The Trump administration may be planning to eliminate the Centers for Disease Control and Prevention's Division of HIV Prevention, possibly as soon as this week, news sources reported late Tuesday, March 18. Advocates are asking the public to call or write to their legislators to urge them to oppose the cuts.
Despite advances in biomedical prevention and a 12% decline in new infections from 2018 to 2022, approximately 31,800 people acquired HIV in 2022, according to the CDC.
"HIV testing, pre- and post-exposure prophylaxis (PrEP/PEP), and preventive services are essential to ending the HIV epidemic," Ande Stone, the San Francisco AIDS Foundation's director of community mobilization and policy, said in an alert from the HIV Action Network Tuesday afternoon. "We must protect widespread access to these lifesaving tools."
While details are still murky, HIV advocates reportedly began circulating a memo warning about the impending changes earlier in the day. The Wall Street Journal, which first reported the news, attributed it to "people familiar with the matter." Politico got confirmation of the deliberations from anonymous former Department of Health and Human Services officials.
According to the unnamed sources, plans have not been finalized and could be modified or pulled back. Rather than being eliminated entirely, the CDC's HIV prevention work could be moved to other agencies, such as the DHHS's Health Resources and Services Administration, which administers the Ryan White HIV/AIDS Program and the Ending the HIV Epidemic initiative launched during President Donald Trump's first term.
"At his 2019 State of the Union address, Trump promised to end HIV in the United States by 2030. However, even before the reported CDC cuts, the Trump administration's policies have been in direct conflict with these goals," said Dr. Colleen Kelley, chair of the HIV Medicine Association. "Not only will we not end the HIV epidemic with the current administration's policies, we could reverse these gains and go back to the dark days of the 1980s, when people died from HIV every day."
So far, the CDC, DHHS, and the White House have not made any official announcements about the division's fate. "No final decision on streamlining CDC's HIV Prevention Division has been made," DHHS spokesperson Andrew Nixon told news sources. "HHS is following the administration's guidance and taking a careful look at all divisions to see where there is overlap that could be streamlined to support the president's broader efforts to restructure the federal government."
Newly appointed Health Secretary Robert F. Kennedy Jr. has expressed a desire to reorganize and limit the scope of the CDC, which falls under DHHS along with the National Institutes of Health, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services. The CDC is still without a director after Trump abruptly withdrew his nominee, Dr. David Weldon, on March 13.
The CDC's Division of AIDS Prevention falls under the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention. The agency's operating budget for 2023 included nearly $1.3 billion for HIV, viral hepatitis, STI, and tuberculosis prevention, addressing the opioid crisis, and promoting adolescent and school health, according to the division's website. About three quarters of the funding is awarded as grants to state, local, and tribal health departments, national and community-based organizations, academic institutions, and education agencies. If CDC funding is cut, California and other states could be forced to fill the gap.
"We cannot end HIV without a fully functioning and sufficiently funded HIV prevention program. If the administration has new ideas on how to conduct HIV prevention, including testing, surveillance, education, and PrEP outreach, we are more than willing to discuss them," stated Carl Schmid, a gay man who is executive director of the HIV+Hepatitis Policy Institute. "With new long-acting PrEP drugs on the horizon, now is not the time to totally disrupt the system but a time to redouble our efforts to prevent HIV."
Since Trump's inauguration on January 20, the administration and Elon Musk's Department of Government Efficiency have moved to dramatically cut federal spending. They have decimated funding for USAID and PEPFAR (the President's Emergency Plan for AIDS Relief), which provides HIV treatment and PrEP to people in low- and middle-income countries. New limits on grants from the NIH threaten to curtail HIV research. And House Republicans have proposed a budget that would require deep cuts to Medicaid, which covers some 40% of people living with HIV.
Judges have issued court orders blocking some of the cuts, but these are reportedly being ignored. HIV service providers in Africa say that their clients are going without antiretroviral drugs and medical care. Interrupting antiretroviral treatment even briefly can cause viral load rebound and disease progression, and loss of access to PrEP can result in HIV transmission and more babies born with HIV. Far from saving money, prevention cuts that lead to new HIV cases could cost far more for treatment, estimated at around $500,000 over a person's lifetime.
"An effort to defund HIV prevention by this administration would set us back decades, cost innocent people their lives and cost taxpayers millions," said Human Rights Campaign President Kelley Robinson, a queer Black woman. "The LGBTQ+ community still carries the scars of the government negligence and mass death of the HIV/AIDS epidemic. We should be doubling down on our investment to end the HIV epidemic once and for all, not regressing to the days of funeral services and a virus running rampant."
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