WASHINGTON (WASHINGTON POST) - The president who fired his HIV/Aids advisory council a year ago and has no one working in the White House Office of National Aids Policy pivoted on Tuesday (Feb 5), pledging to direct fresh money and knowledge to eradicate the epidemic.
In his State of the Union address, President Donald Trump went beyond the promises of any of his predecessors since Aids appeared as a deadly scourge nearly four decades ago.
He announced a strategy to stop the spread of HIV by 2030 by concentrating as-yet unspecified resources on 48 counties and other "hot spots" where half the nation's new infections occur.
"Scientific breakthroughs have brought a once-distant dream within reach," the president said in the latter part of his annual agenda-setting speech to both chambers of Congress. "Together, we will defeat Aids in America and beyond."
The president did not identify how much additional money the government would devote to the effort, saying only that his budget "will ask Democrats and Republicans to make the needed commitment eliminate the HIV epidemic in the United States within 10 years".
Health and Human Services (HHS) Secretary Alex Azar said on Tuesday that the sums requested by several of his top public health officials to accomplish this goal will be in the president's budget next month. He, too, did not specify an amount.
The HIV/Aids pledge was part of a smorgasbord of health policy issues that Trump wove briefly into a speech portrayed by the White House as an attempt to find ideological common ground amid a moment of bitter partisanship that led to the longest government shutdown in history - and a reopening guaranteed to last only until mid-month.
The president reiterated his determination to constrain the price of prescription drugs. He gave his administration credit for what he contended was the largest slowing of drug prices last year in nearly a half-century.
In an allusion to an administration proposal last week to end the widespread practice of drug rebates to middlemen, Trump said that drug manufacturers, health insurers and hospitals should "disclose real prices to foster competition and bring costs way down".
And in a gesture to social conservatives who are key to his political base, Trump broached the perennially divisive issue of reproductive rights by focusing on the legality of late-pregnancy abortions - an issue lately in the Virginia and New York legislatures.
"To defend the dignity of every person," the president said, embracing the position of abortion opponents that life starts at conception, "I am asking the Congress to pass legislation to prohibit the late-term abortion of children who can feel pain in the mother's womb".
Such a proposal has no chance of passing a politically split Congress.
On the other contentious healthcare issue that has dominated his attention, the Affordable Care Act, Trump devoted a single sentence.
"We eliminated the very unpopular Obamacare individual mandate penalty," referring to Congress' elimination of the federal fine for people who flout the ACA's requirement that most Americans carry health insurance. That change took effect last month.
The president made no mention of several other parts of the healthcare law that his administration has worked to undermine through executive powers.
Trump did not elaborate on his strategy to erase HIV.
But Azar, the HHS secretary, said in an interview the plan grew out of several months of work by a team of leaders. They include Anthony Fauci, director of the National Institutes of Health's National Institute of Allergy and Infectious Diseases and a pioneer in AIDS research, and Robert Redfield, a longtime Aids researcher in the military and at the University of Maryland before he became director of the Centers for Disease Control and Prevention (CDC) nearly a year ago.
Azar said that he presented the idea to Trump, who recognised the goal of eliminating HIV infections as "one of the most important moments in public health in the United States", as the secretary put it.
After the president disbanded the HIV/Aids advisory council in late 2017, Azar announced in December the appointment of two new co-chairs, who are scheduled to start meeting next month and are the only members so far. HHS also is creating a hub of Aids advisers.
The administration's plan follows a 2010 HIV/Aids strategy that the Obama administration devised and updated five years later.
Fauci said on Tuesday that the new plan is different in its geographic concentration and because of significant research developments of the past few years.
Recent studies have shown that people at greater risk of infection - such as men who have sex with men - can lower their likelihood of contracting the virus markedly if they take daily, pre-exposure HIV medicines known as PrEP.
Other studies have documented that HIV-infected people whose viral load is reduced through medicine to undetectible levels have little risk of transmitting the infection.
Such developments have reduced new infections in the US to about 40,000 per year, but that figure has plateaued, said Brett Giroir, HHS' assistant secretary for health.
"We really need to have a push," he said.
To do that, Azar and his colleagues said, researchers have studied the geography and demographics of HIV and found that new infections are concentrated in 48 counties, the District of Columbia, Puerto Rico and seven states - primarily across the South - where a large share of HIV cases are in rural areas. The new initiative will start by focusing on those places.
Teams of HIV health workers - CDC employees or working through CDC grants - will fan out into such communities, trying to encourage residents at risk of HIV to get tested and to start preventive medicine or, if they test positive, to go on drug regimens to lessen their chances of getting sick or spreading the virus.
The goal is to reduce new HIV infections by 75 per cent within five years and 90 per cent over the coming decade.