President Donald Trump’s Fiscal Year 2025-2026 budget would eliminate HIV prevention and surveillance at the Centers for Disease Control and Prevention, Housing Opportunities for Persons with AIDS, and other programs. The total cut would be over $1.5 billion.
The budget, however, largely maintains funding for domestic HIV care, treatment, and PrEP programs. The news comes after a period of uncertainty of where cuts in funds to fight the epidemic would come from and how much they’d be.
“We urgently call on Congress to reject these cuts in order to ensure that states and community-based organizations have the resources to prevent HIV, which is still a serious infectious disease and results in about 32,000 new cases each year,” stated Carl Schmid, a gay man who is the executive director of the HIV+Hepatitis Policy Institute in Washington, D.C.
“While we are reassured that the 576,000 low-income people currently accessing care and treatment through the Ryan White HIV/AIDS Program, along with those using PrEP at community health centers, can maintain their services, the obliteration of CDC HIV prevention and surveillance programs is an absurd proposal that will just increase HIV infections and health costs down the road,” he added.
The cuts to HIV prevention and surveillance total $800 million. Housing Opportunities for Persons with AIDS, run out of the U.S. Department of Housing and Urban Development, would be completely eliminated. It currently serves 55,000 households to the tune of $505 million.
Also on the chopping block is Part F of the Ryan White Program, which funds dental reimbursements, clinical training, and community-driven implementation research ($74 million); the Minority HIV/AIDS Fund ($60 million); and the Substance Abuse and Mental Health Services Administration Minority HIV/AIDS Initiative programs ($119 million).
National Institutes of Health research would be cut 40%. The cuts combined total $1.3 billion.
The previous Office of Infectious Diseases and HIV/AIDS Policy at the Office of the Assistant Secretary for Health would be moved to Administration for a Healthy America in order to coordinate Ending the HIV Epidemic in the U.S. and other HIV activities and funded at $8 million. Authorization of HIV and hepatitis C testing at the Indian Health Service would continue.
Trump’s budget also slashes funding for the CDC’s hepatitis prevention initiatives, which are to be replaced with a block grant to states that would also include sexually transmitted diseases and tuberculosis prevention.
“Instead of decreasing and diluting funding for hepatitis, if the Trump administration is serious about addressing chronic health conditions we should be increasing funding so that people with hepatitis can be identified through testing and linked to treatment, and in the case of hepatitis C, a cure,” Schmid continued.
PrEP initiative preserved
The budget proposal maintains $220 million for the Ending the HIV Epidemic in the U.S. initiative, announced in Trump’s first term and continued by former President Joe Biden. The new budget transfers this to the Administration for a Healthy America. The initial leaked budget for the U.S. Department of Health and Human Services did not include these dollars.
The goal of the initiative is 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.
"We will eradicate the AIDS epidemic in America by the end of the decade," Trump said in the 2020 State of the Union address.
The budget also includes $165 million for the Ryan White Program and $157 million for PrEP in community health centers.
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.
“Maintaining funding for the Ending the HIV Epidemic initiative, which only focuses on 57 distinct geographic areas, while eliminating nearly $800 million for our nationwide surveillance, testing, education, and outreach programs is a recipe for disaster,” Schmid warned. “The Ending the HIV Epidemic initiative, which is laid on top of, and relies on, existing programs, will just become a misnomer. … HIV is an infectious disease, and a nationwide testing and surveillance system is necessary to know where infections are occurring and to link people to lifesaving treatment and, if they are at risk of HIV, preventive services such as PrEP. With a new twice-yearly PrEP drug expected to be approved by the FDA in the next couple of weeks, now is not the time to pull the rug out from under HIV prevention.”
Local reaction
Local reaction was swift. As the B.A.R. previously reported, Schmid spoke May 21 on a panel event in San Francisco about federal funding cuts to HIV/AIDS services alongside Tyler TerMeer, Ph.D., a gay Black man living with HIV who is CEO of the San Francisco AIDS Foundation, and Lance Toma, a gay man who is CEO of the San Francisco Community Health Center. Former city health commissioner Cecila Chung, a transgender woman living with HIV, was also on the panel.
TerMeer stated, “The proposed budget released by the Trump administration would be a disaster for our nation’s response to the HIV epidemic if approved by Congress. Since the 1990s, the U.S. has made steady progress in preventing new HIV infections and ensuring that people living with HIV are connected to successful treatment and care. Those hard-won gains will be lost if we end federally-funded programs for testing, prevention and PrEP, surveillance, research, and care.”
TerMeer stated that “already in California, we are seeing the impacts of these decisions.”
Therefore, “End the Epidemics – a coalition that includes San Francisco AIDS Foundation – is urging California lawmakers to allocate $60 million in the state budget to cover cuts at the federal level,” he continued. “As the president’s proposed budget makes all too clear, state funding is desperately needed to maintain systems of care across California.”
Toma, co-chair of the San Francisco HIV/AIDS Providers Network, stated that he is “appalled.”
“Dismantling our HIV prevention infrastructure is malicious and short-sighted,” he stated. “In San Francisco, we have been prioritizing HIV prevention efforts to support people of color communities, trans communities, gay men, youth, substance users, and the homeless community. We have been incredibly effective and continue to see new HIV infections decrease year after year in San Francisco. San Francisco Community Health Center and the HIV/AIDS Providers Network will be doing all we can to advocate to sustain federal funding and all of our efforts in our city and our country.”
A spokesperson for the San Francisco Department of Public Health stated that the department “is currently assessing all possible impacts of the cuts to federal public health funding and remains committed to protecting and promoting the health of all San Franciscans.”
Asked about the potential for backfilling federal HIV/AIDS cuts before the $1.5 billion figure was made clear, a spokesperson for Mayor Daniel Lurie stated, “Historically, we have always made our best efforts to backfill federal cuts related to HIV/AIDS. At this time, we haven’t seen the proposed federal cuts yet and do not have information on the fund. Of course, we will continue to do whatever we can to support folks with HIV/AIDS.”
Lurie’s budget sets aside $400 million in reserve dollars, with the stated intent of addressing federal cuts to San Francisco. He has said the amount in Trump’s cuts could balloon to $2 billion.
Global cuts
All this comes on top of Trump administration cuts to addressing HIV/AIDS overseas.
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.
At the May 21 event, 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.
The New York Times has reported about deaths of children in Africa who could no longer access treatment.