Donald Trump’s HIV program is under threat in the Republican House

When Politico asked Rep. Robert Aderholt (R-Ala.), chairman of the subcommittee overseeing the budget for the Department of Health and Human Services, on the reasons behind the cuts, noted the need to set priorities.

“It’s one of those things that’s like, what are you must-haves and what would be nice-to-haves?” Aderholt said. “We had to get down to the bare bones of what we really had to have.”

A cut of the size envisioned by House Republicans would not be successful in the Democratic-controlled Senate, but advocates fear that losing GOP support for the program would make the gains of the past few years extremely difficult to sustain, and impossible to achieve. Trump’s 2030 goal.

“HIV has historically, and more recently, been such a bipartisan issue and area of ​​real collaboration that we have never seen such an extreme response coming our way,” said Jeremiah Johnson, executive director of the advocacy group PrEP4ALL.

Republicans have cited the program’s slow progress toward interim goals set by Trump’s Department of Health and Human Services as a reason to abandon it.

But advocates of the program who work with people infected with HIV and the disease it causes, AIDS, say it has made a difference.

Funding from the program has helped pay for millions of HIV tests and enabled tens of thousands of people living with HIV to access care, according to the Department of Health and Human Services. The use of effective infection prevention medications, known as PrEP, is on the rise, with 36% of people could benefit from getting a prescription in 2023, up from 22.7% in 2019, according to preliminary data from the CDC. Diseases and their prevention. protection.

Advocates have argued that in order to end the HIV epidemic, the use of pre-exposure prophylaxis drugs must be dramatically expanded in at-risk communities.

The threat to the program has drawn some rare praise for Trump from public health advocates, who hope it will resonate with GOP lawmakers.

“I think Donald Trump has been a very ineffective president in many ways,” said Brittany Williams, a fellow at the National Academy of Education who studies black college women and HIV/AIDS. “I also think he was the most aware, at least in terms of the decisions and the resources and the money and the ideas, (of)…what it would take to actually end the HIV epidemic.”

“A dream that was once out of reach is within reach”

In February 2019, in a State of the Union address delayed by the longest government shutdown in US history, Trump stood before Congress, flanked on the podium by Vice President Mike Pence and the Speaker of the House. Nancy Pelosi.

There were the usual Trump talking points on the border wall, ban on abortions later in pregnancy and anti-China trade policies that received applause from only half the hall.

But then it turned into HIV.

“In recent years, we have made remarkable progress in the fight against HIV and AIDS. Scientific advances have brought a once-elusive dream within reach,” Trump said. “My budget will ask Democrats and Republicans to make the commitment necessary to eliminate the HIV epidemic in the United States in within 10 years. We have made amazing, incredible strides. Together, we will defeat AIDS in America and beyond.

Members of both parties, including Pence and Pelosi, stood in unison and applauded.

The Trump administration was quick to act, providing more details, including the initiative’s goals of reducing new HIV infections by 75% in five years and by 90% in 10 years, which would amount to more than 250,000 infections averted.

In March of that year, Trump released his fiscal year 2020 budget proposal of $291 million for the new initiative. In both the Republican-controlled Senate and the Democratic-controlled House, specialists agreed to launch the program with $266 million. Since then, annual funding has grown steadily, reaching $404 million, $473 million, and $573 million for fiscal years 2021, 2022, and 2023, respectively.

The sudden evaporation this year of that consensus on fighting HIV has confounded Democrats.

“For some reason, they want to cut all the programs,” the representative said. Bonnie Watson Coleman (DN.J.), is a member of the committee that determines funding for the HIV Initiative. “I can only tell you that this is wrong.”

“The little progress we are seeing will be reversed.”

However, public health advocates fear the Democratic-controlled Senate’s proposal, a $3 million increase, is insufficient to meet the 2030 goal.

They compare that with President Joe Biden’s budget proposal, which called for $850 million — the same as his request the previous year when Congress appropriated $573 million for fiscal year 2023.

Furthermore, for the second year in a row, Biden requested the creation of a 10-year, $9.8 billion mandatory spending program to boost access to pre-exposure prophylaxis drugs.

Senate report language accompanying the funding bill supports the future establishment of a national PrEP program, but does not provide funds for it.

Preliminary CDC data for 2022 show there were 36,700 new HIV cases last year. This compares to about 38,300 cases in 2017, five years ago. According to the Centers for Disease Control and Prevention’s dashboard analyzing America’s HIV epidemic, the program’s goals are far-fetched: 9,500 new diagnoses in 2025 and about 3,800 in 2030.

There are still huge differences.

Of new HIV diagnoses in 2022, nearly 40 percent were Black individuals, and more than 30 percent were Latino individuals, preliminary CDC data show. While 94% of white individuals who could benefit have a prescription to prevent the disease, this number is less than 13% for black individuals and less than 25% for Latino individuals.

Republicans pointed to these loopholes in justifying the proposed cuts. The House appropriations report said the program “demonstrated a lack of results-based performance data, inadequate budget justifications, and ambiguous spending plans.” The initiative did not achieve its original goals.”

But for supporters, the program’s failures can be overcome by congressional commitment. To prove the program’s success at its core, they point to the fact that among the initiative’s 50 counties and seven targeted states, infection rates declined faster than the country as a whole.

“Taking these dollars away is not going to be a solution,” said Johnson, of PrEP4ALL. “It will only ensure that the little progress we are seeing is reversed in the near future.”

In the short term, the HIV program is looking at a fixed budget. That’s because Congress couldn’t agree on any spending bills for fiscal year 2024. The deadline is coming up on November 17 to do something. The most likely scenario is a continuing resolution to keep funding running at fiscal 2023 levels.

The House Appropriations Subcommittee approved the proposed cuts in July, but the bill has yet to be considered by the full committee, let alone the full House.

New speaker Mike Johnson He wants to move the bill to a vote the week of Nov. 11, bypassing the entire committee.

The Senate Appropriations Committee submitted its bill in July, but it has not yet been put to a vote.

Right now, supporters are preparing for negotiations between the Senate and House of Representatives, which may not come until next year, as their chance to make their case.

A coalition of organizations is planning a media campaign on World AIDS Day, December 1, to get their message across. They are telling GOP budget hawks that funding the program, especially the HIV prevention component, will save the government money in the future.

They hope this argument, coupled with Trump’s endorsement, will sway GOP votes.

“I’m more optimistic than most that we’ll continue to make progress here,” said David Stacy, government affairs director for the Human Rights Campaign, the country’s leading LGBT advocacy group. “The possibility of ending the epidemic in the United States is on the horizon, and this was not true in the past.”

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