The advisory panel, which has existed in some form since the Reagan years, now sits empty after President Donald Trump removed all 16 of its remaining members last week. | AP Photo Trump's firing sets back AIDS prevention efforts The decision to dismiss 16 advisers comes as the opioid crisis threatens to spike HIV/AIDS cases among those who inject drugs.

President Donald Trump’s decision to fire his HIV/AIDS advisory panel and refusal to fill other key policy positions puts the U.S. at risk of slipping backward on prevention just as the opioid epidemic threatens to spread the virus among intravenous drug users.

The advisory panel, which has existed in some form since the Reagan years, sits empty after Trump removed all 16 of its remaining members last week. That, combined with proposed massive cuts to prevention programs in Trump's fiscal 2018 budget and his not naming a director for the White House Office of National AIDS Policy, sends troubling signals about the administration’s commitment and represents a marked departure from his predecessors, say advocates and lawmakers.


“This White House has to recognize that it must take on a leadership role, as President Bush did, in eliminating the scourge of HIV/AIDS in this generation,” Republican Rep. Ileana Ros-Lehtinen, a co-chair of the Congressional HIV/AIDS Caucus, said in an email.

Administration officials maintain that sacking the Presidential Advisory Council on HIV/AIDS was standard operating procedure. They want to clear out Obama administration appointees and make room for a new, handpicked panel.

But the removal of doctors, business leaders and others tasked with making policy recommendations to the president stunned patient advocates, who were already concerned about Trump’s limited engagement. Six members of the advisory panel had resigned this summer to protest policies, including Trump’s commitment to rolling back Obamacare coverage they said would be detrimental to people with HIV/AIDS.

“The question for many is, what was the precipitating event for this change now? And, does this signal a retreat from the National HIV/AIDS Strategy or evidence-based policy making,” Jeff Crowley, director of the Office of National AIDS Policy for the Obama administration, told POLITICO.

Trump’s decisions about who to place on the panel — if he fills it at all — will help define how he plans to tackle bigger questions about HIV/ AIDS policy, which has been a major public health initiative for previous administrations and underwent a big global push under George W. Bush.

There is added urgency as the opioid epidemic sparks new cases of injection drug-linked HIV in predominantly rural areas where Trump derives some of his strongest political support. The CDC has flagged 200 counties at risk of an injection drug-linked HIV outbreak. It’s still unclear whether Trump will include HIV prevention in his larger federal response to the opioid crisis. His opioid task force, led by New Jersey Gov. Chris Christie, did not raise the issue.

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Trump already has drawn scrutiny for his track record on both HIV/AIDS and the opioid crisis. His budget proposal for fiscal 2018 called for $800 million in cuts to global HIV/AIDS prevention programs, another $186.1 million cut to CDC prevention and screening efforts and additional cuts to housing programs for people with the deadly virus. CDC officials in the budget document said the cuts would result in diminished testing and support services for people living with HIV. Trump's support for repealing Obamacare ran counter to the views of the advisory council, which rebuked congressional Republican's legislative efforts in a letter to the administration, saying the legislation would cause “catastrophic damage” to HIV prevention.

Trump still has yet to name a director for the Office of National AIDS Policy, and the office's website was shut down days after he took office, setting off alarm among activists and others working in HIV/AIDS policy. A recent New York Times report described Trump complaining that all Haitian immigrants have AIDS, which the White House denied.

“I am fearful that the people who are appointed will be in line with the current philosophy of the administration,” said Lucy Bradley-Springer, associate professor of the University of Colorado Denver’s Division of Infectious Diseases and one of the advisory council members who resigned this summer. “In my mind that will mean a decrease in funding for important services, fewer people getting tested, and more people going without care.”

Trump could also leave the panel vacant, which would be a major break from previous administrations.

The advisory council took its present shape during the Clinton administration. Former President George W. Bush created the President’s Emergency Plan for AIDS Relief and committed $148 billion to fight HIV/AIDS over the course of his administration. President Barack Obama reauthorized PEPFAR and created the first ever National HIV/AIDS Strategy.

The Trump administration said terminating the panel was routine and in line with past practice, pointing to the Obama administration’s similar decision to dismiss council members who were appointed under George W. Bush.

“Changing the makeup of federal advisory committee members is a common occurrence during administration changes,” said Kaye Hayes, executive director for the advisory council. She noted that former members can re-apply to serve on the new council that will be convened sometime this year.

The administration on Dec. 1 posted a notice in the Federal Register seeking recommendations for new members, though a Department of Health and Human Services spokesperson declined to discuss the timing of any new appointments.The notice stated an effort will be made “to ensure that the views of women, all ethnic and racial groups, and people with disabilities are represented on HHS federal advisory committees.”

Experts say the United States has made strides in combating the deadly virus. According to federal figures, there were an estimated 37,600 new HIV infections in 2014, an 18 percent drop from 2008. And in that same time frame, reductions were seen in most high risk groups. Still, there are currently estimated 1.1 million people in the United States were living with HIV at the end of 2015.

“For decades, presidents of both parties have relied on PACHA to develop effective, evidence-based federal HIV/AIDS policy,” Democratic Rep. Barbara Lee , co-chair of the Congressional Caucus on HIV/AIDS, told POLITICO. “With an end to AIDS nearly in our grasp, now is not the time to reverse our progress.”

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