ONAP, the Office of National AIDS Policy, and PACHA, the Presidential Advisory Council for HIV-AIDS were established in 1993. Their purpose was to give marginalized AIDS patients and the heavily impacted LGBTQ community input into national policies affecting their health and survival. Under President George W. Bush, they helped update the Ryan White Care Act, secure approval for HIV rapid testing, and establish PEPFAR. They played crucial roles in developing our National AIDS Strategy under President Obama.
Donald Trump has been president for 21 months, and HIV continues to infect thousands of additional Americans. Yet none of the ONAP and PACHA positions, so critical to people living with HIV-AIDS, have been filled. Applications for PACHA closed on Jan. 1 of this year, none who applied have been called to serve. Long delays without explanation or apology are inevitably perceived as indifference or worse, disrespect.
Healthcare is the number one voter concern. If President Trump wants to win again in 2020, he needs to persuade voters that he’s a winner on healthcare. AIDS is always a highly visible issue and barometer of healthcare performance, especially for LGBTQ voters.
About 4.5 percent of U.S. voters now identify as LGBTQ according to a May 2018 poll, that’s more than identify as either Mormon or Jewish. In 2008, John McCain got 27 percent of our vote, in 2012 Romney’s share fell to 22 percent, and in 2016 Donald Trump’s share plummeted to 14 percent. Trump has yet to do anything to counteract this dismal trend. Indeed, Trump administration healthcare policies and collaboration with opponents of LGBTQ rights have more deeply alienated LGBTQ voters. These voters have friends and families who vote, and LGBTQs enjoy ever increasing sympathy and support among younger voters. Ignoring AIDS is not smart politics.
AIDS is a disproportionate threat to African Americans and Hispanics. Forty-three percent of HIV cases are African American and 70 percent are gay or bisexual. Neglect of HIV-AIDS hurts African Americans, Hispanics, and LGBTQ people most, and it endangers the health of everyone in these impacted groups. They all need channels for input and dialogue on national HIV-AIDS policies. ONAP and PACHA served their needs well under previous administrations. The need for AIDS community input and HIV policy transparency under the Trump administration is greater than ever.
When Donald Trump ran for president he promised transparency, and to drain the swamp. That was a prime reason why many conservative LGBTQs, myself among them, courageously supported him despite fierce opposition from our communities. Yet, because he has left ONAP and PACHA vacant, policies and practices that impact HIV-AIDS patients have been relegated to backrooms in the D.C. swamp. Indeed, groups perceived as hostile to LGBTQ rights, such as the Family Research Council, appear to enjoy far greater input on HIV policies than do LGBTQ people. No wonder our people fear that this administration has forgotten the HIV-AIDS communities and listens only to those bent on marginalizing us.
Despite great advances, urgent HIV challenges remain. One seventh of all HIV cases are undetected, this small group seeds most of the 38,000 new infections each year. Moreover, many HIV-positive people still lack stable access to quality care. The vital Ryan White Care Act has not been re-authorized since 2013; it needs updating to reflect changes such as the increasing numbers of patients in the South and among the elderly. The 340B drug program provides many HIV patients with their drugs and essential support services. To be more effective, enhanced enforcement along with greater provider accountability and transparency must be implemented.
Donald Trump still has time to show he cares about AIDS by starting to listen to the impacted communities. Their input can bring transparency and improved efficacy to his HIV-AIDS policies, as it has done for his predecessors.
I voted for Donald Trump in 2016 and expect to do so in 2020 because I prefer his approaches to the economy, regulation, trade, immigration and foreign affairs. However, if LGBTQ supporters like myself are not to become an endangered species, Trump must listen to our community as he has begun to listen to African Americans. The readiest way to start listening would be to fill the vacant ONAP and PACHA positions ASAP.
James Driscoll, Ph.D. is a longtime AIDS activist who served on PACHA under George W. Bush. A Republican, he has publicly supported Donald Trump.