Well, y’all, these last few days have been a doozy. On Tuesday, word started to spread like wildfire that the Trump administration was planning to effectively eliminate the Division of HIV Prevention at CDC, within 48 hours. Having worked almost my whole career in or near to the HIV field, my email, text messages, and social media newsfeeds erupted with information sharing and calls to action.
Maybe this doesn’t sound like that big of a deal to you. Let’s talk for a minute about what it would mean if there was no longer a Division of HIV Prevention at CDC. CDC is the foundation of the U.S.’s domestic HIV prevention efforts. 91% of all federal funding for HIV prevention comes from this division. (You will recall that the U.S. has already effectively eliminated all foreign HIV prevention efforts, so this would just double down on that here at home.) The federal appropriation for domestic HIV prevention funding in fiscal year 2024 was about $1 billion. Reports are that the administration is considering cutting $700 million of that, which would effectively gut the entire division; some administrators within HHS have said off the record that whatever’s left might be moved to the Health Resources and Services Administration, or HRSA.
The problem with that is that while HRSA has played a big role in HIV work in the US, it has almost entirely been focused on the delivery of HIV medical care. HRSA administers the Ryan White HIV/AIDS Program, which is a safety net program that provides medical care for people living with HIV, and by law has restrictions on what percentage of funds (not much) can be used for HIV prevention services. Anyone who’s working in the field of HIV can tell you that CDC focuses on testing and prevention, and HRSA focuses on care and treatment—and the two are very different. The people who work in these two agencies have very different types of knowledge and expertise.
Maybe you think it’s reasonable to cut this division from CDC and save federal dollars, because HIV isn’t the death sentence it used to be. People barely talk about HIV anymore, it can’t be that big of a deal any longer, right? The problem is that it’s because of all these federal dollars being spent—and all this expertise being maintained at CDC and at the state and local health jurisdictions that receive the vast majority of this federal funding—that you may not hear about HIV so much anymore. Because of all this investment, an estimated 27,900 new HIV transmissions were prevented between 2012 and 2022 in the US, which saved over an estimated $15 billion in lifetime medical costs. There has been a 12% decline in new HIV infections in the US from 2018 to 2022, and in the states and cities prioritized for extra funding as a result of the “Ending the HIV Epidemic”—which ironically started because of Trump’s own priorities in his first term—the rate of decline has almost doubled, with 21% fewer new infections during that same time. If all that money and expertise goes away we are likely to see a real resurgence in HIV infections in this country. More people will become infected unnecessarily. More people will die unnecessarily.
The good news is, the Trump administration may have underestimated the strength and ferocity of the people who created the industry that exists to prevent HIV. HIV workers and activists were ignored for years by the Reagan administration, which preferred to pretend AIDS didn’t exist. Their loved ones were dying, so they took to the streets. They saved their own lives since the government wouldn’t, and in doing so they permanently changed the way the government, insurance companies, and pharmaceutical companies functioned. There are some reports that since the news broke of this potential move on Tuesday, more than 7,000 calls have been logged via the congressional switchboard, insisting the cuts be resisted. Now HHS spokespeople are making sure to say loudly that nothing’s been decided.
Maybe these cuts are still imminent. Or maybe the vocal outrage about this plan has actually made a difference. Only time will tell, but in the meantime you can bet I’ll be calling my own representatives early and often so they know I’m mad as hell.
There’s just so much more to be mad about, too, from the continued decimation of health-related research through the NIH to RFK Jr’s wildly dangerous and ignorant suggestion that when it comes to bird flu we should just “let it rip.” It’s too much for one post, and I’m too worn out from this week. I’ll go deeper into those on Monday.
In the meantime, I’ll leave you with the eloquent words of Erin Reinhardt in the scientific journal Nature: “The real crisis is not that public health — which is fundamentally about policies dictating the distribution of resources required to protect human life — has been politicized. It is that it has not been politicized nearly enough.” The United States is increasingly and rapidly becoming a place where each person puts their own health and personal freedom above that of anyone else. This is not how it is elsewhere. This is not how it has to be. Unchecked poverty and inequality harm all of us in the end. Destroying the safety net that protects those who are struggling hurts the fabric of our society. Allowing this to happen is undercutting our own success as a country, and we must stand up—all of us—and say this needs to stop.