HIV Is on the Brink of Defeat, but Trump’s Pending Funding Cuts Could Bring It Back

The Trump administration might be looking to give HIV a hand. The federal government is reportedly eyeing drastic cuts to its funding for HIV prevention efforts at home.

The Wall Street Journal first reported on the potential funding cuts Tuesday afternoon, citing anonymous sources familiar with the matter. Should the pruning go through, it would threaten to undermine the substantial progress made in the U.S. toward eliminating HIV as a major public health problem altogether.

The federal budget dedicated to HIV prevention runs primarily through the Centers for Disease Control and Prevention, via its National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP). In 2023, the CDC’s total operating budget for managing these diseases was around $1.3 billion, three-fourths of which was distributed to state and local health agencies, community organizations, and research institutions through grants and other agreements. And the money spent on preventing HIV certainly seems to have gone a long way.

New reported cases of HIV within the U.S. have steadily declined since the early days of the HIV epidemic. More recently, the estimated incidence of new infections has decreased by 18% between 2018 and 2022, according to the CDC. An estimated 32,000 new cases occurred in 2022—a fourfold reduction from the national peak of 130,000 annual cases during the mid-1980s.

These successes and the arrival of highly effective medications that can manage chronic HIV infection or even prevent cases if taken proactively have made it possible to envision a future where HIV is no longer a major public health threat. And countries, world leaders, and health organizations have made it a realistic near-future goal to effectively end HIV as an epidemic. For a time, that list included President Donald Trump.

During his first term, Trump announced an initiative to end HIV locally by 2030. Specifically, the initiative aimed to reduce the incidence of new cases in the U.S. by 90% over the next decade. It was a plan, to his credit, that some outside experts lauded and saw as achievable with enough dedicated resources. But even at the time, there were reasons to be skeptical. For instance, while the White House secured more funds for HIV prevention domestically, it also pushed for changes to Medicare and Medicaid that would have made it harder for people to obtain their optimal HIV medications.

In his second term, Trump appears to have abandoned any pretense for caring much about HIV at all. In early January, Trump issued an executive order to immediately pause most funding to USAID, the U.S. foreign aid agency that manages many programs, including the President’s Emergency Plan for AIDS Relief program, or PEPFAR. Trump has since planned to cut nearly all jobs at USAID, though the status of this decision is currently still in legal limbo.

PEPFAR, started by President George W. Bush, has been an astonishing success, helping prevent an estimated 25 million HIV-related deaths since its start in 2003. The funding freeze has imperiled the delivery of much-needed HIV medications around the world, which may soon lead to preventable deaths (if they haven’t started happening already). According to the World Health Organization, eight countries are at risk of running out of HIV medications within the next few months due to USAID cuts.

It’s not certain yet whether PEPFAR itself will be fully on the chopping block (even some of Trump’s conservative allies have pushed back against the idea). And according to the WSJ, the government’s decision on whether it will slash domestic HIV funding hasn’t been finalized either. But Trump and Elon Musk’s DOGE have already orchestrated sweeping layoffs at the CDC and the National Institutes of Health (some employees have since been invited back).

Should these funding cuts go through, it will unravel years, if not decades, of the world’s collective efforts to stop a once universally fatal disease.