Latest news with #H.I.V.
USA Today
6 days ago
- Entertainment
- USA Today
Edmund White, prolific writer who chronicled gay life, dies at 85
Edmund White, prolific writer who chronicled gay life, dies at 85 Edmund White, a pioneering author who chronicled gay life and thumbed his own sexual experiences for literature that was at times arrestingly candid, died Tuesday. He was 85. White's agent, Bill Clegg, told USA TODAY June 4 that the author had died June 3 in his New York City home of natural causes. White was diagnosed with H.I.V. in 1985 and survived multiple strokes and a heart attack, continuing to add ink to his prolific literary catalogue even in his later years. With a singular voice, White wrote honestly about the queer experience – his 1980 work "States of Desire: Travels in Gay America" becoming a tome for an oppressed but vibrant culture just before the AIDS epidemic befell it. In "The Joy of Gay Sex: An Intimate Guide for Gay Men to the Pleasures of a Gay Life," White proved himself unafraid of going where few authors at that time had gone before. Collaborating with Dr. Charles Silverstein, he penned a literal how-to for intimate gay life, cracking open a conversation taking place off the page all over America. Born in 1940, White, a native son of the Midwest, eventually sojourned to New York City, where he sharpened his pen and trained a keen eye on a place that was becoming the center of gay life in the U.S. In 1982, shortly before he was diagnosed as H.I.V. positive, White co-founded and served as the inaugural president of the Gay Men's Health Crisis, a collective care unit aimed at advocacy amid the AIDS epidemic. He moved to France the following year, eventually returning to the U.S. in the late '90s. According to Clegg, White is survived by his husband and fellow author Michael Carroll, whom he married in 2013, and his older sister Margaret Fleming.
New York Times
04-05-2025
- Health
- New York Times
Trump Administration Live Updates: President to Discuss Economy in TV Interview
Drawing blood for an S.T.I. test at a San Francisco AIDS Foundation clinic. The N.I.H. canceled several grants to a network of researchers who work on preventing and treating H.I.V. and AIDS in young adults, who account for a fifth of new infections each year in the United States. The Trump administration has scrapped more than $800 million worth of research into the health of L.G.B.T.Q. people, abandoning studies of cancers and viruses that tend to affect members of sexual minority groups and setting back efforts to defeat a resurgence of sexually transmitted infections, according to an analysis of federal data by The New York Times. In keeping with its deep opposition to both diversity programs and gender-affirming care for adolescents, the administration has worked aggressively to root out research touching on equity measures and transgender health. But its crackdown has reverberated far beyond those issues, eliminating swaths of medical research on diseases that disproportionately afflict L.G.B.T.Q. people, a group that comprises nearly 10 percent of American adults. Of the 669 grants that the National Institutes of Health had canceled in whole or in part as of early May, at least 323 — nearly half of them — related to L.G.B.T.Q. health, according to a review by The Times of every terminated grant. Federal officials had earmarked $806 million for the canceled projects, many of which had been expected to draw more funding in the years to come. Scores of research institutions lost funding, a list that includes not only White House targets like Johns Hopkins and Columbia, but also public universities in the South and the Midwest, like Ohio State University and the University of Alabama at Birmingham. At Florida State University, $41 million worth of research was canceled, including a major effort to prevent H.I.V. in adolescents and young adults, who experience a fifth of new infections in the United States each year. In termination letters over the last two months, the N.I.H. justified the cuts by telling scientists that their L.G.B.T.Q. work 'no longer effectuates agency priorities.' In some cases, the agency said canceled research had been 'based on gender identity,' which gave rise to 'unscientific' results that ignored 'biological realities.' Other termination letters told scientists their studies erred by being 'based primarily on artificial and nonscientific categories, including amorphous equity objectives.' The cuts follow a surge in federal funding for L.G.B.T.Q. research over the past decade, and active encouragement from the N.I.H. for grant proposals focused on sexual and gender minority groups that began during the Obama administration. President Trump's allies have argued that the research is shot through with ideological bias. 'There's been a train of abuses of the science to fit a preconceived conclusion,' said Roger Severino of the Heritage Foundation, the conservative think tank that helped formulate some Trump administration policies. 'And that was based on an unscientific premise that biology is effectively irrelevant, and a political project of trying to mainstream the notion that people could change their sex.' Image President Trump during a visit to the National Institutes of Health in 2020. In his first term, Mr. Trump had pledged to end the country's H.I.V. epidemic within a decade. Credit... Doug Mills/The New York Times Scientists said canceling research on such a broad range of illnesses related to sexual and gender minority groups effectively created a hierarchy of patients, some more worthy than others. 