Over the past 40 years, the United States has led the charge in achieving groundbreaking medical and scientific advancements that have resulted in the creation of lifesaving HIV treatments and HIV prevention tools like pre-exposure prophylaxis (PrEP). These advances have turned a disease that was once a death sentence into a manageable chronic illness. Additionally, through these medical interventions, federal investments in the HIV response, and decades of community efforts, we have achieved reductions in new HIV transmissions and AIDS-related deaths so large that we can now see the end of the HIV epidemic in our lifetimes. We are in danger of losing these advances.
All of this progress is rooted in the tireless advocacy of the HIV community, the bipartisan support of HIV funding, including the President’s Emergency Program For AIDS Relief (PEPFAR) program, and the shared commitment of public health workers and policymakers in the investment in evidence-based solutions through investments in research, that serve those who are most directly impacted. Our scientific knowledge of HIV treatment, prevention and epidemiology has never been stronger, but our recent progress in preventing new transmissions of the virus and providing care for those living with HIV, is in grave danger because of the actions taken by the current administration.
Recently the Trump administration has released a series of strategic priorities documents for federal agencies that are at the heart of our nation’s domestic HIV response, including the CDC, SAMHSA and HRSA. These documents provide a comprehensive framework for this administration’s public health goals, synthesizing language from previous executive orders, dear colleague letters, policy papers, and other materials to create a blueprint for future action. If the blueprint that has been provided through these strategic priorities is followed, we will be setting our nation up for failure in the fight against HIV and many other infectious and chronic diseases impacting our communities. Instead of placing us in a position to end the HIV epidemic, the priorities of this administration threaten to send us back to the early days of the AIDS crisis, when stigmatizing policy and deadly opportunistic infections and, thus, hastened deaths were not the exception, but the rule.
Federal agency priorities statements have traditionally been used to describe the specific principles, issues, and populations an administration is committed to serving; the statements by the Trump administration instead focus on the principles, issues, and populations that they are committed to ignoring – or worse – dehumanizing. The statements demonstrate a commitment to undermining the health of undocumented immigrants, reproductive health and rights and the very existence of transgender individuals. The administration is abandoning evidence-based approaches to provide life-saving services to people who use drugs and who experience homelessness by rejecting harm reduction tools and the “housing first” model, which provides the most basic of needs– shelter– before tackling mental health or substance use. This Administration has also shown a commitment to rejecting policies that seek to directly address the incontrovertible health inequities that plague our nation.
None of these priorities will deliver improved health outcomes for our communities. In fact, the publication of these priorities coincides with the passage of H.R. 1, which will take away health insurance coverage for more than 17 million Americans, rendering people without access to healthcare; therefore, making Americans sicker, not healthier. This is compounded by the Administration’s and House Republicans’ proposals for massive and unprecedented funding cuts to HIV prevention, treatment and research, and the FY26 House Labor, Health and Human Services, Education, and Related Agencies bill calling for the elimination of all federal HIV prevention funding, as well as $525 million in cuts to the Ryan White HIV/AIDS program. Robust investment in HIV prevention services and in PrEP is essential for reducing new HIV transmissions and we know that the Ryan White HIV/AIDS Program is indispensable in our nation’s domestic HIV treatment efforts – with a nearly-90% viral suppression rate for those who receive services. Viral suppression is not only an indication of health and wellness for the individual, it also is a proven and effective prevention strategy, in that when a person is virally suppressed to a level the virus is undetectable, they can not transmit HIV sexually to another person – Undetectable=Untransmitable. We know what will happen if support for these interventions goes away.
A recent study from the Johns Hopkins University School of Medicine projected that ending funding for the Ryan White HIV/AIDS program would result in more than 75,000 additional HIV transmissions over the course of five years, a staggering 49% increase in HIV incidence that would lead to more than $31.7 billion in lifetime medical costs and unnecessary sickness, suffering and even death for those who contract the virus. At the same time, we know that more than 90% of all federal HIV prevention funding comes from CDC, and nearly 90% of that CDC HIV prevention funding goes directly to state health departments and community-based organizations. If this administration’s priorities and cuts to HIV prevention funding are realized, the capacity of our country’s state and local health departments and community-based organizations to prevent the spread of HIV and other infectious diseases will be destroyed and major increases in new HIV transmissions, AIDS-related deaths, viral hepatitis and STI cases, drug overdoses and overdose-related deaths will result.
In addition to championing policies that will reverse our hard-won progress toward ending the domestic HIV epidemic, this Administration has also radically deprioritized support for combating HIV globally. Through the systematic destruction of the United States Agency for International Development (USAID) and the abrupt cancellation and rescission of funding for the PEPFAR, this Administration has already undone decades of lifesaving work to provide HIV prevention and treatment services across the globe, with anecdotal reports coming from PEPFAR partner countries of increases in new acquisitions and AIDS-related mortality. Since its inception in 2003, PEPFAR has saved more than 26 million lives in low and middle income nations across the globe, and the lives of those individuals and of millions more people vulnerable to contracting HIV are now in jeopardy due this Administration’s actions. A recent study by researchers at the Duke Global Health Institute projects that current and proposed cuts to HIV funding in the U.S. and elsewhere would result in an additional 10 million people acquiring HIV over the next five years, and lead to the deaths of an estimated 3 million more people from HIV-related diseases.
The contents of these agency priorities documents further demonstrate that this Administration’s actions are consistently in direct conflict with what is actually needed to achieve better health outcomes in our country. Instead of working to address existing issues within our healthcare systems, this Administration has prioritized targeting and inflicting harm on the most vulnerable in our communities. The drastic funding cuts to our country’s safety net systems and the divisive rhetoric coming from the Administration constitute state violence. Stripping vital healthcare from communities, cutting food assistance from communities experiencing financial hardship, targeting immigrants and tearing apart families, attacking the existence and humanity of the LGBTQ+ community, criminalizing people who are unhoused, and the dehumanization of people who use drugs – all constitute state violence. Each and every one of these state actions comes with devastating consequences that threaten the health and safety of the communities we serve. We wholeheartedly reject any attempt to divide our communities or pit us against each other. Each and every attack on any member of our communities is an attack on us all.
Ending HIV in this country – a pledge made by President Trump during his first administration – as well as around the globe is absolutely possible, but only through targeted and sustained investment. The government needs to invest in public health infrastructure and keep whole and expand the programs with proven efficacy, as the Ryan White HIV/AIDS Program has demonstrated, instead of cutting funding. The government needs to remove barriers to make healthcare more accessible for everyone, instead of sowing division and creating obstacles and confusion within the system. We cannot end HIV in the United States and abroad by leaving any community behind. HIV impacts everyone and how we address HIV needs to reflect that reality. The Public Policy Council remains committed to advancing evidence-based solutions that are equitable, inclusive and rooted in the lived experiences of people of all races, orientations and identities to ensure equitable access to care, treatment, prevention, and supportive services for all of the communities we serve. We urge this Administration to reevaluate their strategic priorities and pursue a path that will not inflict harm, but will best support the health of our communities.