A Public Health Crisis in the Making
In recent years, the United States has made substantial progress in combating the HIV epidemic through increased access to treatment, prevention programs, and support services. These advancements have been largely driven by federal funding initiatives, such as the Ryan White HIV/AIDS Program (Ryan White), the Ending the HIV Epidemic (EHE) initiative, and the proper use of the 340B Drug Pricing Program. However, proposed cuts to HIV prevention funding at the federal level pose a significant threat to undoing decades of progress and could have devastating public health consequences.
On March 18th, the Wall Street Journal reported the Trump Administration’s plan to “reorganize” certain programs within the Center for Disease Control and Prevention (CDC). The reports of sources stated that the plan included existing HIV prevention programs and their allocated funding. Reports of the directive were to return to 2019 levels of funding, reduction of 10% of funding and workforce, and potentially move programs under HRSA while keeping surveillance at CDC.
The Trump Administration's proposed significant reductions in HIV prevention funding and workforce have profound implications for both domestic public health programs, mirroring concerns around cuts to USAID, affecting global public health. These cuts threaten to reverse decades of progress in combating the HIV epidemic, leading to increased infections, compromised healthcare systems, and heightened economic burdens.
HIV prevention programs support activities across other areas of infectious disease monitoring, prevention, and treatment, including STI, Viral Hepatitis, Tuberculosis, and Substance Use programs. Prevention programs further support treatment programs with testing, screening activities, and linkage to care upon reactive tests.
Federal HIV programs provide essential services to individuals living with or at risk for HIV, particularly those from marginalized communities who may lack access to private healthcare. Programs like Ryan White ensure access to life-saving antiretroviral therapy (ART), which not only improves individual health outcomes but, as we’ve learned in the past decade, also prevents HIV transmission when individuals remain undetectable. Ryan White programs are housed within the Health Resources and Services Administration (HRSA), which also handles other treatment delivery programs. Additionally, CDCl’s HIV prevention programs and PrEP initiatives have expanded awareness and increased access to the prevention toolbox that reduces new infections.
This serves as a move widely seen as counter to one of the Trump Administration’s most high-profile first-term priorities. The EHE initiative, launched in 2019, aims to reduce new infections by 90% by 2030. Achieving this ambitious target requires sustained and increased investment. In support of these efforts and to help vulnerable patients re-engage and sustain their care, in FY 2024, HRSA awarded EHE grantees approximately $147,000,000 to link people with HIV who are either newly diagnosed or are diagnosed but currently not in care to essential HIV care and treatment and support services, as well as to provide workforce training and technical assistance, leading to 35,724 new diagnoses in 2022. The design of these dollars recognizes the role of people already living with HIV as “prevention warriors” by providing resources to stop chains of transmission.
However, HRSA’s awards operate differently than those programs housed at and funded by the CDC. The Administration's proposal to eliminate some or all federal funding for domestic HIV prevention programs is particularly alarming. This move would dismantle the CDC’s HIV prevention division, effectively halting federally funded prevention efforts for communities where HIV transmission is high and seeking to serve the needs of people vulnerable to HIV acquisition, as opposed to those who have already been diagnosed. Such reductions could undo decades of progress in combating the epidemic.
CANN President & CEO Jen Laws argued: “Moving prevention programs to HRSA, dividing up surveillance and programmatic activities, is a non-starter. HRSA is already under water, by their own admission, in terms of capacity and reports by the Government Accountability Office has outlined necessary oversight of existing programs being less than optimal, thus showing this type of suggestion isn’t a serious one.” “I don't think anyone can disagree that certain efficiencies must be made - duplicative reporting requirements across multiple grants is absolutely a burden on our service providers. But I think folks who might see a HRSA shift as hopeful are being a bit…hopeful. Moving HIV prevention programs to HRSA likely means opening the door to grouping prevention and treatment programs together, without an expanded budget or workforce, and very truly risks a sector shift to prevention only and abandoning people already living with HIV altogether.”
Historically, reductions in prevention funding have led to decreased HIV testing rates and diminished awareness of prevention methods, including mother-to-child transmission prevention, later-stage diagnoses, and reduced linkage to care rate for people who have seroconverted by have not yet been diagnosed. This not only jeopardizes individual health but also facilitates unchecked transmissions of HIV within communities.
The CDC spends about $1 billion a year on domestic HIV prevention, most of it funneled to the states to help with local efforts. The goal of increasing PrEP coverage to 50% according to the CDC’s Monitoring National HIV Prevention Goals by using data from the National HIV Surveillance System (NHSS) had increased from 13.6% at the launch of EHE to 36% in 2022, and a total of 1,736,850 CDC-funded HIV tests were conducted in 2021.
The EHE initiative and CDC have provided much-needed resources to regions most impacted by the domestic HIV epidemic. In 2022, testing was provided to diagnose 19,822 in the disproportionately burdened South, along with the Northeast (5,080), Midwest (4,903), West (7,858), and U.S. territories and freely associated states (380). The CDC provided $495,904,554 in prevention awards in 2024 to state and county health departments and their partners.
Threats of $700 million to $1 billion in HIV prevention funding being cut are not just a dollar amount; they have significant economic repercussions. This would impact state and city health departments, STI clinics, non-profit organizations that provide testing and treatment services, and thousands of individuals who have dedicated their lives and careers to ending this epidemic. These individuals would face the risk of job losses, health insurance coverage, and widespread devastation to the workforce. This move would also eliminate large swaths of 340B revenue sources - expanding the economic impact
Moreover, budget cuts have previously resulted in significant staffing reductions within local health departments. Notably, 43% of departments experiencing funding cuts reported decreases in HIV, sexually transmitted infections (STI), and viral hepatitis program staffing levels. Such workforce reductions hinder the capacity to deliver essential services, further exacerbating the public health crisis.
Without proper funding, many individuals will experience interruptions in care and prevention, leading to late diagnosis, drug resistance, opportunistic infections, and AIDS-related complications. The decline in accessible HIV care and prevention could result in higher mortality rates, disproportionately affecting the most vulnerable regions across the country. In 2022, numbers and percentages of HIV-related deaths were as follows: Northeast—570 (13%), Midwest—430 (10%), South—2,379 (56%), West—766 (18%), U.S. territories and freely associated states—98 (2%).
The Trump Administration's reductions in HIV prevention funding and workforce pose significant threats to both domestic and global health. The potential increase in HIV infections, coupled with strained healthcare systems and escalating economic costs, underscores the critical need for sustained investment in HIV prevention and treatment programs.
Reducing this funding would put millions of Americans at risk, disproportionately affecting Black, Latino, LGBTQ+, and low-income communities, especially those across the South, who already face very real obstacles to healthcare. Every dollar invested in HIV prevention and treatment saves lives and reduces future healthcare costs. Treatment and prevention programs operate like a train on tracks, separate and distinct pieces that need one another to reach a destination - remove one of those pieces, and the goal is entirely unattainable. If we want to continue making progress, the Trump Administration must recognize that reducing funding now is a short-sighted decision that will result in lives lost and financial losses in the future. Federal HIV prevention funding and programs are more than just a budget line item—it is a lifeline for millions of people. Cutting it would set us back decades and put lives at risk.