June 7, 2016
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Currently, the presumptive Republican nominee for president has no stated HIV/AIDS policy. Nothing concerning the disease is listed on Trump's website, nor has the candidate discussed how he would approach the HIV epidemic during any of his campaign appearances. At this point, any discussion of what a Trump presidency would specifically mean for people living with HIV in the United States and across the globe is primarily speculative. Those of us outside Trump's inner circle are forced to read the tea leaves to try and create a narrative for an HIV/AIDS policy that, in all likeliness, may not yet exist.
While we don't have any details on his HIV/AIDS-specific positions, the contents of Trump's overall health care platform
doesn't appear to bode well for people living with HIV. As would be
expected from the presumptive Republican presidential nominee, the focal
point of Trump's health care policy is the complete repeal of the
Affordable Care Act (ACA), for example.
All of the HIV/AIDS activists who spoke with TheBody.com acknowledged
the possibility of a President Trump making good on his promises to
reduce the cost of prescription drugs and encourage price transparency
among health care providers. But even with their metaphorical
rose-tinted glasses on, none of them could muster anything approaching
optimism for HIV-positive individuals in Donald Trump's America.
"As someone living with HIV, I find the way that Trump models
citizenry extremely problematic," said Andrew Spieldenner, co-secretary
of the U.S. People Living With HIV Caucus. "When the leader models
something, the people who work for them will normally take it further,"
he noted. "My gut tells me a Trump presidency would be bad for people
living with HIV, especially globally," he said. "The nativism he's
exhibited during his campaign doesn't seem to me to be good for PEPFAR
[The President's Emergency Plan for AIDS Relief]."
Spieldenner did say during his interview with
TheBody.com that there had been some interest from the Trump campaign in
sitting down for a meeting with HIV/AIDS activists, as Clinton and
Sanders did last month, but that nothing substantive had come from it so
far. Regardless, Spieldenner seemed less concerned by the lack of
direct engagement between Trump and HIV/AIDS groups than by the overall
ideology and bearing of the campaign Trump is running.
What Trump would replace the ACA with is murky, although his
proposals are mostly a hodgepodge of business-friendly measures aimed at
reducing government spending and placing the onus for care on
individuals, such as allowing interstate health insurance competition
and block granting Medicaid to the states.
Trump claims that he will maintain the ban on insurance companies denying coverage
to people with pre-existing conditions, but without an individual
mandate or the provision of financial assistance similar to what it is
now available through the health care marketplace, it would seem there's
no chance of that happening. According to a report by the non-partisan Committee for a Responsible Budget,
Trump's health care plan "would cause almost 21 million to lose their
health insurance" and would wind up costing anywhere between $330 and
$550 billion over a decade.
In addition, the Wall Street Journal reported that Trump would consider privatizing the Department of Veterans Affairs (VA) health care system,
turning it into something more akin to a health insurance provider than
a network of hospitals. This could have drastic implications; as the VA notes, it is "the largest single provider of medical care to people with HIV in the United States."
Hilary McQuie, director of U.S. policy and grassroots
mobilization at Health GAP, emphasized that her organization would try
to work with a Trump administration but was unsure what that would look
like and was deeply concerned about Trump's positions on social issues
and immigration.
"There's no telling what he would do," McQuie said, adding that the
xenophobia, racism and sexism exhibited in Trump's campaign would be
terrible for preventative care and treatment efforts, as well as basic
human rights.
George Ayala, who serves as the executive director of The Global
Forum on MSM & HIV (MSMGF), shared similar concerns. "I'm not aware
of anything Trump's said about HIV, which is a problem right there."
Ayala said. "At this point we can only speculate based on behavior, but I
think gay men -- especially gay men of color -- wouldn't have great
access to the White House, and that spells trouble."
Like the HIV/AIDS activists who were interviewed for this article,
Gregory Angelo, president of the Log Cabin Republicans, said that he
didn't want to speculate about what Trump's HIV/AIDS policy might be.
While the head of the gay Republican group was much more encouraging
about the prospect of a Trump presidency, he still had his reservations.
"I am on record as having said that Donald Trump is the most pro-gay
Republican presidential nomination in history," Angelo told TheBody.com.
"If you look at the statements he's made, there's reason to believe
that he at least might do no harm and may possibly be an ally. However, I
want to be crystal clear on this: The Log Cabin Republicans have not
endorsed Donald Trump and I am not a Trump apologist."
More than any candidate in recent memory, Trump has hitched his
campaign's success, not to putting forward concrete or feasible
solutions, but instead to capturing his followers' nativist anger and
sense of betrayal. As a consequence, instead of having a more fully
formed vision of what sorts of policies to expect from a Trump
presidency, we find ourselves left with an ever-growing collection of
macho posturing and xenophobic pronouncements.
Given that speculation and rhetoric are all we have to go on at the
moment, it may behoove HIV/AIDS activists to prepare for the best as
well as the worst with regard to a Trump presidency, even if an
antagonistic relationship seems to be the more likely outcome. It
remains to be seen exactly how far those who work for and follow Donald
Trump would take his particular brand of jingoistic aggression if he
were to win the White House. But it seems that most HIV/AIDS activists
would be more than content if they never had to find out.
Drew Gibson is a social worker and freelance writer based out of Cincinnati, Ohio. You can follow him on Twitter at @SuppressThis or visit his blog "Virally Suppressed," which covers a multitude of issues related to public health and social justice.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
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