680 15 FEBRUARY 2019 • VOL 363 ISSUE 6428 sciencemag.org SCIENCEW
hen advocacy groups heard that
President Donald Trump’s State of
the Union address last week would
include a call for ending the AIDS
epidemic in the United States by
2030, some weighed in with guf-
faws. One, the nonprofit AIDS Coalition to
Unleash Power New York in New York City,
published a list of ways it says the Trump
administration has “further marginalized
people living with HIV.” But many HIV/AIDS
researchers and some advocates had a more
measured, even enthusiastic, reaction to
the possibility that Trump wants to join an
existing ambitious campaign and cham-
pion a cause he thus far has not embraced.
“Together, we will defeat AIDS
in America and beyond,” Trump
said in the 5 February speech.
His proposal—which officials
fleshed out later—calls for con-
centrating on the places with the
highest rates of new HIV diagno-
ses. According to U.S. Centers for
Disease Control and Prevention
(CDC) data from 2016, 48 coun-
ties in 19 states, plus Washing-
ton, D.C., and one municipality in Puerto
Rico, account for more than half of the nearly
40,000 new HIV diagnoses each year.
Brett Giroir, deputy director of the Depart-
ment of Health and Human Services (HHS)
in Washington, D.C., says Trump’s budget
request, expected next month, will ask Con-
gress for new funding for the initiative, al-
though he would not say how much. “We
are very confident we will have sufficient re-
sources,” he says.
“I’m really excited that this may lead to
something,” Carlos del Rio, an epidemiologist
and leading HIV/AIDS clinician at Emory
University’s Rollins School of Public Health
in Atlanta, told Science. “It’s the last thing I
would have expected coming out of Trump.”
The initiative took shape last summer,
when Robert Redfield, head of CDC in At-
lanta and a longtime HIV/AIDS clinician and
researcher, met with Anthony Fauci, who
heads the U.S. National Institute of Allergy
and Infectious Diseases in Bethesda, Mary-
land. They shared ideas about how to end
the country’s HIV/AIDS epidemic, then took
their proposal to HHS head Alex Azar. “Alex
really, really liked it,” Fauci says. “He said,‘I think we can bring this to the president.’”
The Trump administration aims to re-
duce new infections by 75% in 5 years and
90% in 10. The plan would target the most
affected populations, among them men who
have sex with men and people who inject
drugs. It would promote condom use, clean
needles and syringes, aggressive testing, and
immediate treatment for those who are posi-
tive. It would also help infected people stay
on treatment, which can both stave off AIDS
and make them less infectious. The million
or so people deemed at high risk of infection
would be encouraged to take anti-HIV drugs
themselves, a proven prevention strategy
known as pre-exposure prophylaxis (PrEP).
“I don’t know that there’s a big gap in the
past strategy,” says Jeffrey Crowley, a public
health specialist who directed
the White House Office of Na-
tional AIDS Policy during then-
President Barack Obama’s ad-
ministration and now works
at the O’Neill Institute for Na-
tional and Global Health Law at
Georgetown University Law Cen-
ter in Washington, D.C. “Maybe
there’s a more intentional way to
do things and [the Trump admin-
istration] might identify new resources.”
Some say current policies are an obstacle.
Mark Harrington, who heads the Treatment
Action Group in New York City and helped
launch New York’s ending AIDS campaign,
cites policies he says have undermined the
rights of groups disproportionately affected
by HIV, including transgender people, com-
munities of color, and undocumented immi-
grants. There are “major obstacles to getting
essential HIV prevention tools into the hands
of the people who need them,” he says.
Epidemiologist Chris Beyrer of the Johns
Hopkins University Bloomberg School of
Public Health in Baltimore, Maryland, also
blames Republicans who opposed the expan-
sion of Medicaid. “HIV is worsening in the
American South because low-income and
working poor African-Americans are being
excluded from health care access.”
“We might be able to end AIDS as a pub-
lic health threat in the U.S. by 2030, but we
won’t get there with testing and condoms,”
Beyrer says. “We have to do better with [the]
provision of health care, drug treatment, anti-
retroviral treatment, and PrEP to those who
need it most.” jBy Jon Cohenspond to an interview request from Science.)
Critics say pseudoscience is creeping into
science funding and education. In 2017,
Vardhan decided to fund research at the pres-
tigious Indian Institute of Technology here to
validate claims that panchagavya, a concoc-
tion that includes cow urine and dung, is a
remedy for a wide array of ailments—a no-
tion many scientists dismiss. And in Janu-
ary 2018, higher education minister Satya
Pal Singh dismissed Charles Darwin’s evo-
lution theory and threatened to remove it
from school and college curricula. “Nobody,
including our ancestors, in written or oral
[texts], has said that they ever saw an ape
turning into a human being,” Singh said.
Those remarks triggered a storm of pro-
test; in a rare display of unity, India’s three
premier science academies said removing
evolution from school curricula, or dilut-
ing it with “non-scientific explanations or
myths,” would be “a retrograde step.” In
other instances, too, scientists are pushing
back against the growing tide of pseudo-
science. But doing so can be dangerous. In
the past 5 years, four prominent fighters
against superstition and pseudoscientific
ideas and practices have been murdered,
including Narendra Dabholkar, a physician,
and M. M. Kalburgi, former vice-chancellor
of Kannada University in Hampi. Ongoing
police investigations have linked their killers
to Hindu fundamentalist organizations.
Some Indian scientists may be susceptible
to nonscientific beliefs because they view
science as a 9-to-5 job, says Ashok Sahni, a
renowned paleontologist and emeritus pro-
fessor at Panjab University in Chandigarh.
“Their religious beliefs don’t dovetail with
science,” he says, and outside working hours
those beliefs may hold sway. A tradition of
deference to teachers and older persons may
also play a role, he adds. “Freedom to ques-
tion authority, to question writings, that’s
[an] intrinsic part of science,” Ramakrishnan
adds. Rather than focusing on the past, India
should focus on its scientific future, he says—
and drastically hike its research funding.
The grip of Hindu nationalism on Indian
society is about to be tested. Two dozen oppo-
sition parties have joined forces against Modi
for elections that will be held before the end
of May. A loss by Modi would bring “some
change,” says Prabir Purkayastha, vice presi-
dent of the All India People’s Science Network
in Madurai, a liberal science advocacy move-
ment with some 400,000 members across
the country that opposes VIBHA’s ideology.
But the tide of pseudoscience may not retreat
quickly, he says. “I don’t think this battle is
going to die down soon, because institutions
have been weakened and infected.” j
Sanjay Kumar is a journalist in New Delhi.
PUBLIC HEALTHTrump’s initiative to “end AIDS” promises money, focus
AIDS push gets mixed reviews
“We are very
confident
we will have
sufficient
resources.”
Brett Giroir, HHSNEWS | IN DEPTH
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