'Certain people in the United States shouldn't be getting treated as second-class research subjects,' said Simon Rosser, a professor at the University of Minnesota whose lab was studying cancer in L.G.B.T.Q. people before significant funding was pulled. 'That, I think, is anyone's definition of bigotry,' he added. 'Bigotry in science.' The canceled projects are among the most vivid manifestations of a broad dismantling of the infrastructure that has for 80 years supported medical research across the United States. Beyond terminating studies, federal officials have gummed up the grant-making process by slow-walking payments, delaying grant review meetings and scaling back new grant awards. Bigger changes may be in store: Mr. Trump on Friday proposed reducing the N.I.H. budget from roughly $48 billion to $27 billion, citing in part what he described as the agency's efforts to promote 'radical gender ideology.' The legality of the mass terminations is unclear. Two separate lawsuits challenging the revocation of a wide range of grants — one filed by a group of researchers, and the other by 16 states — argued that the Trump administration had failed to offer a legal rationale for the cuts. The White House and the Department of Health and Human Services did not respond to requests for comment. Andrew Nixon, a spokesman for the health department, told The Daily Signal, a conservative publication, last month that the move 'away from politicized D.E.I. and gender ideology studies' was in 'accordance with the president's executive orders.' The N.I.H. said in a statement: 'N.I.H. is taking action to terminate research funding that is not aligned with N.I.H. and H.H.S. priorities. We remain dedicated to restoring our agency to its tradition of upholding gold-standard, evidence-based science.' The L.G.B.T.Q. cuts ended studies on antibiotic resistance, undiagnosed autism in sexual minority groups, and certain throat and other cancers that disproportionately affect those groups. Funding losses have led to firings at some L.G.B.T.Q.-focused labs that had only recently been preparing to expand. The N.I.H. used to reserve grant cancellations for rare cases of research misconduct or possible harm to participants. The latest cuts, far from protecting research participants, are instead putting them in harm's way, scientists said. They cited the jettisoning of clinical trials, which have now been left without federal funding to care for volunteer participants. 'We're stopping things that are preventing suicide and preventing sexual violence,' said Katie Edwards, a professor at the University of Michigan, whose funding for several clinical trials involving L.G.B.T.Q. people was canceled. H.I.V. research has been hit particularly hard. The N.I.H. ended several major grants to the Adolescent Medicine Trials Network for H.I.V./AIDS Intervention, a program that had helped lay the groundwork for the use in adolescents of a medication regimen that can prevent infections. That regimen, known as pre-exposure prophylaxis, or PrEP, is credited with helping beat back the disease in young people. Cuts to the program have endangered an ongoing trial of a product that would prevent both H.I.V. and pregnancy and a second trial looking at combining sexual health counseling with behavioral therapy to reduce the spread of H.I.V. in young sexual minority men who use stimulants. Together with the termination of dozens of other H.I.V. studies, the cuts have undermined Mr. Trump's stated goal from his first term to end the country's H.I.V. epidemic within a decade, scientists said. Image Truvada, a pre-exposure prophylaxis, or PrEP, medication, at a Manhattan pharmacy. Credit... Nicole Bengiveno/The New York Times The N.I.H. terminated work on other sexually transmitted illnesses, as well. Dr. Matthew Spinelli, an infectious disease researcher at the University of California, San Francisco, was in the middle of a clinical trial of doxycycline, a common antibiotic that, taken after sex, can prevent some infections with syphilis, gonorrhea and chlamydia. The trial was, he said, 'as nerdy as it gets': a randomized study in which participants were given different regimens of the antibiotic to see how it is metabolized. He hoped the findings would help scientists understand the drug's effectiveness in women, and also its potential to cause drug resistance, a concern that Secretary of State Marco Rubio had voiced in the past. But health officials, citing their opposition to research regarding 'gender identity,' halted funding for the experiment in March. That left Dr. Spinelli without any federal funding to monitor the half-dozen people who had already been taking the antibiotic. It also put the thousands of doses that Dr. Spinelli had bought with taxpayer money at risk of going to waste. He said stopping work on diseases like syphilis and H.I.V. would allow new outbreaks to spread. 'The H.I.V. epidemic is going to explode again as a result of these actions,' said Dr. Spinelli, who added that he was speaking only for himself, not his university. 