America the Cruel and Stupid
Decades of progress and a political agenda walk into a public health crisis.
In this very strange world I find myself inhabiting, a lot confounds me. The politics. The cruelty. It is a lot to be confronted with. Like others, I believe stoking that cruelty is the mission of men like Trump, Putin and Netanyahu. But their purchase is not design. They are taking advantage of an environment. The collective stupidity of the masses that has its roots in the gutting of education and the concentration of wealth, a two-pronged scourge fomented by social media and the people who see profit in promoting their own version of reality. This world order where whatever is happening right now constitutes universal truth, a sensibility reinforced by thirty-second Instagram stories - it’s not for me. Nor is Making America Healthy Again - the political kind.
MAHA is the result of a horrific merging of a coordinated campaign to misinform, coupled with ignorance hardening into social construct. Influencers are unregulated and their credentials are more often than not limited to being pretty, angry and performance enlightenment. The damage is spectacular. As the Lancet noted recently, it will take decades to undo what this movement has created under the leadership of its very damaged figurehead, Robert F. Kennedy Jr.
I will not rail about vaccine safety; I will only say that a lot of these self-appointed people in the know would not be here to share their wisdom had vaccines not existed. They would have been culled along with countless others by childhood diseases and viral infections long since controlled. But there are still viruses we have no vaccines for.
Like many men my age who came of age in the 1980s and 90s, HIV and the disease it causes, AIDS, was a defining and ever-present fear. I spent years working in this space and it was exhausting and horrifically sad. After my book AIDS and HIV-Related Diseases was published in 1996, I stepped away. I moved on to other areas of healthcare. It was that hard to witness as a young gay man.
My path took me into healthcare administration, but I watched from a distance as research produced medications that changed the HIV landscape for millions of people around the world. The suppression of viral load in people on treatment has dramatically reduced transmission and delivered a quality of life I never saw when I was in the field. To remember the men and women I watched suffer, haunted and begging for some hope of survival, is softened knowing that the despair of no hope has been genuinely curbed for so many. That is a public health achievement of the first order.
So, what is happening now is not just a policy failure. It is a choice. A deadly one.
More than 20 states are actively reducing or considering cutting back on their AIDS Drug Assistance Programs, which provide HIV medications to low-income and uninsured people. A report from the National Alliance of State and Territorial AIDS Directors found 23 states, including Washington D.C., implementing or considering cost-containing measures. States are lowering financial eligibility thresholds, bringing back waitlists and restricting which drugs they will cover. The root cause is federal stagnation. Federal ADAP funding has been frozen at $900.3 million since 2014, which means states have the same purchasing power they had in 1999 after inflation, while enrollment and costs keep rising.
Florida is the sharpest edge of it. In January, the Florida Department of Health announced it would slash ADAP eligibility from 400 percent to 130 percent of the Federal Poverty Level, strip out the premium assistance framework entirely and restrict access to first-line HIV medications, all effective March 1. When the AIDS Healthcare Foundation filed a legal challenge, it emerged that Florida had tried to implement these changes without going through the formal rulemaking process required by law. That tells you something about how confident they were that what they were doing could withstand scrutiny.
Pennsylvania is cutting 25 percent of Ryan White HIV/AIDS Program Part B funding even as enrollment hit an all-time high of more than 8,200 people in a single week and medication costs jumped from $72 million in 2023 to $139 million today. The federal government’s response has been to propose making it worse. The House Appropriations Committee released a bill proposing to cut domestic HIV care, treatment and prevention by at least $1.7 billion, eliminate all HIV prevention programs nationally, end Trump’s own Ending the HIV Epidemic initiative and slash the Ryan White Program by 20 percent. The NIH has also terminated dozens of HIV research grants, with termination emails citing work no longer consistent with administration priorities, specifically grants focused on LGBTQ populations.
Then there is Florida’s Surgeon General, Dr. Joseph Ladapo, who is worth examining closely because he is the human face of what calculated cruelty dressed up in medical authority looks like. Ladapo holds an MD and a PhD in health policy from Harvard. Before DeSantis appointed him in 2021, he worked at UCLA’s David Geffen School of Medicine, where he treated HIV patients and conducted cardiovascular research. He knew the work. He knew what was at stake for people living with HIV. That is the part that should not get lost.
DeSantis plucked him from UCLA specifically because Ladapo had been writing op-eds challenging scientific consensus on vaccines and pandemic mitigation. He was appointed to run the Florida Department of Health and wasted no time. He repealed quarantine rules for school children exposed to COVID as his first act. He promoted ivermectin and hydroxychloroquine. He altered a state health department study to remove findings that contradicted his claims about cardiac risk from mRNA vaccines in young men. The Faculty Council of the University of Florida College of Medicine investigated and concluded the recommendation was based on careless and contentious research practice that may have violated university research integrity policies. In September 2025, Ladapo announced Florida’s plans to eliminate all vaccine mandates, including childhood school requirements, comparing such mandates to slavery. The American Academy of Pediatrics responded with grave concern. Every Democrat in the Florida Senate voted against his confirmation. The Republican majority confirmed him 27 to 12.
This is the man overseeing the gutting of HIV medication access in Florida, a man who once treated HIV patients professionally and now runs the department that just slammed the door on 30,000 people who rely on the state’s drug assistance program.
Men like Ron DeSantis, who feed on prejudice and mortgage a brand of twisted Christian faith, have found in Ladapo a credentialed instrument. The Harvard degree provides cover. The contrarianism does the political work. Call it medical freedom, call it choice, call it whatever gets the votes from the ill-informed. What it is, in practice, is people losing access to medications that keep them alive.
Our wealthy country, with men and women making billions off medications, health insurance and care, is turning its back on HIV and AIDS prevention. America and the world lived through what happens when you let a virus go unchecked. In states like Pennsylvania and Florida, where the disease raged and cost billions and caused incalculable suffering, I wonder whether what we are seeing is amnesia or, especially in Florida, something more deliberate. This defunding of programs with overwhelming evidence of good is stupidity and greed at best. At worst, it is something I am not sure I have a clean word for. Evil is a strong word. But I am running out of softer ones.
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