One year ago this June, six members of the Presidential Advisory Council on HIV/AIDS resigned, writing in a Newsweek letter that President Trump “simply does not care” about people living with HIV and “seeks zero input from experts” on the issue.
Six months ago this June, the remaining members of PACHA were terminated via overnight mail from FedEx.
Today, PACHA has no members and there is no director for the Office of National AIDS Policy—a situation that experts working on HIV/AIDS policy say is uniquely alarming.
“The HIV policy and advocacy community is very concerned that PACHA is unpopulated,” AIDS United president Jesse Milan, Jr. told The Daily Beast, adding that he and his colleagues have “raised that concern” with the Department of Health and Human Services as recently as this May, only to be told that the nomination and vetting process for a new PACHA remains ongoing.
In response to questions from The Daily Beast about the timetable for that nomination process, HHS did not share any information beyond a statement the agency already issued months ago: “Changing the makeup of federal advisory committee members is a common occurrence during Administration changes. The Obama Administration dismissed the George W. Bush Administration appointees to PACHA in order to bring in new voices. All PACHA members are eligible to apply to serve on the new council that will be convened in 2018.”
HHS did confirm to The Daily Beast that both staffers listed on the PACHA Members & Staff website are federal employees, and neither are considered members of PACHA.
PACHA is an advisory body that was first formed in 1995 to seek the help of external experts in formulating federal HIV/AIDS policy. Prior to Trump, PACHA has existed under three presidents: Bill Clinton, George W. Bush, and Barack Obama.
Although turnover is indeed “common” for federal advisory committees under a new president, as HHS maintains, records show that the Obama administration had announced his full PACHA by February 1st, 2010–a little over a year into Obama’s first term.
By comparison, Trump has been president for one year and four months with no news about PACHA appointments—only a mass PACHA resignation, and a sudden firing of the rest of the council.
In fact, the only recent piece of Trump-related HIV news was the revelation by MSNBC’s Chris Hayes in late May that the President had reportedly asked Bill Gates on two separate occasions to explain “the difference between HIV and HPV,” as Gates recalled.
But a lengthy PACHA nomination process is not in and of itself unusual—even if the Trump administration is operating behind the Obama administration’s timetable.
Jeffrey Crowley, who served under Obama as the director of the Office of National AIDS policy from 2009 to 2011 and now oversees infectious disease initiatives at Georgetown, told The Daily Beast “it definitely took us a period of months to vet and appoint new members, as it has taken this Administration.”
Nor is cleaning house unusual, added Crowley: “We made the decision to not selectively add or remove any members and decided to start out fresh.”
But Crowley noted a critical difference between the current period of PACHA turnover and the one that took place between 2009 and 2010: “During [that] period, I was performing a very public role in providing HIV leadership for the Administration as Director of the White House Office of National AIDS Policy.”
Like PACHA, the Office of National AIDS Policy, or ONAP, was formed under the Clinton presidency. Whereas PACHA solicits recommendations from policy experts, ONAP is responsible for implementing the president’s strategy on HIV/AIDS across various federal offices.
This simultaneous lack of a PACHA and ONAP is precisely what experts working on HIV/AIDS policy find so concerning.
“With the Office of National AIDS Policy currently vacant and no PACHA, it means there are more limited access points for the public to engage with the Administration on HIV policy issues at present,” Crowley told The Daily Beast.
Milan, Jr. told The Daily Beast that “the two vacancies together are definitely creating a heightened concern,” noting that even having an ONAP director without a PACHA would be more encouraging the current situation: “Even if there was someone sitting in that [ONAP] position at the White House, then we would have someone to go directly to to hold accountable for the empaneling of PACHA but we don’t have that.”
The longest time period with no one serving as a director or acting director of ONAP was between February 2006, when George W. Bush appointee Carol Thompson left for a position in the State Department, and February 2009, when Crowley began to serve. Other than that, gaps between directors have typically been a matter of a few months.
For example, George W. Bush appointed Scott Evertz to serve as his first ONAP director on April 9, 2001, as CNN reported, just 79 days after the 2001 inauguration. It has been nearly 500 days since Trump was inaugurated.
With recent biomedical advances like pre-exposure prophylaxis, or PrEP, a daily medication that reduces the risk of HIV infection, and in anti-retroviral therapy, or ART, that suppress HIV for those already infected, experts like Milan Jr. believe that this is an especially critical moment for a failure of leadership from the White House.
In October 2017, for example, the Centers for Disease Control and Prevention announced in a memo that “people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner”—and yet CDC data shows that rates of new infections remain especially high among gay and bisexual men of color.
“We know that our national statistic of people living with HIV who are virally-suppressed is about half of what it should be,” Milan Jr. told The Daily Beast. “But we know that we have the tools that could make it possible for everyone to be virally suppressed—and tools to make sure that there are never again any new infections—but that’s not the reality today.”
Even if PACHA is empaneled again under the Trump administration, that’s no guarantee that its new members will be guided by evidence-based science on HIV/AIDS. Indeed, the George W. Bush-era PACHA was slammed by HIV/AIDS policy advocates like Esther Kaplan who wrote for POZ in 2002 that there wasn’t “a single staffer from a major national AIDS organization” on the advisory council but there were “nine longtime advocates of abstinence-only HIV prevention.”
So far, the Trump administration has made several anti-LGBT appointments in the judiciary and across the executive branch, raising concerns that a new PACHA may not necessarily be a good one. After all, last November— the month before the remaining members of PACHA were fired—the White House’s World AIDS Day proclamation made no mention of the LGBT people or the people of color who are disproportionately affected by HIV/AIDS, as The Daily Beast previously reported.
But not only do HIV/AIDS policy advocates have no idea what the new PACHA will look like, they also have no idea when it will be announced. Former Obama-era PACHA members like Gina Brown, an organizer with the Southern AIDS Coalition who resigned from PACHA last June, told The Daily Beast that they “haven’t heard anything” about the nomination process or the candidates who may be considered.
Crowley told The Daily Beast, “My understanding is that a new council is expected to be appointed, but I have no new information on this, and I really do not know if it will be imminent or the [reason] for the delay.”
All HIV/AIDS policy advocates can do is hope that any reliable experts who are being approached about joining PACHA would even be willing to serve after a year like this.
Said Milan Jr., “If people find themselves being asked to be on PACHA, we need the right people to say yes, especially because of this administration.”