'It's devastating for the communities affected.' Despite a recent emphasis on the downsides of transitioning, federal officials canceled several grants examining the potential risks of gender-affirming hormone therapy. The projects looked at whether hormone therapy could, for example, increase the risk of breast cancer, cardiovascular disease, altered brain development or H.I.V. Other terminated grants examined ways of addressing mental illness in transgender people, who now make up about 3 percent of high school students and report sharply higher rates of persistent sadness and suicide attempts. For Dr. Edwards, of the University of Michigan, funding was halted for a clinical trial looking at how online mentoring might reduce depression and self-harm among transgender teens, one of six studies of hers that were canceled. Another examined interventions for the families of L.G.B.T.Q. young people to promote more supportive caregiving and, in turn, reduce dating violence and alcohol use among the young people. The N.I.H. categorizes research only by certain diseases, making it difficult to know how much money the agency devotes to L.G.B.T.Q. health. But a report in March estimated that such research made up less than 1 percent of the N.I.H. portfolio over a decade. The Times sought to understand the scale of terminated funding for L.G.B.T.Q. medical research by reviewing the titles and, in many cases, research summaries for each of the 669 grants that the Trump administration said it had canceled in whole or in part as of early May. Beyond grants related to L.G.B.T.Q. people and the diseases and treatments that take a disproportionate toll on them, The Times included in its count studies that were designed to recruit participants from sexual and gender minority groups. It excluded grants related to illnesses like H.I.V. that were focused on non-L.G.B.T.Q. patients. While The Times examined only N.I.H. research grants, the Trump administration is also ending or considering ending L.G.B.T.Q. programs elsewhere in the federal health system. It has proposed, for example, scrapping a specialized suicide hotline for L.G.B.T.Q. young people. The research cuts stand to hollow out a field that in the last decade had not only grown larger, but also come to encompass a wider range of disease threats beyond H.I.V. Already, scientists said, younger researchers are losing jobs in sexual and gender minority research and scrubbing their online biographies of evidence that they ever worked in the field. Five grants obtained by Brittany Charlton, a professor at the Harvard School of Public Health, have been canceled, including one looking at sharply elevated rates of stillbirths among L.G.B.T.Q. women. Ending research on disease threats to gender and sexual minority groups, she said, would inevitably rebound on the entire population. 'When other people are sick around you, it does impact you, even if you may think it doesn't,' she said. Irena Hwang contributed reporting.
New York Times
04-05-2025
- Health
- New York Times
Trump Administration Slashes Research Into L.G.B.T.Q. Health
The Trump administration has scrapped more than $800 million worth of research into the health of L.G.B.T.Q. people, abandoning studies of cancers and viruses that tend to affect members of sexual minority groups and setting back efforts to defeat a resurgence of sexually transmitted infections, according to an analysis of federal data by The New York Times. In keeping with its deep opposition to both diversity programs and gender-affirming care for adolescents, the administration has worked aggressively to root out research touching on equity measures and transgender health. But its crackdown has reverberated far beyond those issues, eliminating swaths of medical research on diseases that disproportionately afflict L.G.B.T.Q. people, a group that comprises nearly 10 percent of American adults. Of the 669 grants that the National Institutes of Health had canceled in whole or in part as of early May, at least 323 — nearly half of them — related to L.G.B.T.Q. health, according to a review by The Times of every terminated grant. Federal officials had earmarked $806 million for the canceled projects, many of which had been expected to draw more funding in the years to come. Scores of research institutions lost funding, a list that includes not only White House targets like Johns Hopkins and Columbia, but also public universities in the South and the Midwest, like Ohio State University and the University of Alabama at Birmingham. At Florida State University, $41 million worth of research was canceled, including a major effort to prevent H.I.V. in adolescents and young adults, who experience a fifth of new infections in the United States each year. In termination letters over the last two months, the N.I.H. justified the cuts by telling scientists that their L.G.B.T.Q. work 'no longer effectuates agency priorities.' In some cases, the agency said canceled research had been 'based on gender identity,' which gave rise to 'unscientific' results that ignored 'biological realities.' Other termination letters told scientists their studies erred by being 'based primarily on artificial and nonscientific categories, including amorphous equity objectives.' The cuts follow a surge in federal funding for L.G.B.T.Q. research over the past decade, and active encouragement from the N.I.H. for grant proposals focused on sexual and gender minority groups that began during the Obama administration. President Trump's allies have argued that the research is shot through with ideological bias. 'There's been a train of abuses of the science to fit a preconceived conclusion,' said Roger Severino of the Heritage Foundation, the conservative think tank that helped formulate some Trump administration policies. 'And that was based on an unscientific premise that biology is effectively irrelevant, and a political project of trying to mainstream the notion that people could change their sex.' Scientists said canceling research on such a broad range of illnesses related to sexual and gender minority groups effectively created a hierarchy of patients, some more worthy than others. 