In his campaign rally speeches, President Donald Trump often boasts of his administration’s plan to end the AIDS epidemic in the U.S. in 10 years. It’s true he has proposed funding for that initiative, but he’s wrong to say “the previous administration spent no money” on such efforts.
In fact, the Obama administration spent about the same per year on AIDS research and prevention as the Trump administration has. And that’s only because Congress actually writes the budgets. Because while Obama routinely sought to increase funding, until this year, Trump has proposed cutting it.
The president also has falsely stated that his plan would “eradicate AIDS in America once and for all.” That’s not what ending the epidemic means, and not what his plan proposes.
During a cabinet meeting in July, Health and Human Services Secretary Alex Azar pronounced that “it’s going to be one of President Trump’s great legacies for history … the eradication of HIV as an epidemic here in the United States.”
During speeches, Trump has made it clear that he wants credit for this historic achievement.
At a recent rally in Dallas, for example, Trump claimed that “the previous administration spent no money on that and we’re spending a lot.”
Trump, Oct. 17: We will achieve new breakthroughs in science and medicine, finding new cures for childhood cancer and ending the AIDS epidemic in America in less than 10 years. We’re doing that. Who would have believed we could do that? We’re doing that. And the previous administration spent no money on that and we’re spending a lot. But think of that, who would have thought that. We’re going to end within 10 years the AIDS epidemic in our country. Who would have thought we’ve advanced that far?
During his State of the Union address in 2019, Trump announced that his 2020 budget would “make the needed commitment to eliminate the H.I.V. epidemic in the United States within 10 years.” That pronouncement was backed by a plan, “Ending the HIV Epidemic: A Plan for America,” and Trump’s budget proposed $291 million in spending for that initiative.
The Goal
The term “epidemic” is a bit subjective. The Centers for Disease Control and Prevention says the term “refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.” So, ending an epidemic would mean reducing cases below a certain level. The goal in the administration’s plan is to reduce the number of new HIV infections by 75% by 2025, and by 90% by 2030. If that milestone were achieved, one could argue that that would end HIV/AIDS as an “epidemic.” But that does not mean HIV/AIDS would be wiped out entirely.
Trump has not always been accurate on that point, such as when he said on Feb. 11 and Oct. 3 that the country would be “AIDS-free” in 10 years, or when he said on July 16 that his program would lead to “the eradication of AIDS,” or when he said on June 14 and June 18 that his administration would “eradicate AIDS in America once and for all.”
Obama vs. Trump
While the Obama administration did not fund a program that used the terminology “Ending the HIV Epidemic,” it is highly misleading for Trump to claim that “the previous administration spent no money on that and we’re spending a lot.”
The Obama administration spent more than $3 billion per year on research and prevention in the fight against the HIV/AIDS epidemic, about the same as has been spent under Trump. In fact, the Obama administration had a 2010 initiative it called “National HIV/AIDS Strategy for the United States.” The updated 2015 version of that plan had more modest goals than Trump’s plan — it called for reducing the number of new diagnoses of HIV by at least 25 percent by 2020. But it employed the same strategy at the heart of the Trump initiative — targeting prevention drugs and treatment in high-risk areas.
Before comparing the Obama and Trump funding of HIV/AIDS initiatives — first a word about process. Presidents’ budgets are somewhat symbolic statements of presidential priorities. Congress ultimately passes budgets, and it can accept or reject, or completely ignore, any of the funding proposals included in a president’s budget proposal.
The key domestic HIV programs contained in the federal budget are the Ryan White Program, the Centers for Disease Control and Prevention HIV prevention programs, and National Institutes of Health domestic HIV research. While actual funding for these programs — the funding approved by Congress — has remained relatively flat, Obama often sought to increase that funding.
Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, noted that in six of Obama’s eight years, he proposed funding increases for these programs; in two of his years, he requested flat funding.
“Congress ended up flat funding or decreasing funding for these programs in these [Obama] years,” Kates told us via email. “If you look at the trend line of final funding, therefore, they look pretty flat over the Obama years.”
By contrast, in his first two budget plans, Trump proposed cuts to those programs overall.
In Trump’s third budget plan, the fiscal year 2020 budget unveiled in March, Trump “has requested a significant increase in Ryan White and CDC, and a little for NIH, which still needs to be finalized by Congress,” Kates said.
