For the first time, stakeholders from two major medical associations -- the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) -- have joined forces to advocate for HIV priorities during the annual IDWeek meeting.
This year's IDWeek conference takes place in Washington, D.C. against the backdrop of Capitol Hill. According to Melanie Thompson, M.D., the immediate past chair of HIVMA, a growing number of infectious-disease and HIV clinicians have expressed interest in advocacy and activism in recent years.
Specifically, they have grown increasingly concerned by continued threats to federal funding for HIV and infectious-disease initiatives, as well as specific Trump administration policies they say perpetuate stigma and discrimination against groups that are already at risk for HIV.
At the same time, HIV clinicians were surprised and emboldened by President Trump's pledge to end HIV by 2030 in the United States during his State of the Union address earlier this year. Now, HIV clinicians feel inspired to protect the federal funding allocated as part of that pledge.
"We as advocates in the HIV community never would have predicted that at this particular time in history, [HIV] would rise to the level of additional funding and a federal initiative -- but it has," Thompson said. "So, we're not only going to protect that and take that [funding], we're going to push it further."
During IDWeek, advocates gathered for two events -- both called "The Big IDea." The first was an all-day event hosted on the Tuesday prior to the conference, and the second was a follow-up breakfast event on Thursday. Each event was attended by about 70 clinicians.
During these events, clinician-advocates hammered out their priorities.
"One of the key parts of our HIV advocacy [day] was -- ironically -- to support the president in the Ending the HIV Epidemic initiative funding," said Thompson.
As part of the initiative, the White House proposed a budget of $140 million for the Centers for Disease Control and Prevention's efforts, $120 million for the Health Resources and Services Administration's Ryan White and community health center programs, $25 million for the Indian Health Service, and $6 million for implementation science research at the National Institutes of Health.
According to Thompson, "It's not enough -- but it's a down payment of what we need." Although there are "a couple of troublesome things in the president's budget," such as a lack of funding for teen sexual health, Thompson says that on the whole, advocates would like to protect the White House's proposal as it moves through the House of Representatives, and eventually through the Senate.
She noted that the Democratic-controlled House has already approved a budget that affirms -- and in some cases increases -- the funding proposed by the White House. Next, the budget will move to the Republican-controlled Senate, where it is likely to face more obstacles.
Technically, the president's Ending the HIV Epidemic plan will not officially launch until the Senate approves the budget. If that doesn't happen, Thompson and her colleagues have a back-up plan.
She explained that if the Senate does not approve a budget, the federal government will be funded by a so-called "continuing resolution," in which all budget line-items are essentially carried over from the prior budget.
If this happens, there is a special process policy-makers use to tack on new, high-priority items. Behind the scenes, Thompson and other advocates have been encouraging elected officials to include HIV funding as part of these additional funding items.
Still, Thompson and others are hopeful that the new funding will be approved by the Senate to officially launch the Ending the HIV Epidemic initiative.
"I think there is an advantage, that this has bipartisan support at this point," she said. "We are trying to work with people on the Hill to ensure that that 'Ending the Epidemic' money survives the budget process. It's easy for things to be horse traded. It's easy for things to disappear."
The IDSA/HIVMA advocacy group has other priorities beyond the budget. The group would like to see the administration focus more on stigma and social determinants of health.
"If this administration wants to end the HIV epidemic, it has to go all in," she said. "Because we know that stigma kills." Transgender people and immigrants, in particular, have been attacked by Trump administration policies, said Thompson.
"I think we really have to fight back," she said.
Beyond these policy ambitions, Thompson said a key focus of the IDSA/HIVMA advocacy collaboration has been to encourage more talented clinicians to join the HIV/infectious disease workforce -- and they're turning to advocacy to do it.
The problem, Thompson explained, is that medical students, often saddled with debt, are turning away from infectious-disease practices because those fields are not as lucrative as other medical fields.
The federal government -- leveraging the power of Medicaid and Medicare reimbursement policies -- could help to change the incentive structure, bolstering the amount of money infectious-disease doctors stand to earn in their careers and therefore drawing more talent to the field overall.
"We have a big agenda. We have a lot to do," said Thompson. But, in many ways, Thompson says that advocacy among HIV clinicians is nothing new. The field was born in the fire of the AIDS crisis and the activism it inspired.
"Since the early days ACT UP, there has always been a social justice part working in HIV," she said. Now, HIV clinicians feel enraged all over again.
"I think it provides extra juice and extra energy from your day-to-day work," she said. "Being an advocate, being an activist actually helps you reclaim some hope in the world and helps you reclaim your voice."