The Department of Health and Human Services (HHS) is reportedly poised to slash funding for domestic HIV prevention at the Centers for Disease Control and Prevention (CDC), The Wall Street Journal first reported on Tuesday.
The cuts threaten to flare the rates of HIV infections across the country by stemming access to preventive therapies like pre-exposure prophylaxis (PrEP), needle exchanges and public health reporting.
The cuts also could impact drugmakers such as Gilead Sciences that sell HIV/AIDS treatments. Shares of both Gilead and GSK, another HIV-focused drugmaker, fell following the WSJ story about the funding cuts.
A CDC webpage says that in the 2023 fiscal year, Congress appropriated roughly $1.3 billion for the CDC’s HIV, viral hepatitis, STD and tuberculosis prevention budget. The budget funds state, tribal, local and territorial health departments and health organizations.
The CDC puts infectious disease experts on the ground in communities across the country to address the HIV epidemic, connects HIV-positive folks with treatment, sponsors outbreak response teams and trains healthcare providers. It has invested in disease surveillance, screening recommendations, epidemiological studies and disease intervention specialists.
Will Ramirez, director of public policy and advocacy at the Southern AIDS Coalition, first heard about the looming cuts from a phone call early Tuesday morning.
According to Ramirez, CDC officials met with political leadership and the White House to discuss drastic cuts to the HIV prevention program at the CDC, including President Donald Trump’s 2019 ending HIV initiative, which aimed to eliminate new HIV infections by 2030. The initial conversation, Ramirez said, was to terminate the program within 48 hours.
Personnel in the Trump administration has changed since the launch of the 2019 program, Ramirez said, and he’s not sure the new leaders knew about the program. “It was the premier HIV prevention program for the country, and a lot of the states that are heavily funded are in the South,” he said.
WSJ reported that there have been talks of cutting HIV prevention by $700 million. Because of pushback from senators and the media, the White House began to soften its position on the CDC cuts, Ramirez believes.
He says this is when narratives emerged that the cuts were actually a reorganization of the HIV prevention program into HHS’ Health Resource and Services Administration (HRSA), that funding would only be cut at 50% of the original numbers and that some CDC staff would be eliminated while others would move to the HRSA.
“As of right now, nothing is firm. And I think that because of the pushback that occurred yesterday … I think that a cut more than likely will happen, but the method of how that cut happens is what is in the air right now," Ramirez said.
According to a comment to Fierce Healthcare from an HHS spokesperson, the agency has not made a final decision to make any cuts to the HIV prevention program; and, if it did, it would continue the work elsewhere in the department. "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," the HHS spokesperson said.
Jeremiah Johnson, acting executive director of PrEP4All, said he learned about the potential changes at a recurring industry roundtable around noon on Tuesday. An advocate from another organization reported to the group that the administration is considering major changes to the HIV prevention program.
“It seems that certainly the division of HIV prevention is being targeted in some specific way, whether that's as part of a reorganization, which I think is what some administration contacts are saying at this point, or if it's a massive funding cut, more akin to what we've seen with like USAID,” Johnson said.
While the organizations do not yet have a clear idea on what the changes will be, they have concerns about the CDC’s HIV prevention program being reorganized.
A reorganization could disrupt the relationships that the CDC has with community organizations, and vice versa. If the reorganization is done in a haphazard way, Johnson fears that core CDC initiatives will be disrupted. He said the HHS can’t simply rehouse a massive public health operation and not expect differences on the other side. “It's not just a light switch that you switch on and off,” he said.
While PrEP4All and other HIV prevention and treatment organizations were nervous about the potential policy changes under Trump, they’ve had reason to hope that the president would support HIV prevention, continuing efforts that began in his first term.
And, until yesterday, PrEP4All didn’t have a clear reason to fear domestic program cuts. But, combined with the shuttering of USAID and House Republicans attempts to cut HIV funding through the annual appropriations process, Johnson is starting to sweat. “I think this moves us closer to being really quite concerned about just how disruptive these efforts can be,” he admitted.
In 2022, the HHS began encouraging providers to offer PrEP services through telehealth to reach rural and underserved Americans who need the preventive treatment. The HHS webpage informs providers that PrEP counseling and prescribing can be done remotely via telehealth and points providers to remote monitoring apps that help patients track their usage of the medication.
"CDC really holds a number of invaluable relationships with state health departments, community-based organizations and other key stakeholders to really coordinate the entire sort of public health response to ensure that we are getting HIV testing, treatment prevention, including PrEP, to every American who needs access,” Johnson said.
The CDC is also central to HIV surveillance, Johnson explained, because it collects infection and treatment information from state health departments and compiles it into national reports. “They really are the eyes and ears within the ongoing national epidemic,” he said.
Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement that both Trump and HHS Secretary Robert F. Kennedy Jr. have committed to combating HIV.
“President Trump during his first term initiated the Ending the HIV Epidemic initiative, an historic effort to end HIV in the US by 2030,” Schmid said. “HHS Secretary Kennedy has stated on the record as part of his confirmation process that he ‘look[s] forward to continuing the good work that President Trump did in his pursuit to eradicate HIV/AIDS’ and that ‘HHS will support all appropriate prevention programs, including those which include pre-exposure prophylaxis.’”
The Ending the HIV Epidemic initiative has been credited with a 21% decrease in HIV infections in key jurisdictions, Johnson said.
“If the really quite reasonable increase in investment in ending the HIV epidemic led to a 21% decrease in new HIV infections … there's no reason that we'll be able to preserve that progress if you're undermining HIV prevention more broadly,” Johnson said.
PrEP4All is also concerned about an initiative it is working on with the CDC to increase PrEP access to areas in the U.S. with high infection rates, including South Carolina, Oklahoma, Florida, Houston and Baltimore.
Fierce Healthcare and Uncloseted Media jointly reported in October that Black gay and transgender people in the southern U.S. consistently lacked access to PrEP.
“In the last 30 years, HIV rates have gone down, in large part because of the game-changing prescription drug pre-exposure prophylaxis (PrEP), which reduces the risk of contracting HIV through sex by 99%. Since the FDA approved the drug in 2012, more people have started to use it, and HIV rates have steadily decreased. But not everyone is seeing the same results.
From 2019 to 2022, 94% of white people who could benefit from PrEP were prescribed it, while only 13% of Black and 24% of Latino people were. HIV— which has claimed an estimated 42.3 million lives to date and remains a global public health issue—continues to have a disproportionate impact on people of color, men who have sex with men, and trans women. The lifetime risk of acquiring HIV is still 1 in 3 for Black gay and bisexual men, according to data from the Centers for Disease Control and Prevention (CDC).” – How HIV prevention stays out of reach for many, Anastassia Gliadkovskaya and Sam Donndelinger
PrEP4All is ready and willing to work with the Trump administration through any changes to HIV programs, Johnson said.
“I think that the challenge that we always have with prevention healthcare is you're not always aware of just how much rain is coming down on you until the umbrella over your head is taken away,” Johnson said. “That's what we're concerned about, is we don't even know just how bad it could be.”
The CDC did not respond to a request for comment.
Editor's note: The Wall Street Journal reported that there may be a $700 million cut to CDC HIV Prevention funding.