'Certain people in the United States shouldn't be getting treated as second-class research subjects,' said Simon Rosser, a professor at the University of Minnesota whose lab was studying cancer in L.G.B.T.Q. people before significant funding was pulled. 'That, I think, is anyone's definition of bigotry,' he added. 'Bigotry in science.' The canceled projects are among the most vivid manifestations of a broad dismantling of the infrastructure that has for 80 years supported medical research across the United States. Beyond terminating studies, federal officials have gummed up the grant-making process by slow-walking payments, delaying grant review meetings and scaling back new grant awards. Bigger changes may be in store: Mr. Trump on Friday proposed reducing the N.I.H. budget from roughly $48 billion to $27 billion, citing in part what he described as the agency's efforts to promote 'radical gender ideology.' The legality of the mass terminations is unclear. Two separate lawsuits challenging the revocation of a wide range of grants — one filed by a group of researchers, and the other by 16 states — argued that the Trump administration had failed to offer a legal rationale for the cuts. The White House and the Department of Health and Human Services did not respond to requests for comment. Andrew Nixon, a spokesman for the health department, told The Daily Signal, a conservative publication, last month that the move 'away from politicized D.E.I. and gender ideology studies' was in 'accordance with the president's executive orders.' The N.I.H. said in a statement: 'N.I.H. is taking action to terminate research funding that is not aligned with N.I.H. and H.H.S. priorities. We remain dedicated to restoring our agency to its tradition of upholding gold-standard, evidence-based science.' The L.G.B.T.Q. cuts ended studies on antibiotic resistance, undiagnosed autism in sexual minority groups, and certain throat and other cancers that disproportionately affect those groups. Funding losses have led to firings at some L.G.B.T.Q.-focused labs that had only recently been preparing to expand. The N.I.H. used to reserve grant cancellations for rare cases of research misconduct or possible harm to participants. The latest cuts, far from protecting research participants, are instead putting them in harm's way, scientists said. They cited the jettisoning of clinical trials, which have now been left without federal funding to care for volunteer participants. 'We're stopping things that are preventing suicide and preventing sexual violence,' said Katie Edwards, a professor at the University of Michigan, whose funding for several clinical trials involving L.G.B.T.Q. people was canceled. H.I.V. research has been hit particularly hard. The N.I.H. ended several major grants to the Adolescent Medicine Trials Network for H.I.V./AIDS Intervention, a program that had helped lay the groundwork for the use in adolescents of a medication regimen that can prevent infections. That regimen, known as pre-exposure prophylaxis, or PrEP, is credited with helping beat back the disease in young people. Cuts to the program have endangered an ongoing trial of a product that would prevent both H.I.V. and pregnancy and a second trial looking at combining sexual health counseling with behavioral therapy to reduce the spread of H.I.V. in young sexual minority men who use stimulants. Together with the termination of dozens of other H.I.V. studies, the cuts have undermined Mr. Trump's stated goal from his first term to end the country's H.I.V. epidemic within a decade, scientists said. The N.I.H. terminated work on other sexually transmitted illnesses, as well. Dr. Matthew Spinelli, an infectious disease researcher at the University of California, San Francisco, was in the middle of a clinical trial of doxycycline, a common antibiotic that, taken after sex, can prevent some infections with syphilis, gonorrhea and chlamydia. The trial was, he said, 'as nerdy as it gets': a randomized study in which participants were given different regimens of the antibiotic to see how it is metabolized. He hoped the findings would help scientists understand the drug's effectiveness in women, and also its potential to cause drug resistance, a concern that Secretary of State Marco Rubio had voiced in the past. But health officials, citing their opposition to research regarding 'gender identity,' halted funding for the experiment in March. That left Dr. Spinelli without any federal funding to monitor the half-dozen people who had already been taking the antibiotic. It also put the thousands of doses that Dr. Spinelli had bought with taxpayer money at risk of going to waste. He said stopping work on diseases like syphilis and H.I.V. would allow new outbreaks to spread. 'The H.I.V. epidemic is going to explode again as a result of these actions,' said Dr. Spinelli, who added that he was speaking only for himself, not his university. 