“I can say that the Obama Administration spent a good deal of money on HIV/AIDS research and care, and that President Trump’s goals are laudable, but the resources needed to accomplish his Ending the HIV Epidemic are only now starting to be put in place,” Kenneth Mayer, a professor at Harvard Medical School and founder, co-chair and medical research director at the Fenway Institute in Boston, told us via email. “Given that the plan has a decade time horizon, it is too early to comment on long term expenditures and effectiveness.”
Trump’s Initiative
In a speech on Oct. 3, Trump said progress made on combating HIV/AIDS has been “somewhat of a secret” and that there has been “tremendous progress that we’ve made over the last few years on AIDS and AIDS research.” In fact, most of the research on which the initiative relies predates Trump’s presidency.
One of the key strategies to reduce new diagnoses of HIV under the Trump initiative is to target initial efforts on “geographic hotspots” and to provide pre-exposure prophylaxis (PrEP) pills to protect people at the highest risk of getting HIV. PrEP is a biomedical prevention tool approved by the Food and Drug Administration in 2012 that helps reduce the risk of getting HIV.
The plan also calls for diagnosing people as early as possible and expanding treatment so that people who are HIV-positive have only very low or even undetectable amounts of virus in their blood. That allows them to stay healthy and makes them far less likely to infect others.
Similar strategies were detailed by the Obama administration in its updated “National HIV/AIDS Strategy for the United States,” which it released in 2015. According to the stated vision of the plan, “The United States will become a place where new HIV infections are rare, and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.” (The Obama administration also produced the first National HIV/AIDS Strategy in July 2010.)
The 2015 updated plan from the Obama administration “also had ambitious goals, but technically did not call for the end of the epidemic, which is somewhat new terminology [in the Trump initiative],” Emily McCloskey, a director of the policy and legislative affairs team for NASTAD (National Alliance of State and Territorial AIDS Directors), told us via email.
After several years of declines, however, the number of new HIV diagnoses has remained relatively flat since 2012.
The Trump proposal includes a significant infusion of new funding. Trump proposed $291 million in funding for his initiative, over and above the existing domestic funding to combat the HIV/AIDS epidemic. As we noted earlier, that is a turnaround from Trump’s first two budget proposals, which sought to cut about an average $200 million per year from the Ryan White and CDC HIV/AIDS budgets.
McCloskey said she anticipates that the Trump administration will request significantly more funding in its next budget request.
“The initiative announced by the president is an important one and the administration has requested new funds and plans to pursue proven public health interventions and efforts which can make a difference,” Kates, from the Kaiser Family Foundation, told us. “However, it is too early to say if the trajectory toward the goal has improved significantly under or because of the Trump administration. The funding requested has not yet been approved by Congress and the implementation of the new initiative is only in the planning stage.”
Kates and other experts also cautioned that other parts of Trump’s policy may work against the goals of the initiative.
“The Trump administration has cut back access to health insurance in ways that could run counter to the proposed goals of the Ending the HIV Epidemic initiative,” Kates said, mentioning efforts to eliminate the Affordable Care Act. The number of people lacking health insurance rose by nearly 2 million from 2017 to 2018, according to figures reported by the U.S. Census Bureau.
Also, despite mentioning in his 2019 State of the Union address his aim to defeat AIDS “in America and beyond,” his budget proposals have consistently called for reductions in the global health budget to combat AIDS. The Kaiser Family Foundation said Trump’s 2020 budget would cut $1.35 billion from the President’s Emergency Plan for AIDS Relief, which seeks to control HIV around the globe.
Greg Millett, vice president and director of public policy at the HIV research foundation amfAR, told Kaiser Health News that Trump’s budget is “schizophrenic.”
“There’s just so many opposites within this budget of things that are truly helpful and useful,” Millett said. “And then, they are counterbalanced by things that just erase that goodwill.”
“Still,” Kates said, “if Congress approves the funding — which it has indicated it will do — the new effort could provide a much needed infusion of funds and serve as a catalyst to further drive down new HIV infections in the U.S.”
So, it’s accurate for Trump to boast that he has proposed a significant funding increase to combat the HIV/AIDS epidemic. But that funding increase has yet to be approved by Congress, and experts say it’s too soon to tell if the president’s program will achieve its lofty goals. Trump is wrong to say that the Obama administration did not fund similar efforts. Trump’s initiative seeks to build on research and prevention efforts that long predate his time in office.