Federal vacancies and faulty beliefs exacerbate HIV prevention efforts

Is HIV even still a problem? The answer is yes and that is part of the problem because we don’t talk about it. Abstinence-only education ignores the realities of how both teens and adults express themselves sexually and is partly the blame, starving out funding for comprehensive sex education grounded in reality.

In the revolving door that is the Trump White House, the fact the president fired remaining members of his Presidential Advisory Council on HIV/AIDS is another reason.

{mosads}In fact, states that use abstinence-only education, such as Arkansas, Texas and Arizona, have the highest teen pregnancy and sexually transmitted infection rate rates among young people. Major urban areas like Atlanta, New York, and San Francisco have the highest HIV rates among cities.

One problem is the Trump administration never appointed a director of the Office of National AIDS Policy. Vacant for nearly a year, the sole job of this office is to reduce the number of HIV infections across the country.

Now, we have seen an overall gradual decline in HIV rates from over 58,000 new HIV cases in 1997 to 40,000 in 2015. But we should be really concerned about high HIV infection rates in black and Latino communities, among LGBTQ individuals, and in the South.  

With no one directing critical federal HIV-prevention activities, we can expect HIV rates to increase. And this means an increased burden on our health-care system, an increased financial burden to patients and their families, and of course an increase in AIDS-related deaths.

HIV-prevention efforts have focused on increasing HIV testing, condom use, pre-exposure prophylaxis (PrEP) and needle exchanges.  

HIV testing has been quite successful as just several years ago one in five people were unaware of their HIV status and now it’s down to one in seven, however, we still have a ways to go.

PrEP is a once-daily pill that people who are HIV-negative take who engage in high-risk behaviors can take that will prevent HIV. PrEP is highly effective if taken daily, and helps ensure people who are HIV-negative are less likely to contract HIV.

Needle exchange programs are effective and while research shows they do not increase drug use there are still those who are against this prevention method, such as Vice President Mike Pence. As Indiana governor, Pence was faced with an overwhelming number if HIV infections in a rural county linked to drug users sharing needles.

After two months of this horrendous outbreak and Pence refusing to allow needle exchanges for moral reasons — he believed needle exchanges support drug abuse — he decided to pray. Meanwhile, people were contracting HIV at epidemic levels while he ignored scientific evidence.

Finally, he agreed on March 25, 2016 to allow needle exchanges and after rigorous outreach and treatment, the HIV outbreak slowed. Who knows how many infections could have been prevented if Indiana officials has acted sooner.

No one prevention effort works alone; it is all in combination.

When six members of the HIV/AIDS advisory council resigned in summer 2017 because of looming funding cuts that would undermine their progress, then the remaining 16 got fired in December, America’s progress has been severely challenged. The White House revolving door has left us vulnerable.

While these vacancies eventually may be filled, threatened cuts to HIV/AIDS efforts, the obvious beliefs and homophobia of our vice president and the overall blatant disregard for HIV, I have little faith they will be filled by anyone who will advise and coordinate efforts on the same trajectory.

We have made improvements, but there is still much work to be done. For now, it’s up to us to do grassroots awareness and work in our own communities. We can’t stop fighting because we can — and must — win this fight against HIV/AIDS with or without this administration.

Liesl Nydegger, PhD, MPH is an assistant professor in Health Behavior & Education in the Department of Kinesiology & Health Education at The University of Texas at Austin