and his followers.”
Many activists and researchers alike point to the appointment of Robert Redfield to head the CDC as another good sign. Before his appointment, Redfield cofounded the Institute for Human Virology, which, according to The New York Times, “provides HIV treatment to more than 6,000 patients in the Baltimore-Washington area and more than one million people in Africa and the Caribbean.”
“[Redfield] has publicly stated that he believes we can end the epidemic in seven years,” says McColl. “The Centers’ staff for HIV are currently very strong, and it’s clear that they want to prevent as many cases of HIV as possible. Given Dr. Redfield’s and CDC staff professionalism, we would be surprised if the quality of their reports change. But we’ll be watching!”