Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

January 08, 2018
5 min read

Experts worry about consequences of Trump’s HIV/AIDS council firings

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Image of White House
A red ribbon hangs from the White House on World AIDS Day 2010.
Source: Official White House photo/Lawrence Jackson

The AIDS czar under former U.S. President Barack Obama worries about the consequences of the Trump administration’s recent termination of the last members of a presidential HIV/AIDS council.

“Is this a signal that they’re moving away from evidence-based policymaking? That’s what’s troubling,” Jeffrey S. Crowley, MPH, program director of infectious disease initiatives at the O’Neill Institute for National and Global Health Law at Georgetown University, told Infectious Disease News in an interview.

Without explanation, the Trump administration fired every remaining member of the Presidential Advisory Council on HIV/AIDS (PACHA) in letters on Dec. 27. The firings came 6 months after six members of the council publicly resigned in a letter that said President Donald J. Trump “simply does not care” about the subject of HIV/AIDS.

Crowley and others have questioned the timing and meaning of the terminations by a White House now seen as detached from the HIV/AIDS community and possibly disdainful of science-based solutions to public health issues.

Fired PACHA advisor Gabriel Maldonado, founder and CEO of the Southern California-based LGBT and HIV/AIDS nonprofit TruEvolution, said many council members had voiced their opposition to the Trump administration’s efforts to repeal the Affordable Care Act, which has provided patients with HIV better access to health care. However, they said their disagreements with the White House extend beyond practical matters involving policy and implementation.

“For all intents and purposes, it’s really a restructuring with members who are more in alignment with their ideological, philosophical and moral beliefs,” Maldonado said of the firings. “This administration leans more toward abstinence-only sexual health education as opposed to comprehensive sexual health education, which is what the majority of the council members have advocated for.”

Maldonado also said that the council had clashed with the Trump administration over Medicaid block grants — most progressive HIV advocates are against them — as well as Trump’s attempt to ban transgender troops from the military and reports that the CDC will be prohibited from using certain words — including “science-based,” “evidence-based,” “transgender” and “diversity” — in federal budget documents.

“As the former co-chair of the disparities committee, my job is to look at vulnerable populations that come from a wide range of diverse communities and are experiencing a disproportionate level of new infections as a result of extenuating social determinants of health,” including racism, anti-gay sentiment, homelessness, domestic violence, mental health disorders and substance abuse, Maldonado said.

“[HIV] largely impacts communities of color, the LGBT community ... and we’ve seen that morally, this administration and many of its surrogates do not believe in the identity or existence of these communities, certainly not the empowering of these communities through any kind of resource investment.”


Not unprecedented

Crowley served as the director of the White House Office of National AIDS Policy under Obama from 2009 to 2011. He oversaw the dismissal of all of President George W. Bush’s PACHA advisors in the first few months of the Obama presidency so that the administration could appoint candidates that it had vetted.

Crowley said it is every administration’s right to appoint its own advisors, but he questioned the timing of the recent firings.

“I don’t really think anyone’s disputing that they have a right to do this, but what was troubling to me is that they had some natural opportunities before and they didn’t take them,” he said.

Crowley said it would have been better to fire the remaining members at the first-quarter PACHA meeting last year, or when Trump signed an executive order on Sept. 29 to keep the council in place until at least Sept. 30, 2019. Maldonado said a third option would have been to remove the council members last January, after the inauguration.

“We were led to believe that we were going to be continuing to the end of our term,” Maldonado said. “There were no indications given that there was going to be any kind of imminent change.”

PACHA executive director Kay Hayes stated that members were “eligible to apply to serve on the new council,” Maldonado said, but the date of their dismissal left little time to be renominated. HHS — which oversees PACHA — set the deadline for new nominations as Jan. 2 — just 6 days after fired members received their letters. Maldonado said it can take weeks to put together all the materials required to be nominated to the council — letters of reference, letters of support, an updated CV, a statement and more.

“There wasn’t a sufficient amount of time to do that, which was an indicator to me that there wasn’t necessarily a wide-open door for us to come back,” he said.

HHS spokesman Miguel Gomez, who works in the Office of HIV/AIDS and Infectious Disease Policy, told Infectious Disease News that he did not have information on why the administration chose to fire the members on Dec. 27, so close to the deadline. He also did not know when new members would be announced.

One problem with filling the spots right away is that PACHA members are appointed by the HHS secretary, a post that has remained absent since Tom Price, MD, resigned in September after coming under scrutiny for his costly travel habits. The Senate Finance Committee is set to hold a confirmation hearing on Trump’s nominee to replace Price, former HHS official and pharmaceutical executive Alex Azar II.


No lines of communication

Not only is PACHA now empty, but the Trump administration has also not filled the Office of National AIDS Policy, which has overseen implementing the country’s HIV/AIDS strategy for decades. These are troubling signals that the White House is not interested in communicating on the issue, according to Crowley.

“There’s just almost no way for our community to interact with this administration,” he said. “(PACHA) was one formal venue that they had to provide input. The administration could choose to ignore their input, but it was at least a way that people could come to the table.”

Scott A. Schoettes, HIV project director at Lambda Legal and author of the June letter published in Newsweek that announced six PACHA members were resigning, called the recent firings “dangerous” and said the administration was “eliminating (the) few remaining people willing to push back against harmful policies.”

The HHS notice seeking PACHA nominees says they are picked from “prominent community leaders” who are experts in the field of HIV/AIDS and that “it is important that the perspectives of people living with HIV, those from groups that are disproportionately affected by HIV infection and AIDS, health care providers, and organizations providing prevention, care and treatment services to these populations be included.”

But Crowley and Maldonado worry about what a council picked by the current administration will look like. Would it be better to have an empty council, or one filled with nonexperts?

“That’s like saying, Do I want to starve to death or die of food poisoning,” Maldonado said. Forced to choose, he would pick an empty council over one filled with advisors giving bad advice.

“A PACHA advisor is someone who can not only bring academic and scholarly insight, but also has a community-centered perspective on the everyday lives of people living with HIV and the communities that are most impacted,” he said. “You have to have both. If you don’t have both, then you’re only playing with a half-deck of cards.” – by Gerard Gallagher

Disclosures: Crowley reports receiving an honorarium from Gilead Sciences for speaking engagements unrelated to promoting any pharmaceuticals and that Georgetown University receives grant funding from Gilead. Gomez works for HHS. Maldonado reports no relevant financial disclosures.