Trump's AIDS Moonshot: Will It Fly Tonight?

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Three years after the Obama administration galvanized the cancer community by unveiling “Cancer Moonshot 2020,” President Trump has settled on his own medical moonshot: making AIDS go the way of polio and smallpox.

HIV, the virus that causes AIDS, has taken millions of lives since its discovery in the early 1980s, and according to the Centers for Disease Control and Prevention more than a million Americans still carry HIV today. When Trump delivers his State of the Union address Tuesday night, he is expected to announce plans to effectively end the disease.  

As Politico first reported, the president will pledge to halt HIV transmission altogether by 2030. Details are still forthcoming. A spokesperson for the Department of Health and Human Services referred RealClearPolitics to the White House, where requests for comment were not returned.

Lack of specifics didn’t stop critics from panning the yet unveiled strategy late Monday.

The Human Rights Campaign expressed skepticism that “a real commitment” to end the epidemic was being offered. GLAAD, an advocacy group for lesbian and gay individuals, was similarly dismissive, calling the Trump pledge “empty rhetoric.” 

Likewise, Scott Schoettes, who resigned in protest from the presidential advisory council on HIV six months after Trump’s inauguration, wondered in a RCP interview whether the president would make the pledge just “to have something to talk about other than his border wall.”

The criticism follows a familiar argument from the president’s critics. Trump can’t be serious about combating HIV, they say, after proposing cuts to Medicare, scaling back the Affordable Care Act, and making a social conservative like Mike Pence his vice president.

“It does feel like they’re just picking this issue up out of the air,” added Schoettes, who asserted in a June 2017 Newsweek op-ed that Trump “does not care” about people living with the disease. 

Even if this is a political calculation on Trump’s part, however, it has been a point of focus for HHS Secretary Alex Azar, whom the AIDS Institute praised for his “knowledge, expertise, and leadership.” Azar has promised a plan “to combat HIV not just as a biomedical issue, but as a social challenge.”

Making that happen will likely fall to CDC Director Robert Redfield. A longtime AIDS researcher before heading the Atlanta-based agency, Redfield pioneered treatments at Walter Reed Army Institute of Research and later at the University of Maryland School of Medicine as a virologist and physician.

When Redfield addressed CDC employees for the first time in March of 2017, the new director insisted that ending the AIDS epidemic “could be done in the next three to seven years if we put our mind to it.” A still bullish Redfield revised that timeline several months later, telling the Wall Street Journal the job could take “seven years or maybe a little longer.”

Redfield prescribed “comprehensive prevention strategies,” stressing the need for an approach called pre-exposure prophylaxis, or PrEP. While no vaccine for HIV exists, this pharmaceutical treatment can significantly reduce the likelihood of infection among at-risk individuals with daily medication. 

“Although behavioral strategies are important, they’ve always had limitations. And with the advent of PrEP, we know we have a biological mechanism that can prevent infection,” he told the Journal. “The data is rock solid.”

Adopting a strategy designed by Redfield isn’t without political risk for Trump. It could mean alienating social conservatives who have long been chary of government advice about sexually transmitted diseases – unless that advice is mostly focused on abstinence. Unlike Pence, who once panned condoms as “a very poor protection against sexually transmitted diseases,” the CDC director has said their use will be part of the solution and described himself as never having been “an abstinence-only person.”

James Curran, dean of the Rollins School of Public Health at Emory University, said a comprehensive approach works and likened HIV mortalities to deaths from treatable cancers. “With the available treatments we have for HIV,” he told RCP, “it is really a shame people are dying of AIDS in the United States.”

Curran, who led CDC efforts against HIV/AIDS for 15 years and was one of the first to recognize the illness as an infectious disease in the 1980s, said the Trump goal isn’t implausible.   

“If we have the biologic tools for the virus,” Curran argued, “it’s simply a matter of applying those tools, motivating people, and paying for things that are needed to make sure it gets done.”

Whether Trump can turn rhetorical aspiration into concrete health strategy will be a question that continues past the State of the Union address. Now-eradicated scourges such as polio and smallpox had more visible symptoms that led to more immediate treatment. HIV, by contrast, often goes years without detection, and as yet there is no cure—only preventive measures.

Political resentment could present another impediment to an already daunting task. If Trump demonstrates “a visible commitment” during Tuesday’s speech, though, Curran urged the communities most effected to give the president a shot.

“If the leadership is willing to take steps, then give them a chance and assume they want to reduce stigma and provide coordinated resources,” Curran said. “Hold them accountable for that, not accountable for whom they voted for in the last election.”

While Trump hasn’t demonstrated the most nuanced understanding of sexually transmitted diseases—he was reportedly confused about the difference between HPV and HIV during a meeting with billionaire philanthropist Bill Gates—Curran remains optimistic even if the moonshot falls short.

“What if we were able to reduce the deaths by 50 percent in the next couple of years?” he said. “Wouldn’t that be a remarkable thing?”

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