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Science

We just don't know what President Trump will do on HIV, but 'the signs are worrisome'

During the US election campaign, plenty was said about emails and sexual harassment. But there was little or no talk on global health or HIV. That has left Mitchell Warren, the head of advocates AVAC, worried.

DW: One line jumps out from AVAC's first response to Donald Trump's becoming president: you say that the results of the US election "could imperil [the] progress" that you've made over the last 21 years, advocating for a rights-based response to the HIV epidemic. Why do you feel that?

Mitchell Warren: Thirty-five years into the epidemic, 21 years as an organization for AVAC, there has been enormous progress. Much of that progress has been in the last five or six years. And it's across the board: treatment scale-up, prevention science and increasingly prevention opportunities to reduce new infections thanks to voluntary medical male circumcision and oral PrEP. And we are now for the first time as a community talking about possibly ending the AIDS epidemic. That's a tantalizing idea. Science has got us to a remarkable point. Now it's our task to make good on that science.

And the reason we say this election could imperil that is we have never witnessed an election that was so unpredictable and unprecedented. The AIDS response has enjoyed bipartisan support in the United States. Democrats and Republicans supporting PEPFAR (the US President's Emergency Plan for AIDS Relief), supporting investments in the global funds, supporting the US National Institutes of Health, which is the lion's share of investment in HIV research. And we just don't know what a Donald Trump administration will do. And it may be that these programs continue to enjoy bipartisan support.

But that's just it, isn't it? We don't know. A lot of people have spoken about the "candidate Donald Trump" and now let's see what the "president Donald Trump" does.

Exactly. And this is true of any administration. It's not just the president. It depends on who that person appoints, and it would have been true had Hillary Clinton won the presidency.

USA Präsidentschaftskandidaten Hillary Clinton (picture-alliance/AP Photo/M. Altaffer)

As US Secretary of State, Hillary Clinton "prioritised the idea of an AIDS-free generation"

But we knew Hillary Clinton's track-record. We knew what we were getting. But now we just don't know. Certainly the signs are worrisome.

Like what?

In one [election] debate, where it wasn't about an AIDS vaccine particularly, he aligned himself with the anti-vaccination campaign, questioning whether vaccines were safe and effective. And, of course, we know that vaccines are one of the most powerful tools. So what he said as candidate might be completely unlike what he will do and say as president. Certainly in the case of vaccines let's hope he's evidence-based. We need his commitment to follow the evidence - his commitment and the commitment of those people he appoints - to follow the evidence and to follow the science, and do the right thing.

So when you write "racism, xenophobia, sexism and homophobia place all people at risk," are you suggesting it's a short trip from the President-elect talking about incarcerating Mexicans to a hardline approach to people living with HIV/Aids?

Oh, absolutely.

So what is the worst-case scenario?

We could see a lot of things. President Obama was able to abolish laws and rules that kept people living with HIV out of the country. We were one of the few countries in the world that had those laws, and Obama abolished them. One could imagine this coming back in a period of xenophobia and racism and homophobia.

You've mentioned the vision of ending the epidemic by 2030. As the Namibian Health Minister Bernard Haufiku told me at this year's World Health Summit, male medical circumcision - which you've also mentioned - is one way to achieve that. He's even performed them himself. Given the situation in the US, but also because HIV is a global issue, how likely are we to eradicate HIV/Aids by 2030 and are such goals helpful?          

I always make a distinction between goals and targets. It's entirely appropriate that we should have a global goal of "health for all" and that we should have a goal of ending the epidemic. We should certainly aspire to that. When it gets to targets - what can we operationally do? - we're on shakier ground, and I get a little nervous. You know, the United Nations' "90-90-90" targets for treatment by 2020, and ending the epidemic by 2030, they have had a bit of a boomerang effect in that some people, particularly policy-makers and funders, hear that and think, "Oh great, we're almost done with that and we can divert our resources elsewhere."

Mitchell Warren AVAC Archiv 2009 (picture-alliance/dpa)

Mitchell Warren says the signs from the Trump administration on HIV are "worrisome"

Yes, we've made huge progress. And the mathematical models confirm the concept that maybe, if we do all the right things, we could end the epidemic. But the price tag of all of that by 2030 is far beyond our current means. I worry that we've sold people on a concept that is not funded appropriately. For instance, a lot of people have focused only on antiretrovirals. So it is so reassuring that the Namibian health minister talked about voluntary medical male circumcision. Because what the models tell us is that not one component is enough. You have to provide primary prevention and that includes circumcision, it includes condoms, and it now includes oral pre-exposure prophylaxis.

It's so important we don't let the goal diminish our understanding of the resources that are needed for a truly comprehensive, integrated and sustained response to the epidemic. And, fundamentally, we have to develop a vaccine, and potentially a cure if it's possible, if we're going to sustain the end of the epidemic. We are not going to eradicate HIV by 2030. We may end the epidemic, but we're not going to see eradication in our lifetime. I think that's very clear. And we certainly won't have it if we don't have a vaccine or a cure.

Mitchell Warren has been the executive director of AVAC since 2004. AVAC is a New York-based organization, originally known as the AIDS Vaccine Advocacy Coalition.

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