The Trump administration is considering eliminating the U.S. Centers for Disease Control and Prevention's (CDC) Division on HIV Prevention, a move that has alarmed public health experts and HIV advocacy groups across the country.
According to sources familiar with the discussions, the proposal could shift HIV prevention responsibilities to the Health Resources and Services Administration (HRSA), another agency within the Department of Health and Human Services (HHS) that currently focuses primarily on treatment through the Ryan White HIV/AIDS Program.
"It would be devastating," said Jesse Milan, president and CEO of AIDS United. "Every new HIV transmission results in a person having a lifetime cost related to being HIV positive."
Potential Impact on Public Health
The CDC's HIV Prevention Division has been instrumental in tracking HIV infections, conducting research, and promoting prevention strategies such as pre-exposure prophylaxis (PrEP), a medication that significantly reduces infection risk. Recent data shows progress in the fight against HIV, with new infections declining, particularly among 13- to 24-year-olds. Despite this progress, an estimated 31,800 new cases were reported nationwide in 2022.
Harold Phillips, deputy director for programs at NMAC, an HIV advocacy organization, emphasized the critical gap that could emerge if the division is eliminated. "The Ryan White HIV/AIDS Program does not fill all the HIV gaps," Phillips noted. "It only serves those with an HIV diagnosis."
Another proposal reportedly under consideration could slash up to $700 million from the CDC's HIV division budget. Public health advocates warn that reducing prevention funding could ultimately cost taxpayers millions in additional treatment expenses.
Current Status of Discussions
HHS spokesman Andrew Nixon stated that no final decision has been made regarding the restructuring of the CDC's HIV Prevention Division.
"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," Nixon said in an emailed statement. "This is to ensure that HHS better serves the American people at the highest and most efficient standard."
Sources indicate that discussions are still in the "very, very preliminary stages," though a memo circulating among HIV prevention advocates suggests changes could be implemented soon.
Historical Context and Current HIV Landscape
The CDC's HIV prevention work dates back to the 1980s when the agency responded to the emerging AIDS crisis. The division has been central to the nation's response to HIV for decades.
Currently, approximately 1.2 million people in the United States are living with HIV, with about 13% unaware of their diagnosis. The burden of HIV is not equally distributed, with racial and ethnic minorities, men who have sex with men, and people living in the South facing disproportionately higher risks.
Broader Pattern of HIV Policy Changes
This potential elimination follows other actions by the Trump administration affecting HIV programs, including previously removing several HIV prevention pages from the CDC website and proposed changes to the President's Emergency Plan for AIDS Relief (PEPFAR) and the United Agency for International Development (USAID).
These actions could have significant implications for HIV outcomes both domestically and globally, potentially undermining progress made in recent years toward reducing new infections and improving access to prevention and treatment.
Pharmaceutical Industry Implications
The elimination of the division could also affect manufacturers of PrEP medications, including Gilead and Merck. While the decision would not dramatically impact these companies' overall business, it could hamper new PrEP rollouts, including Gilead's lenacapavir, a long-acting version of PrEP awaiting FDA approval this year.
As discussions continue within the administration, HIV advocates and public health experts remain vigilant about potential changes that could affect the nation's approach to HIV prevention and the communities most vulnerable to the virus.
