Longtime leaders in advocating for HIV/AIDS funding – including the heads of two organizations who are plaintiffs in a suit against the Trump administration spurred by recent executive orders – said at a panel discussion in downtown San Francisco May 21 that their work is in dire peril.
“It’s very grim, I’m not going to lie,” said Cecilia Chung, a transgender woman who is HIV-positive and a former member of the San Francisco Health Commission. “It doesn’t look to me like there is any light at the end of the tunnel. … It’s actually putting the entire country at high risk.”
Chung, senior director of strategic initiatives and evaluation at the Oakland-based Transgender Law Center, spoke at San Francisco’s Commonwealth Club World Affairs alongside Tyler TerMeer, Ph.D., a gay man who is CEO of the San Francisco AIDS Foundation; Lance Toma, a gay man who is CEO of the San Francisco Community Health Center; and Carl Schmid, a gay man who is executive director of the HIV+Hepatitis Policy Institute in Washington, D.C.
As the Bay Area Reporter previously reported, TerMeer and Toma’s organizations are plaintiffs in a suit challenging the administration on three executive orders relating to diversity, equity and inclusion efforts; equity-related grants; and gender identity. They had received stop-work orders or termination notices for federal funds as a result of the orders.
“We find ourselves in a very dangerous inflection point to end the HIV/AIDS epidemic,” TerMeer said. “What once seemed within reach now seems fragile. I’m not speaking just as the CEO of the San Francisco AIDS Foundation, but as a Black, queer man who has been living with HIV for 20 years.”
A hearing on the lawsuit, brought by Lambda Legal Defense and Education Fund, was held in federal court in Oakland May 22, a day after the Commonwealth Club program. Judge Jon S. Tigar is expected to issue a decision in a couple of weeks on whether to issue an injunction.
While Trump has touted his early moves on DEI and gender identity, the administration’s shifting response to HIV has garnered less headlines. Schmid said that it was “such a stark contrast from the first Trump administration, so we didn’t expect it to be this bad.”
The first time Trump was president, his administration began the Ending the HIV Epidemic initiative with the goal of reducing 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.
"We will eradicate the AIDS epidemic in America by the end of the decade," Trump said in the 2020 State of the Union address.
As the B.A.R. reported earlier this month, initial cuts proposed in a leaked U.S. Department of Health and Human Services budget draft would eliminate funding for the initiative. Since the release of the White House’s so-called skinny budget, the status of that funding going forward is now unclear.
Schmid said the cuts to prevention appear to be motivated by “a whole anti-government” animus.
“We’re wrapped up in that,” he said.
RFK Jr.’s MAHA moment
And then there’s Health and Human Services Secretary Robert F. Kennedy Jr., who wants to focus government health efforts more on chronic conditions than infectious disease, part of his Make America Healthy Again, or MAHA, effort. Schmid said people who want to see HIV prevention more fully funded need to hammer home the point that “HIV is a chronic condition. It’s an infectious chronic condition.”
Toma agreed that messaging needs to improve, noting that “treatment is prevention.”
He said the administration is trying to ignore the health differences between various communities.
“What it says is, ‘Let’s treat everyone all the same,’ and we’re not the same,” Toma said of the administration’s proposals. “We saw the potential to end the HIV epidemic, but if we don’t have the infrastructure to reach people of color, we have lost again.”
Most new HIV diagnoses in the U.S. are among racial minorities. In 2022, Black and Latino Americans had a higher percentage of new diagnoses, according to the most recent federal statistics available, than white Americans.
HIV cases ticked up in San Francisco in 2024, according to a preliminary report from the San Francisco Department of Public Health.
Chung said that the attacks on HIV prevention are “on the same line of how they go against reproductive health and reproductive justice.”
“Because, somehow in their mind, it translates to promiscuity, and that’s now a very Christian thing. That’s the framing that’s happening,” Chung said.
Indeed, a lawsuit challenging the United States Preventive Services Task Force’s ability to define which preventative care is covered under the Patient Protection and Affordable Care Act was brought by plaintiffs who do not want to cover the HIV preventative tool PrEP.
In the case of Braidwood Management v. Robert F. Kennedy Jr. (the defendant had been former HHS secretary Xavier Becerra before the presidential transition) the plaintiffs are arguing that covering PrEP makes them "complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman."
PrEP, or pre-exposure prophylaxis, refers to the use of antiviral drugs to prevent people exposed to HIV from becoming infected. The pill Truvada was first approved for PrEP use in 2012 by the federal Food and Drug Administration; since then the FDA has also approved the pill Descovy for some groups, and the drug Apretude as an injectable treatment.
According to federal Centers for Disease Control and Prevention statistics, only 25% of the approximately 1.2 million Americans who could benefit from PrEP had prescriptions in 2020.
The U.S. Supreme Court heard the case last month, as the B.A.R. reported.
HIV treatment programs
Domestic HIV care and treatment programs appear to be largely preserved in budget proposals, though they, too, would not be without 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.
AIDS housing and dental care programs are also threatened.
“We’re really headed to a potential future where we see the dismantling of organizations that we hold dear,” Toma said.
Abrupt cuts to the President’s Emergency Plan for AIDS Relief, or PEPFAR, and the United States Agency for International Development, or USAID, have put people at risk in countries where the HIV/AIDS infrastructure relied on U.S. government assistance.
“Things ended very abruptly,” Chung said. “So HIV testing, especially in the Global South, has been reduced significantly.”
Schmid cited Secretary of State Marco Rubio, who told a congressional hearing May 20 that, “85% of PEPFAR is functional right now.”
“We’ll see,” Schmid said. “He did decimate USAID. … When American presence leaves, who do you think is going to come in? Some foreign powers we don’t want to see come in. It really destroys things and goes against our national interest.”
Schmid continued that the PEPFAR and USAID cuts caused fear domestically.
“If the U.S. government is pulling treatment from people with HIV in Africa, oh my God, that can happen here,” he said people have worried.
