Dr. Ruth Madievsky is terrified for her patients. As a clinical pharmacist who specializes in HIV care, she has watched the people she works with react in real time to the Trump administration’s antagonization of LGBTQ+ people and HIV/AIDS prevention programs.

“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 HIV response,” she wrote in the New York Times.

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Madievsky said she has had heartbreaking conversations with patients about their fears. One man, she said, was interested in starting the HIV prevention medication PrEP and asked her for the cheapest option he could get with cash.

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“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,” she continued. “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 HIV care may be a first sign of worse fears to come.”

She called this “one of the most agonizing conversations” of her career. “No one should have to worry that preventing HIV could endanger them,” she said.

These “painful discussions” have only increased, she said, as the Trump administration abandons the fight against HIV.

“For each patient who discloses fears about what will happen under this administration, I wonder how many others are too afraid to seek the care they need altogether,” she said. “As health care providers, we have committed ourselves to protecting our patients from harm. Words of support are not enough to combat policies and rhetoric that could worsen public health inequities for marginalized groups.”

Her solution: intensify PrEP prescriptions to prevent the disease from spreading.

She urged healthcare providers to routinely screen people for PrEP, saying it should be as common as checking blood pressure. “For some, this won’t be difficult; others may need help working through their own biases.”

“Studies suggest that even many clinicians buy into stereotypes that PrEP encourages people of color to engage in unprotected sexual activity, or that they do not take their medications as instructed,” she said, “which could allow drug-resistant HIV strains to flourish. Those assumptions contribute to PrEP being prescribed at inequitably low rates. But research suggests these risks are overstated, and they are far outweighed by the ability of PrEP to reduce HIV infections.”

“The disparities in diagnosis and care are grim,” she explained. “The incidence of HIV in the United States is about 0.4 percent. But studies have estimated that 14 percent to 42 percent of transgender women are living with HIV. Compared to other women with HIV, transgender women are less likely to receive care that suppresses the virus to undetectable levels in the blood or to have adequate medical care at all. Men who have sex with men represent 67 percent of new infections, and yet Black and Latino men in this group are the least likely to be virally suppressed. Overall, Black and Latino people account for 70 percent of new diagnoses and 61 percent of deaths among individuals with HIV.”

The Trump administration could disrupt HIV/AIDS care and prevention at catastrophic levels, and while Madievsky acknowledged that she and her colleagues “certainly cannot avert mass death on that scale,” she also emphasized that “to continue with business as usual is to surrender to the future.”

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