Yahoo Movies The One Crisis Where Biden Is Getting High Marks
President Joe Biden was elected on the promise of bringing competent leadership to the fight against the coronavirus pandemic. But the new administration inherited more mismanaged public health emergencies than just COVID-19—from opioids and mental health to gun violence and vaccine disinformation.
As the HIV/AIDS epidemic enters its fifth decade this year, however, it is Biden’s handling of that crisis that has earned him greatest credit among public health advocates and researchers who often felt isolated and ignored under the previous administration.
“I’m encouraged,” said Jeffrey S. Crowley, who served as director of the White House Office of National AIDS Policy under President Barack Obama. “President Biden is dealing with the COVID pandemic, so much politicization, and a huge agenda for the American people, but he still has time to care about HIV. And the fact that he’s made a major commitment is encouraging.”
On Wednesday, the president will host a World AIDS Day event with prominent HIV/AIDS researchers, activists and philanthropists at the White House, during which he will recommit to America’s role in ending the epidemic that has claimed more than 36 million lives since it was first discovered four decades ago.
During the event, Biden will announce the release of an updated National HIV/AIDS Strategy, senior administration officials told reporters, which has been drafted with the goal of targeting inequities in the health-care system and improving access to comprehensive HIV-prevention medication. Their plan, one official said, “incorporates some of the latest data on HIV incidence, prevalence and trends,” with an expanded focus on social causes of HIV infection, as well as stigmatization of people with HIV/AIDS by encouraging reform of state HIV criminalization laws.
“My administration remains steadfast in our efforts to end the HIV epidemic, confront systems and policies that perpetuate entrenched health inequities, and build a healthier world for all people,” Biden said, noting his reinstatement of the White House Office of National AIDS Policy and a budget request for $670 million in new funding to support the Department of Health and Human Services’ “Ending the HIV Epidemic in the U.S.” initiative.
“This updated strategy will make equity a cornerstone of our response and bring a whole-of-government approach to fighting HIV,” Biden said in the proclamation.
As a result of the funding increases and medication expansion to personnel selection and destigmatization, the Biden administration receives top marks on reinvigorating the nation’s fight against HIV/AIDS, according to longtime advocates and experts on the epidemic. But the challenges Biden faces in successfully following through on his commitment to “pursue our shared goal of ending the HIV epidemic,” as he vowed in his World AIDS Day proclamation on Tuesday, are rooted in more than just the Trump administration’s incoherent response.
“We’re seeing these disparities now magnified in the HIV community, just like we’ve seen these disparities in COVID-19 by race and ethnicity,” said Greg Millett, the vice president and director of public policy at amfAR, the Foundation for AIDS Research. “We’re ending the HIV epidemic in some communities while it still remains spiraling out of control in others.”
Trump’s own legacy on HIV/AIDS is more complicated than his all-encompassing mismanagement of the coronavirus pandemic. During his State of the Union address in 2019, Trump vowed to end the epidemic in the United States within a decade, promising to “defeat AIDS in America and beyond.”
According to public health advocates, Trump followed through on that promise—to a degree.
“It was under the Trump administration that they initiated this remarkable program to end HIV/AIDS and put that goal out there,” said Carl Schmid, executive director, HIV + Hepatitis Policy Institute and a co-chair of the Presidential Advisory Council on HIV/AIDS. Under that program, Schmid said, the government increased funding for testing and treatment in geographic areas where infection rates were at their highest, and created a novel program to provide pre-exposure prophylaxis (or PrEP) to low-income people and community health centers.
“They did get the ball rolling, and so I have to give them credit,” Schmid said.
But other aspects of the Trump administration’s handling of HIV/AIDS, he added, were “shameful.”
“He did quite a bit of damage,” Schmid said.
From proposing massive cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest global health program in history, to his attacks on the Affordable Care Act and on minority communities that are particularly at risk of contracting HIV, Trump “took away more than he gave,” as Crowley put it.
“There would be efforts to address HIV that would be announced, but then the administration would introduce policies that would effectively shiv that response at every turn,” said Millett. “There were an awful lot of policies that were, unfortunately, politically popular for that administration’s base, but really served as cross-purposes for ending the HIV pandemic.”
Trump’s long history of stigmatizing public rhetoric on HIV/AIDS, too, complicated efforts to address the epidemic. The former president reportedly grumbled that Haitians “all have AIDS,” a point that he has continued to make publicly post-presidency, and he once claimed to have tested his own dates for HIV during the 1990s.
“In one side of his mouth he was saying we need to end HIV as the other side of his mouth was perpetuating this terrible stigma,” said Schmid. “Comments like that make it worse.”
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Frustration with the Trump administration’s handling of the epidemic presented serious personnel challenges. This was particularly true after Trump dismissed his entire Presidential Advisory Council on HIV/AIDS panel with no explanation in January 2018—nearly a quarter of the members of council had already resigned the previous summer after declaring that Trump “simply does not care” about people living with AIDS—and took nearly a year to replace them.
“It was hard to get people,” said Schmid. “They didn’t want to work with the administration.”
But under Biden, the number of HIV/AIDS authorities in positions of responsibility in the administration has soared—most notably Dr. Rochelle Walensky, a former HIV researcher who now leads the Centers for Disease Control and Prevention, and Dr. Anthony Fauci, who has been one of the leading authorities on the epidemic since the 1980s and now serves as Biden’s chief medical adviser.
“We’re actually seeing experts in the field who are leading the response in terms of public health, as well as policy and science,” said Millett, who listed Dr. John Nkengasong, Biden’s nominee to serve as the PEPFAR ambassador, and Health and Human Services Assistant Secretary for Global Affairs Loyce Pace as “integral forces in global HIV work.”
“It’s really nice to see these experts in the field who are leading those spots, domestically as well as globally,” Millett said.
But even with those experts in place, the fight to eradicate HIV/AIDS has been thrown into disarray by the coronavirus pandemic, which has siphoned money and manpower from the cause.
COVID, said Schmid, “put a monkey wrench in a lot of those activities,” by requiring the full-time focus and labor of some of the world’s preeminent authorities on HIV/AIDS.
“Look at the attention of Rochelle Walensky and Anthony Fauci and Debbie Birx,” Schmid said. “These are the HIV experts, and they were sidelined by COVID.”
Asked about the ability to effectively address both crises given the limited resources, a senior administration official told The Daily Beast that the decades of experience with HIV/AIDS currently being applied to COVID-19 will end up being beneficial to the fight against both viruses.
“Having our trusted experts like Dr. Walensky and Dr. Fauci working on coronavirus, using what they’ve learned from years of HIV care, treatment and research, really has helped us a lot to be able to address COVID-19,” the official said. “We’re looking forward to seeing what additional insights and knowledge and expertise researchers have gained through fighting this virus that can now be applied to our search for a vaccine and a cure for HIV.”
Crowley, too, noted that the globally coordinated response to COVID-19 could not have happened without the decades of epidemic-fighting experience that HIV/AIDS epidemic had fostered. The trick, he said, will be continuing those investments in public health infrastructure once the pandemic has abated.
“We’re all worried about how COVID setting back our efforts to end the HIV epidemic,” Crowley said. “The challenge for the HIV community is, this is a big country with lots of problems and lots of pressing issues. As HIV recedes from the foremost minds of many parts of the American public, how do we keep them engaged in the fight?”
That engagement, the White House official said, begins with reminding Americans that efforts to end the HIV/AIDS epidemic have not been lost in the turmoil of COVID-19.
“We are seeing an increase in funding, as well as a health care workforce that is dedicated to ensuring that services are available,” the official said. “And they’ve been able to do this during this pandemic as well.”
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