'It's devastating for the communities affected.' Despite a recent emphasis on the downsides of transitioning, federal officials canceled several grants examining the potential risks of gender-affirming hormone therapy. The projects looked at whether hormone therapy could, for example, increase the risk of breast cancer, cardiovascular disease, altered brain development or H.I.V. Other terminated grants examined ways of addressing mental illness in transgender people, who now make up about 3 percent of high school students and report sharply higher rates of persistent sadness and suicide attempts. For Dr. Edwards, of the University of Michigan, funding was halted for a clinical trial looking at how online mentoring might reduce depression and self-harm among transgender teens, one of six studies of hers that were canceled. Another examined interventions for the families of L.G.B.T.Q. young people to promote more supportive caregiving and, in turn, reduce dating violence and alcohol use among the young people. The N.I.H. categorizes research only by certain diseases, making it difficult to know how much money the agency devotes to L.G.B.T.Q. health. But a report in March estimated that such research made up less than 1 percent of the N.I.H. portfolio over a decade. The Times sought to understand the scale of terminated funding for L.G.B.T.Q. medical research by reviewing the titles and, in many cases, research summaries for each of the 669 grants that the Trump administration said it had canceled in whole or in part as of early May. Beyond grants related to L.G.B.T.Q. people and the diseases and treatments that take a disproportionate toll on them, The Times included in its count studies that were designed to recruit participants from sexual and gender minority groups. It excluded grants related to illnesses like H.I.V. that were focused on non-L.G.B.T.Q. patients. While The Times examined only N.I.H. research grants, the Trump administration is also ending or considering ending L.G.B.T.Q. programs elsewhere in the federal health system. It has proposed, for example, scrapping a specialized suicide hotline for L.G.B.T.Q. young people. The research cuts stand to hollow out a field that in the last decade had not only grown larger, but also come to encompass a wider range of disease threats beyond H.I.V. Already, scientists said, younger researchers are losing jobs in sexual and gender minority research and scrubbing their online biographies of evidence that they ever worked in the field. Five grants obtained by Brittany Charlton, a professor at the Harvard School of Public Health, have been canceled, including one looking at sharply elevated rates of stillbirths among L.G.B.T.Q. women. Ending research on disease threats to gender and sexual minority groups, she said, would inevitably rebound on the entire population. 'When other people are sick around you, it does impact you, even if you may think it doesn't,' she said.
New York Times
21-04-2025
- Health
- New York Times
Supreme Court Wrestles With Challenge to Affordable Care Act Over Free Preventive Care
The Supreme Court appeared divided during arguments on Monday over the constitutionality of a provision of the Affordable Care act that can require insurance companies to offer some types of preventive care for free. At issue is a part of the 2010 health care law that established a task force that determines certain kinds of preventative health measures that insurance companies are required to cover. Two small Christian businesses that provide health insurance to their employees, along with some Texas residents, had sued the federal government, challenging the constitutionality of the task force. In particular, they had objected on religious grounds to the task force's approval of no-cost H.I.V. medications, claiming the drugs 'encourage and facilitate homosexual behavior.' But the case, Kennedy v. Braidwood Management, could have broader implications for tens of millions of Americans who receive a wide array of free health care services, including cancer and diabetes screenings, medications to reduce heart disease and strokes, and eye ointment for newborns to prevent infections causing blindness. A ruling in favor of the challengers could mean that insurers would no longer be required to offer these health services for free. Want all of The Times? Subscribe.
New York Times
08-04-2025
- Health
- New York Times
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. Eventually, I convinced my patient that taking PrEP was the best way to protect himself from infection, and was all the more important amid this administration's eroding support for H.I.V. care. H.I.V. prevention is something all health care providers need to integrate into their practice. Despite being one of the best tools at our disposal for preventing the spread of H.I.V., PrEP continues to be especially under-prescribed to those populations most burdened by the disease. Health care providers can start by educating themselves on PrEP and imploring their practices to make prescribing easier. It's a disservice to delay or withhold it from those for whom prevention may be a matter of life and death. The disparities in diagnosis and care are grim. The incidence of H.I.V. 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 H.I.V. Compared to other women with H.I.V., 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 H.I.V. That's why health care providers should make PrEP screening and prescribing a routine part of their work, akin to checking for high blood pressure and cervical cancer. 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, which could allow drug-resistant H.I.V. 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 H.I.V. infections. 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. 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. Estimates suggest that there could be 2,000 daily new H.I.V. infections globally, and 10 times more related deaths if American funding remains frozen or is not replaced. My colleagues and I certainly cannot avert mass death on that scale. But to continue with business as usual is to surrender the future. Intensifying PrEP prescribing is one of the best forces at our disposal to prevent a new H.I.V. crisis.
