LGBTQ Agenda: White House proposed cuts alarm HIV groups

San Francisco HIV organizations and national advocates are sounding the alarm about massive cuts presented in the White House’s proposed budget. The White House announced President Donald Trump’s so-called skinny budget proposal May 2. 

Initial cuts proposed in a leaked U.S. Department of Health and Human Services budget draft would have eliminated funding for the Ending the HIV Epidemic initiative, which was started during Trump’s first term as president. The status of that funding is now unclear. Trump touted the initiative in his 2020 State of the Union address. 

"We will eradicate the AIDS epidemic in America by the end of the decade," he said at the time.

The initiative seeks to reduce the number of new HIV infections in the U.S. by 90% by 2030 for an estimated 250,000 total HIV infections averted. It had been continued by the Biden administration.

As summarized by the HIV+Hepatitis Policy Institute, a Washington, D.C.-based advocacy organization, domestic HIV care and treatment programs appear to be largely preserved, but HIV prevention is left out, the Bay Area Reporter previously reported. Most treatment-related components of the Ryan White HIV/AIDS Program would remain intact, but it could lose ancillary services such as dental care. AIDS housing programs are slated to take a hit. The budget proposal does not include Centers for Disease Control and Prevention funding for HIV prevention, and it is not yet known whether this will be eliminated or moved to another part of HHS.

Local health organizations and others were critical.

“I think what we’re seeing is that it’s a decimation of efforts we’ve been making with respect to ending the HIV epidemic,” Lance Toma, a gay man who is chief executive officer of the San Francisco Community Health Center, told the Bay Area Reporter. “These cuts across the board will undo years and years of progress across the country.”

Carl Schmid, a gay man who is the executive director of the HIV+Hepatitis Policy Institute, said that the skinny budget might be maintaining the Ending the Epidemic funding.

“In the initial leaked draft, it said Ending the HIV Epidemic Initiative would be gone,” Schmid said. 

That is now unclear, as the document doesn’t state that the funding is being eliminated like the leaked copy stated.

“That does not appear in this document,” Schmid said.

Still, “it’s pretty bad,” Schmid said. 

Among the cuts, the skinny budget proposal eliminates $74 million for the education and training components of the Ryan White HIV/AIDS program. It also would eliminate a dedicated viral hepatitis prevention program at the CDC. It consolidates the hepatitis program, along with STI and HIV prevention programs, in the form of a single $300 million block grant program to the states.

There’s also a proposed cut of $534 million from the National Institute on Minority Health Disparities, the elimination of Substance Abuse and Mental Health Services Administration harm reduction programs, and the end of research on so-called radical gender ideology.
 
Schmid pointed out the document does not mention HIV tracking and surveillance. 

“Is it gone? Is it transferred? There’s no mention,” Schmid said. “That’s scary. … We don’t know if HIV prevention is completely gone, but we do know they’ve cut five of the 10 previous branches for HIV, and they’ve already cut many of the grants.” 

Toma said that if these cuts are passed by Congress and signed by Trump, it could lead to bad outcomes for local organizations like his, which is a federally qualified health center.

“Yes, I think the impact will be that there will be drastic – potential drastic – funding reductions to San Francisco,” Toma said. As co-chair of the HIV/AIDS Provider Network, he’s “working directly with the city leadership, folks at the department of public health, and also with the HIV Community Planning Council, to plan for any potential reductions in funding to our city.”

Another local service provider expressing concern is the San Francisco AIDS Foundation.

“We have deep concerns over the massive spending cuts that are proposed in President Trump’s FY 26 proposed budgets, which will be devastating to public health and the HIV response in this country and globally,” stated Tyler TerMeer, PhD, CEO of SFAF. “In addition to affecting direct HIV programs and services such as those covered by Ryan White and the CDC, the 22% reduction in federal funding would impact a wide swath of other support and health care services for people living with and at risk for HIV – including housing support, mental health care, and more. These proposed cuts are cruel to our communities and we strongly urge Congress to reject this proposal.” 

SFAF and the San Francisco Community Health Center are plaintiffs in a federal lawsuit against the Trump administration. That suit targets Trump’s elimination of diversity, equity, and inclusion initiatives that have included stop-work orders or the termination of federal funds. Lambda Legal Defense and Education Fund filed the lawsuit in U.S. District Court, Northern District of California, San Francisco Division in February, as the B.A.R. reported.

Local organizations are also concerned that San Francisco may not be able to backfill federal cuts as it’s done in the past, due to its own budget deficit.

Toma recalled that, “year after year, San Francisco’s leaders – the mayor and the Board of Supervisors – have stepped up to fill in the gaps from the federal government. … We are working hard with the city to do all they can to backfill any losses that come our way from the federal government.”

The city, however, is going through its own challenging budget period. There’s already a $876 million budget shortfall – and more federal cuts could balloon the deficit to $2 billion, according to Mayor Daniel Lurie. 

Last year, then-San Francisco mayor London Breed backfilled about $200,000 in cuts from one of the city’s federal funding streams, as the B.A.R. reported.  

The San Francisco Department of Public Health declined to comment, referring the B.A.R. to UCSF, which itself didn’t return a request for comment.

LGBTQ Agenda is an online column that appears weekly. Got a tip on queer news? Contact John Ferrannini at [email protected]