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Content Warning: many of these updates include information about harmful attacks on Black, Indigenous and people of color (BIPOC) and LGBTQ+ folx.

Hot Topic – National HIV/AIDS Strategy Interim Report

On December 4th, the White House published a National HIV/AIDS Strategy Interim Action Report. The purpose of these reports is to provide an update on the government’s plan to “end the HIV epidemic in the country by 2030.” The interim report highlights specific action that various federal agencies have taken. This makes it difficult to assess progress towards the objectives and strategies laid out in the National HIV AIDS Strategy 2022-2025. That said, the report highlights some progress, largely through biomedical measures of success such as numbers related to HIV incidence rates, PrEP prescriptions, and viral suppression rates. It also foregrounds its own shortcomings, stating that the “NHAS Interim Action Report does not declare victory, but serves as an ongoing call to action.” In this hot topic, we dig into what that actually means.

What was good? Firstly, the report contained an important update relevant to HIV and aging. The Administration for Community Living (ACL), an agency underneath the U.S. Department of Health and Human Services, is working on finalizing a rule which would prioritize people aging with HIV for funding and services available under the Older Americans Act.

Furthermore, the report provided some important updates on the relevant activities of the U.S. Department of Justice (DOJ). The DOJ has issued statements of interest and brought numerous lawsuits to combat both: 1) discriminatory state bans on gender-affirming healthcare, and 2) discrimination against people living with HIV as a violation of the Americans with Disabilities Act (ADA) 

What did they miss? The report uncritically indicates that Molecular HIV Surveillance (MHS) and Status Neutral are successful facets of HIV-related government programming. There is no mention of the privacy, informed consent, and human rights concerns with MHS or the lack of meaningful involvement of networks of people living with HIV in the development of Status Neutral initiatives. 

Furthermore, the report was mostly silent on Quality of Life indicators for people living with HIV, choosing instead to focus on biometric indicators of success such as numbers related to prevention, treatment, and testing. The developmental Quality of Life Indicator that was announced in the 2022-2025 NHAS was a momentous and hard-fought win for people living with HIV. We will continue to demand transparency and accountability on that body of work in future action reports. 

Here’s why it matters. The NHAS interim report is a tool that can help advocates hold the federal government accountable to the promises they have made to people living with HIV. As Congress continues to negotiate over the budget, the report and accompanying plan can be useful in demonstrating the necessity of certain imperfect but useful programs. Furthermore, there may be great upheaval at the federal level with the 2024 elections, including the possibility of a new administration that is more hostile to the rights, health, and quality of life of people living with, and most impacted by, HIV in the US. Advocates must work now to guarantee protections for HIV funding and programming that last beyond 2024.

LGBTQ+ Health, Rights, and Justice

  • Florida House Bill 599, introduced by Representative Ryan Chamberlain, changes Florida employment statutes to bring “don’t say gay” into the workplace, introducing numerous, violent prohibitions on sharing and respecting a person’s pronouns.
  • Even in states where gender-affirming care is legal, some doctors are dropping coverage for this lifesaving care out of fear of the liability provisions included in anti-gender-affirming care policies and bills. The Movement Advancement Project recently released a report outlining the 22 states where anti-gender-affirming care legislation has been either proposed or enacted.
  • On December 6th, Governor Tony Evers of Wisconsin vetoed a bill that would ban gender affirming care for trans youth.

Access to Healthcare

  • After 10 years of North Carolina Republicans refusing to accept federal funding for this purpose, North Carolina has expanded Medicaid to make nearly 600,000 residents now eligible for coverage.  The federal government will pay 90% of the costs of expansion.
  • Washington became the first state to open its health insurance marketplace to all residents, regardless of immigration status. Residents do not need citizenship, a green card, or any other immigration papers to enroll.
  • The Centers for Medicare & Medicaid Services (CMS), a government agency, has created a pathway for states and localities to use federal Medicaid funds to pay for incarcerated people’s healthcare. CMS approved California’s application to waive the “Inmate Exclusion Policy,” which previously prohibited this disbursal, and has issued instructions on how every state can apply for the same authority.
  • During the process of Medicaid redeterminations, nearly 11.8 million beneficiaries have been disenrolled for administrative reasons, despite actually being eligible for the program. In response, CMS has issued an interim final rule which could withhold or cut Medicaid funding if impacted states don’t create and follow a corrective action plan.

Reproductive Health, Rights, and Justice

  • The Supreme Court has agreed to review a lower court decision that challenged the U.S. Food and Drug Administration’s approval of mifepristone, which was granted over twenty years ago. Mifepristone, often called “the abortion pill,” is an FDA-approved, World Health Organization-approved method of self-managed abortion.
  • Dozens of Mississippi women have been arrested for using drugs while pregnant, despite the fact Mississippi law does not provide a legal basis for the charges. Prosecutors in Alabama, Oklahoma, and South Carolina are attempting to bring similar cases under expanded interpretations of child abuse and neglect laws.
  • The state of Idaho has appealed its near total abortion ban to the Supreme Court, after the 9th Circuit Court of Appeals granted a request to block the law. The ban is one of the strictest in the country and imposes criminal penalties on doctors performing abortions, which has already had a chilling effect on Idaho providers.
  • A Congressional inquiry has revealed that three of the largest pharmacies operating nationwide – CVS Health, Kroger, and Rite Aid – allow pharmacy staff to provide customers’ medical records to police without a warrant. The Congressional inquiry was born out of an interest in strengthening protection for reproductive health data after the Supreme Court overturned Roe last year.

Economic Justice

  • Since October, Congress has failed to pass the 12 appropriations bills that fund federal agencies and programming. As negotiations continue, Congress has passed continuing resolutions which maintain the current funding levels until new agreements can be reached. In November, Congress passed a two-tiered continuing resolution which extended funding for agencies covered by the agriculture, energy-water, military construction-Veterans Affairs, and Transportation-Housing and Urban Development bills until January 19th. Funding for eight other appropriations bills are set to expire on February 2nd. 
  • In September, the federal government’s $24 billion in grant money for child care stabilization expired. Since its expiration, 29% of families nationally reported that childcare tuition increased, and 28% of childcare providers reported they had reduced staff wages.
  • For the first time, the Department of Labor has published sample agreements for domestic workers which clarify workers’ rights and employers’ expectations. DOL devised three separate sample agreements for house cleaners, home care workers, and nannies, all part of a large set of executive orders on caregiving that Biden signed in April.

Ending Criminalization

  • The Department of Justice (DOJ) has demanded that the Attorney General (AG) in Shelby County, Tennessee cease enforcement of the state’s HIV criminalization law, finding it violates the Americans with Disabilities Act. The DOJ has also instructed the AG’s Office to end all consequences for people convicted under the law, offer monetary compensation to those people, and repeal the law through the state legislature.
  • After years of failed settlement negotiations, the DOJ is bringing Philadelphia nonprofit Safehouse to court to block the opening of an overdose prevention site. Simultaneously, Pennsylvania lawmakers have proposed a harmful involuntary commitment bill for people who have recently experienced an overdose.
  • A federal appeals Court has ruled that Texas must remove a razor wire buoy barrier from the Rio Grande. The razor buoys are a part of Governor Greg Abbott’s racist immigration plan, titled “Operation Lonestar,” many provisions of which remain in effect.
  • On November 6, fifty-seven activists were arraigned on charges related to organizing within the Stop Cop City movement. The 110-page indictment finds prosecutors criminalizing basic concepts of political organizing, including “social solidarity” and “mutual aid.”