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Decades of progress in HIV treatment and prevention in the United States is being derailed by the Trump administration, public health experts say — and without reversing course, the damage will be devastating.
Threats to key federal programs are unfolding just as science has significantly advanced how easily patients can treat and manage HIV — leaving experts deeply frustrated. The development of a vaccine, which researchers believed was closer than ever to becoming a reality, is now dead in its tracks. A twice-yearly dose of PrEP to prevent HIV, approved by the Food and Drug Administration this year, is expected to have significant benefits — but experts are concerned about who will be able to afford this drug. Millions of Americans are expected to lose health care coverage due to Trump’s federal spending cuts.
Employees at the Centers for Disease Control and Prevention have reportedly been tasked with dismantling their own work at the agency’s HIV prevention division. Researchers at the state level are also struggling. At one of the country’s oldest and largest historically Black medical schools in Tennessee, $2 million in federal HIV research funding has been scrapped. Federal programs funding the country’s pivotal HIV services are in danger of being defunded or eliminated completely.
On top of these cuts, Medicaid, the single largest source of insurance coverage for adults with HIV in the country, has been slashed — creating a dire situation for HIV-positive Americans. About four in ten Americans living with HIV rely on Medicaid. New paperwork requirements go into effect in 2027, which advocates expect will keep many people from renewing their coverage or enrolling at all.
“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 of the energy and all of the excitement we’ve had about bringing an end to the AIDS epidemic … that has just completely had the wind taken out of its sails.”
Health experts are watching with fear and confusion as Republicans are undermining the country’s baseline 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 — like monitoring for new HIV cases on a national scale, getting funds to state health agencies, and promoting HIV testing on a large scale. If these services lose funding, then outbreaks will go unchecked, experts say.
“There will be more consequences. There will be people who get diagnosed later, perhaps already with opportunistic infections and showing up into emergency rooms already sick, harkening back to a much darker and more visible and more deadly 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 those with HIV. These conditions can lead to an AIDS diagnosis, the most serious stage of an HIV infection. Some of the most common opportunistic infections are thrush, lung infections and tuberculosis.
The White House has proposed shutting down HIV prevention and surveillance at the CDC as part of its federal budget proposal. In Congress, House Republicans have gone even further. Their budget proposal would eliminate the federal program launched during President Donald Trump’s first term that has strived to significantly reduce new HIV infections. House Republicans also want to axe core parts of the Ryan White HIV/AIDS Program, which is considered the fallback option when people with HIV lose access to their healthcare coverage. The breadth of these proposed cuts, which would strip the country’s most foundational HIV programs of nearly $2 billion, have shocked longtime advocates and experts.
“The vitriol and hostility they have towards HIV prevention work is unprecedented,” said Matthew Rose, senior public policy advocate at the Human Rights Campaign. “It is breaking with a time-honored Washington consensus that HIV is a bipartisan issue.”
During his first term, Trump struck a deal to get free PrEP, or pre-exposure prophylaxis, to uninsured Americans living with HIV. At his 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 House Republicans are currently looking to shutter. Now, these promises seem to be forgotten.
Some attribute this abrupt change to the stark difference in staffing between Trump’s first and second terms. There are more loyalists, more newcomers to government, and less of the old conservative guard. During his first term, Bush-era staffers who cared about this issue were still around, Rose said; but in his view, that same compassion is just not evident in the MAGA crowd.
“They are sort of scarred and hostile towards public health after the whole COVID situation,” said Rose, who has worked as a health equity and HIV patient advocate for over a decade. “There’s not a nicer way to say it, they just seem to be hostile to the concept of public health.”
The Trump administration is also newly fixated on rolling back the rights of transgender people and immigrants in ways that will hurt health care access across the board, Rose and other experts said. Trans and gender non-conforming people are at a high risk of acquiring HIV and are disproportionally impacted by the virus, due to economic discrimination that leaves many without health care. But trans people are being excluded and erased from government websites, from health grant research, and now from official communication about groundbreaking HIV prevention.
The CDC’s endorsement of a new PrEP drug, which is available in a twice-yearly dose instead of a daily pill or an injection every three months, does not mention transgender people at all. This absence struck Lindsey Dawson, director of LGBTQ health policy at KFF, as odd. Clinical trials for this drug included trans and nonbinary people to ensure that 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 stating that the government recognizes only two sexes, Dawson said. That order signaled the Trump administration’s opposition to gender diversity and tasked federal agencies with excluding trans people from laws that protect against sex discrimination. The order also equates being transgender to an ideology, or belief system, instead of an identity that is protected by state and federal law.
The twice-yearly PrEP drug has a lot of potential to expand access to HIV prevention, Dawson said, but the CDC’s endorsement could thwart that access by limiting it for a high-risk group. The White House is creating an environment of fear for transgender patients and their doctors, experts say — and if trans people are too afraid to be honest with their doctor, then they won’t access the treatments they need.
“Politically, the communities that we serve are under direct attack on so many fronts,” Johnson of PrEP4All said. 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, so is the likelihood of a resurgence of the epidemic.
“You don’t really appreciate just how protected you are, so long as you have the infrastructure there,” Johnson said. “We don’t want to learn the hard way what happens when you take that away.”
Americans living with HIV face high medical costs — which most can’t afford. One 2021 study estimated the average lifetime HIV-related medical costs for a single person to be over $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 in the gaps where they can.
Lyndel Urbano, senior director of public policy and government relations at Amida Care, a Medicaid health insurance plan in New York, has already felt some of this pressure. His job has been especially hard this year. Mounting pressures threaten how Americans are able to access health care overall, he said, including how they can access HIV treatment and prevention — which is the main focus of his organization.
“Not that long ago, HIV was really a death sentence,” Urbano said. “We’ve gotten to the point where you can treat HIV, you can prevent HIV relatively easily with medical and behavioral interventions. We have right now the kind of tools that can get us to the end of HIV … the challenge is, people need to access those mechanisms.”
Without that access, experts expect more Americans to suffer and get needlessly sick, despite readily available treatments and preventative measures that could help them.
Great Job Orion Rummler & the Team @ The 19th Source link for sharing this story.
