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Could President Trump Spell Trouble for AIDS Research?

by Carissa Andrews - December 1 , 2016


by gustavofrazao, despositphotos.com
by gustavofrazao, despositphotos.com

December 1, 2016 will mark the 28th year World AIDS Day has been dedicated to raising AIDS awareness throughout the world. It’s also a day for mourning the loss of those who have died because of this disease. Approximately 38 million people have HIV across the globe. Of those, only 18 million or so are getting the treatment they need. Since its discovery almost thirty years ago, 39 million people have died.

With World AIDS Day just around the corner, it’s time to ask ourselves some hard-hitting questions. In the United States, the future of funding for HIV/AIDS research has been put into question as we prepare for the new administration to take office. How will this new team of leaders tackle the situation and will it be good for those hoping to discover a cure within our lifetime?

Aids was first discovered in 1983, by Françoise Barré-Sinoussi, at the Pasteur Institute in Paris. She managed to isolate the retrovirus killing the T-cells from the lymphatic system of a gay patient. The virus initially went by several names, including LAV, and HTLV-III. In 1986, the virus officially adopted the name HIV.

The actual time between infection and the onset of AIDS varies greatly. Without treatment to slow down the virus, about half of those diagnosed with HIV will develop AIDS within 10 year’s time.

Who is Most at Risk for HIV/AIDS?

While anyone can contract HIV through unprotected sex, or contaminated drug use, the fact remains some portions of the public are more susceptible than others. Here’s a list of a few of the most at risk:

Gay, or bisexual men who have sex with men (MSM), are most at risk to sexually contract HIV. Though they only equate to 2% of the United States population, nearly 2/3 of all newly diagnosed cases fit into this category.

Injection drug use (IDU) is also another well-known risk factor for contracting HIV. Making up 1/3 of the HIV positive cases. IDU patients often contract the disease due to contaminated needles.

While HIV and AIDS affects men more often, 1 in 4 are women. An unfortunate circumstance of poverty places an overwhelming majority – nearly ¾ the women living with HIV or AIDS are women of color. To address the disparities, the United States needs to work on better funding for education in African American communities.

Treatments for AIDS/HIV

Even in 2016, there is no cure for HIV or AIDS, though breakthroughs are happening all the time. The medications used to treat HIV are better known as antiretroviral drugs (ART). According to the Mayo Clinic, there are different classes of anti-HIV medications. Each blocks the HIV virus in different ways, and some can even be combined for a more effective treatment.

The classes of anti-HIV drugs include:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).

• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine-tenofovir (Truvada), and lamivudine-zidovudine (Combivir).

• Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan).

• Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

• Integrase inhibitors. These drugs work by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. Examples include raltegravir (Isentress), elvitegravir (Vitekta) and dolutegravir (Tivicay).

There are four new combination HIV medications on the market to consider: Abacavir/Dolutegravir/Lamivudine (Trimuq), Emtricitabine/Tenofovir Alafenamide Fumarate (Descovy), Cobicistat/Elvitegravir/Emtricitabine/Tenofovir Alafenamide Fumarate (Genvoya), Cobicistat/Darunavir Ethanolate (Prezcobix).

Trump’s Stance on AIDS/HIV

President-elect Trump has been touted the most pro-LGBT Republican candidate in the 2016 election. However, the bar was set pretty low. In addition, Trump’s stances seem to change with his moods, so it’s hard to tell where his real discernment lies. He also hasn’t specifically mentioned his approach to HIV or AIDS funding and research.

"My gut tells me a Trump presidency would be bad for people living with HIV, especially globally," Andrew Spieldenner, co-secretary of the U.S. People Living with HIV Caucus has said. "The nativism he's exhibited during his campaign doesn't seem to me to be good for PEPFAR [The President's Emergency Plan for AIDS Relief]."

Considering the fact Trump has put a spotlight on dismantling the Affordable Care Act (ACA) without any clear direction on what will replace it, AIDS suffers may be in for a fight. It’s estimated that 21 million people will likely lose their health insurance without an affordable replacement if the ACA is repealed. So even if Trump happens to follow through on his campaign promises to reduce the cost of prescription drugs, the overall sentiment won’t be good for people living with HIV/AIDS in the United States.

George Ayala, the executive director of The Global Forum on MSM & HIV (MSMGF), is on record having said, "I'm not aware of anything Trump's said about HIV, which is a problem right there. At this point we can only speculate based on behavior, but I think gay men -- especially gay men of color -- wouldn't have great access to the White House, and that spells trouble."

Who will Trump Hire for the NIH?

The National Institutes of Health (NIH) invests roughly $32 billion annually toward medical research that benefits the American people. Of that, $3M has been designated funding for HIV/AIDS across their Offices of AIDS Research.

In the Fiscal Year 2017 Congressional Budget Justification for the NIG: Office of AIDS Research, current Director Francis S. Collins has stated “In more than three decades since the first cases of AIDS were reported, NIH has been the global leader in sponsoring research to prevent, diagnose, and treat HIV and its associated comorbidities, coinfections, and other complications. NIH has established a comprehensive and coordinated AIDS research program that has demonstrated unprecedented progress against this global AIDS epidemic. NIH-sponsored research has led to groundbreaking advances in understanding the HIV life cycle, development of safe and effective antiretroviral drugs and drug regimens for the treatment of HIV-infected individuals, and strategies to prevent HIV transmission/acquisition. While significant progress has been made, the AIDS pandemic continues to spread in the United States and worldwide representing the most serious global public health crisis of our time. NIH will continue to build on the scientific advances and knowledge that has been gained to address the unprecedented scientific opportunities that we now face to successfully develop a safe and effective AIDS vaccine, a cure for AIDS, and ultimately, lead to an AIDS-free generation and an end to the AIDS pandemic.”

President-elect Trump, on the other hand, doesn’t feel the department as a whole is doing its job, for unspecified reasons.

“I hear so much about the NIH, and it’s terrible,” Trump has said in the past.

It’s hard to say who Trump will tap for the position, but if his recent cabinet picks are any indication, they will likely be controversial outsiders who have been loyal to him in the past. Which doesn’t necessarily spell out good news for AIDS funding or research.

Without having detailed information on what the President-elect’s stances are on HIV/AIDS, it’s hard to know how this will play out. Everything at this point is merely speculation based in his past and more recent history. There are a good many things up in the air about how this new administration will operate, and for those who live with HIV/AIDS, the ambiguity isn’t a relief. Only time will tell just how LGBT-friendly Trump really is, and how right-leaning the agenda of his team becomes. Keeping a watchful eye on this cause—and many others—may be more important than ever before.

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Carissa Andrew considers herself a triple threat: write, design and marketing. Her passion lies in mixing these three together with creativity and sass.


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