Is This the End of Progress on H.I.V.?

A patient was recently interested in starting pre-exposure prophylaxis, known as PrEP, to protect himself from getting H.I.V. A Black man who had lost many friends to AIDS, he was nervous but eager to try it. After we discussed his sexual practices and I reviewed his blood work, I thought he was a great candidate.

When I asked whether he preferred the once-daily pill or the long-acting injection, he said he wanted whichever option was cheapest with cash. I explained his insurance would almost certainly cover both options free of charge, but he expressed fear that going through his insurer would alert the government.

Since I am a clinical pharmacist and do not dispense medications, I asked which pharmacy to send the prescription to. He seemed especially anxious that a prescription would create a paper trail. Though there was not yet a specific threat to his safety, he was scared that recent cuts to H.I.V. care may be a first sign of worse fears to come. It was one of the most agonizing conversations of my career. No one should have to worry that preventing H.I.V. could endanger them.

And yet, as the Trump administration lays waste to essential H.I.V. prevention and care, I’m having more of these painful discussions, especially with Black and Latino people and patients from other groups that have typically faced higher rates of infection and worse care.

Among other cuts to federal health agencies, Health and Human Services Secretary Robert F. Kennedy Jr. is said to be planning to lay off the entire staff of the Office of Infectious Diseases and H.I.V./AIDS Policy, which was working to end the H.I.V. epidemic in the United States and to solve related racial health disparities. The National Institutes of Health has canceled more than 100 grants for research into the disease. Marginalized groups fear they may lose access to PrEP from the gutting of federally supported programs — and this may worsen if congressional Republicans follow through with plans to cut Medicaid. Later this month, the Supreme Court will hear oral arguments over whether private insurance companies must continue to pay for PrEP and other preventative medications.

These events — coupled with the attempted dissolution of America’s global H.I.V./AIDS program, the scrubbing of language from federal websites on H.I.V. said to promote “gender ideology,” and the termination of L.G.B.T.Q.-focused H.I.V. programs and research — have terrified my patients and colleagues. It’s enraging to watch the Trump government, which previously set a goal to eradicate the virus in the United States by 2030, abandon vulnerable Americans and retreat from its longstanding global H.I.V. response.