by Scott Schoettes

2020 was a challenging year in so many ways, and it capped off the very challenging four years of the Trump administration. In June 2017, I led a group resignation from the Presidential Advisory Council on HIV/AIDS (PACHA) because it had become crystal clear in a few short months that Donald Trump was not going to take advice from us (or anyone) and that he did not really care about people living with HIV or ending the HIV/AIDS epidemic. Sure, the leaders at the Department of Health and Human Services got him to mention HIV in his State of the Union address in 2019 (a “Teleprompter Trump” moment), but he never involved himself in the plan he announced that night, except to falsely brag about all he was accomplishing.

That is not to say, however, that progress was not made on HIV during the Trump administration—it was just progress made despite Trump, not as a result of anything he did. As I said in the op-ed announcing the group resignation from PACHA, lots of career folks at HHS care deeply about HIV, and they continued to move things forward. We witnessed the introduction of the “Ending the HIV Epidemic: A Plan for America” and the beginning of its implementation. It is a plan deeply rooted in a biomedical approach to ending the epidemic: get everyone tested, get everyone who tests positive into treatment, and get PrEP to everyone at higher risk who tests negative. All important features of any plan to end the HIV epidemic, but the Trump plan failed to meaningfully address social determinants of health and barriers to implementation of the biomedical interventions.

Expect to see a Biden/Harris administration repair the damage inflicted by Trump over the past four years and build on the solid foundation provided by Obamacare.

While I am confident that implementation of all of those biomedical approaches will continue under the Biden/Harris administration, we can also look forward to actions that will demonstrate a commitment to addressing the social determinants of health and dismantling barriers to care, such as the following:

Acknowledge and Address Structural Racism and Sexism. In September, President Trump issued an executive order that would prevent federal contractors and grantees from training people to recognize their implicit biases, to acknowledge different types of privilege they may possess, or to address structural racism and sexism. Lambda Legal sued to stop implementation of this executive order in November, and President Biden will undoubtedly rescind whatever remains of it on his first day. We will not eliminate the HIV or COVID epidemics unless we address these racial and gender inequities.

Recognize and Promote the Civil Rights of Transgender and LGB People. The Biden/Harris administration will reverse course on what has been a nonstop assault on the rights of transgender people during the Trump/Pence years. Biden will undo the infamous Trump tweet (and ensuing policy change) that prevented the open military service of transgender people—the subject of another Lambda Legal lawsuit—and will stop denying that gender identity and sexual orientation are covered under federal nondiscrimination laws. On this latter change, Lambda Legal was at the forefront of the legal campaign to persuade courts to recognize that the federal employment nondiscrimination statute (Title VII) covers sexual orientation and gender identity, leading to a favorable U.S. Supreme Court ruling in Bostock v. Clayton County in 2020. The federal government cannot gain people’s trust and engage them in care while attacking them at every turn. (The Biden administration has also pledged to lift restrictions on the military service of people living with HIV—more on that in a future column.)

Treat Health Care as a Human Right. Assuming the Affordable Care Act survives the Trump/Republican-led challenge currently pending before the U.S. Supreme Court, expect to see a Biden/Harris administration repair the damage inflicted by Trump over the past four years and build on the solid foundation provided by Obamacare. In addition to maintaining greater access to PrEP, the survival of the ACA will sustain expanded Medicaid eligibility, access to health insurance for people with pre-existing conditions, and protections against discrimination in health care based on sex (which includes sexual orientation and gender identity) and disability status. The importance of the ACA in defeating HIV cannot be overstated.

There are a slew of other things the Biden/Harris administration can—and likely will—do to improve engagement in care and the lives of people living with and at higher risk for HIV. The above steps are a good start—and I am (once again) hopeful about what can be accomplished by a leader who believes in science and embraces solutions to address social determinants of health. It’s a new day!

Scott Schoettes lives openly with HIV and is the HIV Project Director at Lambda Legal, where he engages in impact litigation, public policy work, and education to protect, enhance, and advance the rights of everyone living with HIV.