Trump Administration Considers Changes to National HIV Prevention Strategy
During his initial presidential term, Donald J. Trump launched a significant initiative aimed at eradicating the HIV epidemic in the United States by 2030. This plan targeted 57 localities identified as having the most pressing needs.
Announced in 2019 during a State of the Union address, the proposal initially surprised advocacy organizations but garnered widespread praise and ultimately demonstrated success.
By 2022, the initiative had contributed to a 30 percent reduction in new infections among adolescents and young adults nationwide, and approximately a 10 percent decrease in most other population groups.
However, the current stance of the Trump administration on HIV appears markedly different.
Federal officials indicate that the Department of Health and Human Services (HHS) is currently evaluating the possibility of dissolving the HIV prevention division within the Centers for Disease Control and Prevention (CDC). The plan involves potentially transferring some of its functions to another agency.
Potential Reorganization of HIV Prevention Programs
The CDC currently allocates funds to states and territories for crucial HIV-related activities, including:
- Detection and response to HIV outbreaks
- Prevention programs
- Syringe exchange initiatives
- Expanded testing in emergency departments
- Public education and awareness campaigns
Agency funds contribute to roughly one in four new HIV diagnoses.
While discussions are ongoing, the administration’s plan remains unfinalized, and the timeline for any potential changes is uncertain.
According to a federal official with inside knowledge of the deliberations, while the plan is “not 100 percent going to happen, it is 100 percent being discussed.”
The Wall Street Journal initially reported on these considerations.
Previous budget reductions have already impacted global HIV prevention efforts, notably through the scaling back of the U.S. Agency for International Development. Furthermore, some domestic funding for prevention and treatment has been reduced due to its ties to programs serving transgender individuals, a population disproportionately affected by HIV.
Adding to these concerns, the National Institutes of Health (NIH) has reportedly terminated funding for numerous related research projects. These include studies focusing on HIV in children, the influence of substance use, and strategies to improve the adoption of preventative therapies among underserved populations, such as Black women.
Past Successes and Shifting Priorities
The prior Trump administration’s HIV strategy specifically prioritized assisting many of the groups now facing funding cuts. The initiative focused on preventing infections within vulnerable communities, including impoverished Black communities, gay and bisexual men, and transgender women – demographics with elevated HIV risk.
Admiral Brett Giroir, former deputy secretary of health and human services under the first Trump administration, acknowledged in a past interview that these groups were “not his constituency,” yet affirmed the former president’s strong support for the initiative.
States targeted by the initial initiative witnessed a reduction in new infections exceeding 20 percent by 2022. Admiral Giroir confirmed the success, stating, “That’s exactly what we were trying to do, and we did it.”
The previous administration also leveraged government-held patents on preventative medications to secure more favorable pricing agreements with drug manufacturers.
Jeremiah Johnson, executive director of PrEP4All, an advocacy group, recognized, “These actions made a real difference.” However, he expressed concern that “it doesn’t seem like the current administration is motivated by prior accomplishments.”
Proposed Transfer to HRSA and Expert Concerns
The potential plan under consideration involves relocating certain CDC prevention programs to the Health Resources and Services Administration (HRSA). HRSA channels funding to state and local health departments and community organizations that deliver HIV services, notably through the Ryan White program.
Emily G. Hilliard, HHS deputy press secretary, stated that “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.”
She reiterated that no final decision has been reached.
Mixed Reactions to Potential Changes
Some organizations have expressed conditional optimism about the potential shift to HRSA. They suggest it could streamline comprehensive HIV and maternal health services, provided the CDC retains its lead role in surveillance and treatment guideline development.
David C. Harvey, executive director of the National Coalition of STD Directors, remarked that “Providing new funding to HRSA opens up new possibilities for efficiencies in biomedical prevention of HIV and other sexually transmitted infections.”
Conversely, other experts voice deep apprehension regarding the potential dilution of CDC involvement.
Mitchell Warren, executive director of AVAC, an advocacy organization, emphasized, “HRSA and their Ryan White program are terrific but focus on HIV care and treatment.”
He added, “They do not engage in HIV prevention as a priority, which is why CDC’s prevention focus is so critical.”
Michael Ruppal, executive director of the AIDS Institute, raised concerns about HRSA’s lack of expertise in administering and evaluating public health prevention initiatives.
“The leadership that’s within the CDC and all the institutional knowledge there, we need it in the field — the states need it, the communities need it,” Mr. Ruppal asserted.
Referencing Mr. Trump’s previous commitment to HIV prevention, Mr. Ruppal, whose organization supports HIV service planning in Florida counties, including seven high-risk areas from the 2019 initiative, questioned, “It just seems like it’s counterproductive to his personality to let this happen to this program after he put his name on it.”
Concerns over NIH Research Cuts
Public health authorities also express alarm over the NIH’s reduction in grants for studies concerning stigma and prevention, particularly those focused on LGBTQ+ populations. Gay and bisexual men, and transgender women, account for the majority of new HIV infections.
Dr. Chris Beyrer, director of the Duke Global Health Institute, asserted, “That’s where the epidemic is, and if you are not there, you are not addressing the epidemic.”
While approximately 7 percent of the NIH budget is allocated to HIV research, some Republican lawmakers have proposed aligning HIV funding with its national prevalence of under 0.4 percent.
Dr. Beyrer, also an advisor to the HIV Vaccine Trials Network, warned, “That certainly would not be enough to continue the research toward a vaccine, which we need, and toward a cure.”
Looking Ahead: Adapting to a Shifting Landscape
Given the evolving landscape of HIV programs both domestically and internationally, public health organizations may need to adopt new strategies to sustain their efforts.
Potential adaptations could include direct purchase agreements between companies and states or large non-profits, or the development of entirely novel partnership models.
Mr. Warren urged action, stating, “We’ve got to snap out of any paralysis or any disbelief or shock, and we’ve really got to look at what needs to be built in the future.”
He cautioned against allowing uninformed voices to dictate the narrative, adding, “One of the biggest tragedies in all of this would be if we let this narrative be written entirely by people who don’t understand science or health care or research or foreign assistance.”