HIV-positive Americans contemplate challenges in Donald Trump's America
Dee Borrego spent election night at home in Boston, watching the results livestream over YouTube. Around 8:30 p.m., dismayed by early results and fatigued from doing electoral math, she moved to her couch and watched Will & Grace for a few laughs. She found out the results at 5:30 the next morning.
"I was kind of in shock," she said in a phone interview. "I felt very disillusioned."
As an HIV-positive transgender woman of Mexican descent, so much about the future felt unsure and even hostile to her. In several interviews, people living with HIV told Mic that they fear that the progress during the last two administrations may be undone. Both the Bush and Obama administrations left historic marks on the fight against HIV — Bush internationally with 2003's PEPFAR and Obama domestically with the 2010 National HIV/AIDS strategy.
The Trump administration represents a stark turn for people living with HIV. What scares many within the community, unlike among other marginalized groups, is not Trump's rhetoric, but rather that he's been relatively silent about the epidemic, which disproportionately affects the most vulnerable people in the United States.
For people living with the virus, HIV is more than a health issue; it affects their social and economic realities, as well. HIV status exists alongside their gender identity, sexual orientation, race and religion. After an election that brought identity politics into laser focus, people with HIV are trying to look into their crystal ball, figure out how Trump's policies will affect their complex existences and create a roadmap for their own activism.
"I'm a Jewish, Mexican-American, HIV-positive transgender woman, so you know it's hard to pick which is the thing that bothers me the most about his various proposals and the position that he and the vice president-elect espouse," Borrego said.
Pinning down Trump's policies regarding HIV remains difficult. In January, Gay Men's Health Crisis invited presidential candidates to share their plans for fighting the U.S. HIV/AIDS epidemic. Trump, along with every single Republican candidate, did not respond to the invitation. Trump also dodged several chances to meet with HIV/AIDS activists, according to Andrew Spieldenner, the chair of the U.S. People Living With HIV Caucus. Spieldenner said a meeting with the activists piqued Trump's interest only after Bernie Sanders cancelled his meeting with HIV/AIDS activists in May. Still, plans never materialized. Trump's silence on HIV/AIDS issues might spell trouble for HIV-positive Americans.
But what he has said is also troubling. Trump has hinted at privatizing health care under the Department of Veterans' Affairs, which is the largest single provider of medical care to people with HIV in the United States. He is also not a fan of the Affordable Care Act, which has made it easier for people with pre-existing conditions like HIV to get access to health care. After meeting with Obama shortly after his election win, Trump indicated that he might be open to keeping the ACA's pre-existing conditions clause. But, that glimmer of hope isn't enough for some.
Equally worrying for Spieldenner is the prospect of funding cuts to the National Institutes of Health, which researches new treatments and cures for HIV and other illnesses.
"We could very easily see a shift away from HIV research at the NIH level because of how anti-[people of color], anti-HIV and anti-substance use the administration might be," he said.
He added, speaking about sexual and reproductive health, "I've been terrified by the people who have been put forward who are anti-LGBT health and anti-women's health."
One such person is Vice President-elect Mike Pence. In 2011, Pence defunded Indiana's Planned Parenthood, the sole provider of HIV tests in southeast Indiana's Scott County, which led to an HIV outbreak there. In 2015, nearly 200 people living in southeast Indiana were infected with HIV due to an outbreak spread via intravenous drug use. Though Pence eventually acquiesced to legislation allowing for some needle exchanges, he offered counties next to no aid.
Trump's choice for secretary of health and human services, Tom Price, also espouses views in line with some of Spieldenner's greatest worries. He opposes abortion access and civil rights for LGBTQ communities. He's also argued that LGBTQ rights may have a negative impact on public health.
Spieldenner worries that those coming into power may begin to dismantle the Affordable Care Act, which could leave some people with HIV without the option to purchase health insurance through the health care exchanges.
The Ryan White HIV/AIDS program, a federal system of care for Americans living with HIV, currently pays for many HIV-positive people's insurance plans obtained through the health care exchange. The insurance someone gets through the health exchange, though paid for by Ryan White, is just like anyone else's health insurance. Get rid of the health care exchanges and HIV-positive people may be forced to use Ryan White funds directly, meaning they can only use those clinics to get their care.
That may not be a problem for people in urban areas, but HIV-positive people living in rural areas may have a harder time finding care. For instance, there are only four Ryan White care clinics located within 100 miles of Shreveport, Louisiana — as opposed to more than a dozen within New York's city limits.
But the potential complications and pitfalls don't end with health care. Like Borrego, many respondents pointed out that living with HIV is not just about the virus, but about the various identities they each carry and how it affects their lives.
"There's a lot of fear about the racism and misogyny and anti-immigration movement because people living with HIV are also immigrants, people of color and women," Spieldenner said. "There's fear that those kinds of attacks on our identity will have some kind of material impact [for people with HIV]."
People who access Medicaid, like Borrego, also face an uncertain future. Borrego uses Medicaid to help her medically transition and stay healthy. Medicaid acts as a safety net for those who are chronically ill and have a low income. Trump has proposed capping federal funding for Medicaid and moving to a "block grant" system, which means states would get a fixed amount of money to spend on health care in a year, even if the number of people enrolled rises. According to CNN, in the aftermath of the Great Recession, the number of Americans using Medicaid jumped from 42.4 million in 2007 to 55 million in 2013. Fixing the amount of money for a state's Medicaid budget means having to use the same amount of money to take care of all enrollees, even if it rises dramatically.
