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Will the Trump Administration Stall HIV Prevention Efforts?

Some people in the LGBT Community are feeling disregarded, if not blatantly attacked, by the Trump administration. In his first week of presidency, all references to LGBT people were erased from the White House website, including an apology from Secretary of State John Kerry about the government’s history of purging LGBT workers from federal jobs in the 1950s, according to a report published in the Advocate.

Then, also during the first few weeks into his presidency, the White House Office of National Aids Policy (ONAP) was closed down. ONAP was a program that first began in 1993 by the Clinton administration to reduce the number of HIV infections, and its closing sent a message to many activists that HIV/AIDS prevention would not be a Trump administration priority. While the closing of ONAP may have just been part of the transition process, there has been no indication that the program will be reopened.

Now the administration’s new efforts to repeal the Affordable Care Act (ACA), may deprive many Americans of access to pre-exposure prophylaxis (PrEP) drugs. In his new health plan, which would replace the Affordable Care Act, Medicaid expansion would be eliminated.

Currently, many men rely on government drug assistance programs, which only began to cover PrEP after the Affordable Care Act’s Medicaid expansion came into effect. If Medicaid expansion is eliminated, then many men would be denied access to PrEP.

The new bill would begin to phase out federal money and block new applicants and access to medications like PrEP, according to a report by Time Magazine. Over time, the current model of Medicaid would be replaced by per-capita grants, which would result in further cuts.

The repeal of the Affordable Care Act’s cost-sharing assistance program, which paid insurers to reduce the burden pay by enrollees based on their income, so that lower income Americans were able to pay less, would make coverage more expensive for poor Americans, according to Lindsey Dawson, senior HIV policy analyst of the Kaiser Family Foundation.

The number of new HIV infections in the next ten years could be cut by a third if PrEP drugs are taken by eligible men, according to new figures published by the U.S. Centers for Disease Control and Prevention (CDC).

Since the beginning of the Obama administration, there has been a huge increase, of about 738 percent, in PrEP users in the U.S. There have been 80,000 new PrEP users between 2012 to 2015, which has likely prevented countless HIV infections. The new move by the Trump administration that would potentially make PrEP less affordable, potentially derailing the progress thus far.

“When PrEP was first approved, gay and bisexual men were not using it,” said Noël Gordon Jr., a senior program specialist for HIV prevention & health equity at the Human Rights Campaign. “Now, we’ve seen an exponential increase in users. The repeal of the ACA would be devastating as it has the potential to turn the tide the other direction, where we could potentially see the spread of HIV.”

In addition to the potential loss of PrEP, the repeal of the Affordable Care Act (ACA) could also leave many HIV-positive Americans without health coverage. Before the ACA was passed, only about 13 percent of people with HIV had private health insurance and 24 percent had no coverage at all. The ACA, and the expansion of Medicaid, greatly increased HIV-positive people’s access to medical treatment in a number of states, according to the CDC.

“These are these shocking, irresponsible cuts that would come just as we are finally poised to make real progress in containing the HIV/AIDS epidemic,” said the Gay Men’s Health Crisis (GMHC) Chief Executive Officer, Kelsey Louie. “The repeal of the ACA could possibly result in the loss of affordable and accessible healthcare for at least 3.4 million lives.”

A loss of insurance coverage could mean a loss of access to antiretroviral treatment, which is necessary for keeping HIV-positive people at undetectable levels and unable to transmit the virus for others. Ensuring that HIV-positive people are undetectable is crucial for HIV prevention efforts.

“As an LGBT community (and this applies to our supporters, too), we cannot be focused simply on the Trump administration’s conservative stance on our civil rights,” writes Stephen Thrasher, an LBGT journalist, in a Guardian column. “We must be vigilant about how HIV/AIDS stands to harm the most vulnerable among us first, do all we can to protect the 1.2 million people in the U.S. already living with HIV, and insist that the government keep the epidemic from getting even worse.”

Additionally, the ACA funds government HIV/AIDS prevention programs that could disappear under Trump’s new plan, leading to a loss of crucial information for those who need it on how they can prevent an HIV infection.