Why Are We Missing In Action?

When Trump’s Department of Health and Human Services released its strategic plan for the next four years, activists couldn’t help but notice it barely mentioned HIV, STIs, LGBT people, or ethnic and racial minorities.

That’s a big change from past years, notes Matthew Rose, policy and advocacy manager at NMAC, an organization advocating for people of color living with HIV. “In the previous version, HIV was mentioned 20 times. In the current version, HIV is only mentioned once,” says Rose. “Given the administration’s praise of HIV programs in its budget outline, it seems strange that there would only be a single mention in the plan.”

Five of the nation’s leading organizations focused on ending the HIV epidemic collectively expressed their grave concern “with the lack of focus on HIV and other sexually transmitted diseases” in the 2018-2022 strategic plan. AIDS United, NASTAD (the National Coalition of STD Directors), NMAC, and The AIDS Institute submitted formal comments to the Department of Health and Human Services, which read: “Despite the crucial importance of the intersectional issues of HIV and STDs, including hepatitis, to our nation’s public health, the report is relatively silent on these issues. The document contains no mention of other STDs, mentions HIV only twice, and hepatitis just once. This lack of specificity regarding these diseases is of paramount concern.”

In addition, the comments pointed to “the failure to reference, even once, the unique health needs of America’s lesbian, gay, bisexual, and transgender populations, who bear the greatest burden of the nation’s HIV and STD epidemics. The report barely mentions the health needs and disparities facing racial and ethnic minorities. At the same time, the plan seems to prioritize faith-based approaches that have the potential to lead to discrimination against religious and sexual minorities.”

The 2014-2018 strategic plan, in sharp contrast, called out “health disparities among populations including racial and ethnic minorities, individuals with disabilities, refugees, [and] lesbian, gay, bisexual, and transgender (LGBT) individuals.”

Each of the previous plan’s strategic goals included similar language — and often went further to include specific subpopulations, such as older and disabled LGBT adults. The Obama plan also called for “cultural competency training for social service providers in the unique needs and experiences of LGBT youth, especially youth in foster care, youth experiencing homelessness, youth in juvenile detention, and youth in congregate living facilities related to mental health and substance abuse.”

Rose says this is why these HIV organizations are now urging the Trump administration to adjust its approach. “At a time when STD rates have increased to their highest levels ever, and four out of every 10 people living with HIV are not engaged in care, we should be refocusing our national resources on addressing these challenges, not turning our attention away from them. The HHS Strategic Plan is an opportunity to not only reinforce the national goals and priorities of the United States, but it is an opportunity for the United States to effectively plan to end the HIV epidemic and to address the worsening trends in STDs. Unfortunately, the latest version fails to accomplish either goal.”

However, Rose isn’t expecting an official HHS response to the statement, which was submitted via the notice-and-comment process. “Notice-and-comment rulemaking is a common procedure under which a proposed rule is published in the Federal Register and is open to comment by the general public,” he explains. While these comments won’t necessarily cause Health and Human Services to amend their strategic plan, Rose points to one silver lining: “The plan doesn’t have the force of law.”