Additionally, Borrego pays for her housing through the Section 8 program and said she is "concerned" about the incoming government's approach to housing subsidies. Trump has not said much about Section 8, but as Citylab pointed out, he has a "penny plan" to cut non-defense spending by 1% annually, which "would shred the government's budget for housing assistance."
"My housing subsidy has been the basis of maintaining my physical and mental health for the last few years that I've had it," Borrego said. "It's provided a great deal of security for me to build a life for the last decade."
Trump's looming presidency weighs heavy on Hussain Turk, 28, an HIV-positive, gay, practicing Muslim living in California. He told Mic that his fears of a Trump presidency stem from the president-elect's Islamophobic rhetoric and the possibility of a national Muslim registry. Though Trump has ruled out putting Muslims in internment camps, Trump's capriciousness and the political climate makes Turk uneasy. Turk, a graduate of UCLA School of Law who is preparing to take the bar, said that the historical, political and legal signs are all there for the rights of Muslim Americans to be curtailed. He cited the U.S. Supreme Court ruling in Korematsu v. United States, where they upheld the legality of Japanese internment camps during World War II. The prospect of internment is not too far-fetched, according to Turk.
"To think about what that would mean, to be interned and not provided my medication," Turk said. "It's created this sense of terror."
Turk also worries about his clients. He works at the Los Angeles HIV Law & Policy Project and helps HIV-positive people living in Los Angeles county, many of whom are immigrants. Recently, Trump met with Kris Kobach, a potential head of the Department of Homeland Security. In a photo taken after their meeting, a document caught on camera shows troubling evidence supporting the idea that many immigrants may face deportation.
HIV-positive immigrants detained in the United States by Immigration and Customs Enforcement may not get the care they need. A 2009 study in the Health and Human Rights Journal found that HIV-positive detainees in ICE facilities were "especially vulnerable to lapses in proper medical care."
"For some, if they're deported, that's a death sentence," Turk said. "They don't get the HIV treatments [in some other countries] that they offer in the United States."
Turk said that, if life becomes difficult for Muslims in the U.S., he may have no choice but to leave.
"I do not know if that's selfish or self-care, but if they start locking people up, I'm peacing out," he said.
Martez Smith, 25, is also worried about the ways that race and class intersect with HIV status and HIV risk. Smith is a community organizer who is involved in New York City's ballroom scene, a community of black and Latino LGBTQ youth. He said that he worries specifically about Trump's promises to restore "law and order" in the United States. Smith also worries about his advocating for stop and frisk, a policy that put many black youth into the criminal justice system unnecessarily.
"I'm always thinking about my friends who are the most marginalized," Smith said in a phone interview. "When I think about racially coded rhetoric like 'law and order,' hearing shit like that, hearing how xenophobic his policies are, it's petrifying."
The criminal justice system is a huge driver of the United States' HIV/AIDS epidemic. According to the 2012 report Fenced In: HIV/AIDS in the US Criminal Justice System, on any given day in the U.S., one in 10 black men in his 30s is in jail or prison. Many arrests are due to the "war on drugs," which disproportionately punishes black Americans and sends them to prison. And among the U.S. prison population, which is almost universally denied access to condoms except in two states and some cities, the HIV rate is four times the general population. Interruption of HIV treatment in prison is not uncommon, including after release. Solitary confinement has also made access to medications "even more difficult," according to the Fenced In report.
Smith said that he will work in the coming years to make sure people understand the complex nature of HIV and the structural issues behind it, like poverty, the criminal justice system, structural homophobia and sexism. But, he doesn't imagine there will be as much funding out there for these services in the near future.
"I plan to use my own money to fund my community organizing efforts," Smith said. "I expect the worst."
Charles Sanchez has braced for the worst, as well. At 48 years old, Sanchez said he's "never been this afraid" for his personal safety. Sanchez said he believes that Trump won because he played into people's fears, which he says doesn't bode well for HIV-positive people. However, that's only emboldened him.
"It's made my resolve even stronger," he said. "I can't give in to that fear."
Several respondents told Mic they've already begun to think about how they plan to contribute to the betterment of HIV-positive and HIV-negative Americans under Trump. Sanchez, whose web series Merce is about an HIV-positive, middle-aged man living in New York City, says he's made a concerted effort to make the second season of his show much more in-your-face about HIV.
"I've been joking and saying it's more AIDS-y this year," he said. "We're talking about more issues: slut shaming and PrEP and secondary conditions to HIV. And I think, now, it's more important than ever that my little show — my little musical that could — gets the word out that life with HIV is not the end. People need joy in their lives."
Borrego said that her form of activism has to do with making sure that she's able to survive day to day.
"I'm going to try and go through and make sure as many of my records throughout my history are updated to reflect my current legal name and gender before inauguration day," Borrego said. That includes making sure her high school diploma is up-to-date, as Borrego hopes to go back to college soon. "I'm trying to go through everything with a fine-toothed comb, making sure everything has the proper documentation and is correctly noted."
And Turk plans to fight Trump in the courtroom.
"Once those policies do start to take effect, it will be up to lawyers to challenge them on their constitutionality," he said. "We can use the law to stall and delay any process that Trump is trying to put into place to take away our rights. Because litigation takes a really long time, so even just filing a lawsuit and applying for an injunction is something that I think we can use to slow down the process in a way that will give us time to organize."