This story was originally reported by Orion Rummler by The 19thand republished via Newsgroup rewiring‘s partnership with The 19th News Network.
Decades of progress in HIV treatment and prevention in the United States is being derailed by the Trump administration, public health experts say — and if course is not reversed, the damage will be devastating.
Threats to key federal programs are unfolding just as science has made significant advances in how patients can treat and manage HIV, leaving experts deeply frustrated. The development of a vaccine, which researchers thought was so closer than ever to become a reality is now dead in its tracks. It is expected that a dose of PrEP will be administered twice a year to prevent HIV, which was approved by the Food and Drug Administration this year significant benefits – but experts worry about who can afford this drug. Millions of Americans are expected to do so losing health care coverage as a result of Trump’s cuts in federal spending.
Officials from the Centers for Disease Control and Prevention have reportedly been charged with disassembly their own work in the agency’s HIV prevention division. State-level researchers are also struggling. Bee one of the oldest and largest in the country Historically, black medical schools in Tennessee have had $2 million in federal funding for HIV research cut. Federal programs that fund the nation’s most important HIV services are in danger of being phased out or eliminated entirely.
On top of these cuts, Medicaid, the largest source of insurance coverage for adults with HIV in the country, has been cut, creating a dire situation for HIV-positive Americans. About 4 in 10 Americans living with HIV relying on Medicaid. New paperwork requirements take effect in 2027, which advocates say will deter many people from renewing their coverage or enrolling in the first place.
“For HIV-positive people right now, I think this is a very depressing moment,” said Perry Halkitis, dean of the Rutgers School of Public Health. “All the energy and all the excitement that we’ve had about ending the AIDS epidemic… that has completely taken the wind out of our sails.”
Health experts are watching with fear and confusion as Republicans undermine the nation’s basic HIV prevention infrastructure. Without key federal programs, they say, the system will collapse. In particular, the CDC performs certain functions that cannot be replaced or replicated anywhere else, e.g supervise for new HIV cases on a national scale, obtaining funding for state health agencies and promoting widespread HIV testing. If these services lose funding, outbreaks will go unchecked, experts say.
“There will be more consequences. There will be people who are diagnosed later, perhaps already with opportunistic infections and who show up to the emergency room already sick, harking back to a much darker, more visible and deadlier version of the epidemic, and that will be directly because these services have been cut,” said Jeremiah Johnson, executive director of PrEP4All. “It really threatens to undermine everything.”
Opportunistic infections target people with weakened immune systems, including people with HIV. These conditions can lead to an AIDS diagnosis, the most serious stage of HIV infection. Some of the most common opportunistic infections are thrush, lung infections and tuberculosis.
The White House has proposed ending HIV prevention and surveillance at the CDC as part of its federal budget proposal. In Congress, Republicans in the House of Representatives have gone even further. Their budget proposal would eliminate the federal program launched during President Donald Trump’s first term which has aimed to significantly reduce the number of new HIV infections. House Republicans also want to eliminate core parts of the Ryan White HIV/AIDS program, which is considered the fallback option when people with HIV lose access to health care coverage. The scope of these proposed cuts, which would strip the nation’s most basic HIV programs of nearly $2 billion, have shocked longtime advocates and experts.
“The vitriol and hostility they harbor toward HIV prevention work is unprecedented,” said Matthew Rose, senior public policy advocate at the Human Rights Campaign. “It breaks with the long-standing consensus in Washington that HIV is a bipartisan issue.”
During his first term, Trump made a deal to get free PrEP, or pre-exposure prophylaxis, for uninsured Americans with HIV. Be with State of the Union Address in 2019, he pledged to end the HIV epidemic in the United States by 2030 – largely through the program that Republicans in the House of Representatives currently want to close. Now these promises seem to have been forgotten.
Some attribute this abrupt change to the stark difference in staffing between Trump’s first and second terms. There are more loyalistsmore newcomers in government, and fewer members of the old conservative guard. During his first term, there were still Bush-era staffers who cared about the issue, Rose said; but he says that same compassion is just not clearly visible among the MAGA audience.
“They’re a little bit scarred and hostile to public health after the whole COVID situation,” said Rose, who has worked as an advocate for health equity and HIV patients for more than a decade. “There’s no nicer way to put it, they just seem hostile to the concept of public health.”
The Trump administration is also fixated on it again rolling back transgender rights And immigrants in ways that will hurt access to health care across the board, Rose and other experts said. Trans and gender non-conforming people are and are at high risk for contracting HIV disproportionately affected by the virus, due to economic discrimination that leaves many without health care. But transgender people are excluded and removed from government websites, from research into health care subsidies and now from official communications about groundbreaking HIV prevention.
The CDCs recommendation a new PrEP drug, available in a biannual dose instead of a daily pill or a three-monthly injection, makes no mention of transgender people at all. This absence struck Lindsey Dawson, director of LGBTQ+ health policy at KFF, as strange. Clinical trials for this drug included trans and non-binary people to ensure it would be tested by those most likely to use and need it. Now that context is missing.
This exclusion is likely a result of the White House executive order Dawson stated that the government only recognizes two genders. That order signaled the Trump administration’s resistance gender diversity and have directed federal agencies to exclude transgender people from laws that protect against sex discrimination. The order also equates being transgender with an ideology or belief system, rather than an identity protected by state and federal law.
The biennial PrEP drug has a lot of potential to expand access to HIV prevention, Dawson said, but the CDC’s approval could thwart that access by limiting it to a high-risk group. The White House is creating an environment of fear for transgender patients and their doctors, experts say — and if transgender people are too afraid to be honest with their doctors, they won’t get access to the treatments they need.
“Politically, the communities we serve are under direct attack on so many fronts,” said Johnson of PrEP4All. At the same time, public health is facing unprecedented trust issues and politicization, he said. Ending the HIV epidemic is still possible, he said, but amid all these factors, the likelihood of a resurgence of the epidemic is also high.
“You don’t really realize how protected you are as long as you have the infrastructure in place,” Johnson said. “We don’t want to learn the hard way what happens when you take that away.”
Americans with HIV face high medical costs, which most cannot afford. A 2021 study estimated that the average HIV-related medical cost for one person over a lifetime is more than $420,000. Without lifelines like the Ryan White program or Medicaid coverage, HIV-positive people will be on their own; and nonprofits and state programs will have to fill the gaps where they can.
Lyndel Urbano, senior director of public policy and government relations at Amida Care, a Medicaid health insurance company in New York, has already felt some of this pressure. His work was particularly hard this year. The mounting pressure threatens the way Americans can access health care in general, he said, including how they can access HIV treatment and prevention — which is his organization’s main focus.
“Not long ago, HIV was basically a death sentence,” Urbano said. “We’re at the point where you can treat HIV, you can prevent HIV relatively easily with medical and behavioral interventions. We now have the kind of tools that can get us to the end of HIV… the challenge is that people need to have access to those mechanisms.”
Without that access, experts expect more Americans will suffer and become needlessly ill, despite readily available treatments and preventative measures that could help them.
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