President Trump unveiled his proposed budget for fiscal year 2018, which starts October 1, and, as Reuters reports, the plan calls for a $3.6 trillion cut in government spending during the next 10 years, mostly from health care and assistance programs for the poor, including Medicaid.
Although the plan is not likely to pass Congress, it reveals Trump’s vision of the role government plays in our world. Where do the nation’s HIV efforts fit into this picture? AIDS organizations have released statements explaining how the proposed budget could affect specific HIV-related programs. (As new press releases and statements come in, they will be excerpted and linked at the end of this news item.)
On the domestic front, The AIDS Institute highlighted the following:
- In one of the biggest setbacks, the president has proposed to cut HIV prevention programs at the CDC by $149 million, which translates to a 19 percent cut.
- The budget proposed to entirely eliminate the AIDS Education and Training Centers (AETCs) ($34 million) and the Special Projects of National Significance (SPNS) ($25 million).
- In another disappointment, the budget maintains CDC Hepatitis Prevention funding at only $34 million [at a time when new infections have nearly tripled].
- Given that racial and ethnic minorities are disproportionately impacted by HIV/AIDS, The AIDS Institute was shocked that the budget eliminates the Secretary of Health and Human Services Minority AIDS Initiative (MAI) Fund ($54 million).
- The budget also cuts $26 million from the Housing Opportunities for Persons With AIDS (HOPWA) program at HUD.
- Funding for the National Institutes of Health would be cut by over 20 percent, which will certainly result in a dramatic cut to AIDS research.
“We call on the Congress to reject these cuts and craft a responsible budget that provides adequate funding for non-defense discretionary and other mandatory funded programs, such as Medicaid,” said Michael Ruppal, executive director of The AIDS Institute, in the press release. “These are lifesaving programs that provide for a stronger, healthier and more prosperous nation.”
AIDS United, in a statement you can read in full on its POZ Blog, said it is “shocked” by Trump’s budget request. The group’s president and CEO Jesse Milan Jr. said, “Investment in targeted approaches are effective and save money at a time when 1 in 2 and 1 in 4 Black and Latino gay and bisexual men respectively are at substantial risk for HIV infection in their lifetime. How can we reduce funding to programs that address these disparities? The president’s budget isn’t just a set of numbers, it’s a disturbing statement of values.”
On the global front, Trump’s budget slashes $1.08 billion from global HIV programs, according to Health GAP (Global Access Project), an international advocacy group for people with HIV. Those cuts include:
- A 17 percent cut to the Global Fund, which will result in $450 million fewer dollars leveraged from other countries through the $2 to $1 matching agreement that governs the U.S. contribution;
- Bilateral PEPFAR programs were also cut by 17 percent overall, including:
- An approximate 10 percent cut to State Department HIV/AIDS funding;
- Eliminating entirely the global AIDS programs at the U.S. Agency for International Development (USAID), a $330 million cut;
- Cutting in half the Centers for Disease Control’s (CDC) global AIDS budget; and
- Eliminating all funding for the International AIDS Vaccine Initiative (IAVI), which will stop 10 current promising candidates from progressing and halt research toward the development of a preventative HIV vaccine.
“This budget turns its back on 14 years of investment to end the epidemic by 2030—a goal that’s in reach if we commit $2 billion in additional annual funding to scale up HIV treatment,” said Hilary McQuie, Health Gap’s director of U.S. policy and grassroots mobilization, in the statement. “Congress should reject these cuts out of hand and fulfill the promise of a fully funded global AIDS response in the Fiscal Year 2018 budget.”
The Treatment Action Group (TAG), an activist-based group fighting for people with HIV, hepatitis C and tuberculosis, condemned the “murderous” proposed budget. TAG’s statement highlighted not only the cuts to HIV-related science and research but also the reduction in funds to fight tuberculosis and hep C globally and at home, including limiting the use of federal funds to purchase syringes.
“Another way of continuing to blatantly undercut the value of science is to defund science and programs that implement the fruits of our investments,” said Mark Harrington, executive director of TAG. “While the Trump administration continues to value massive tax cuts on the rich, the true costs will be the loss of health, lives, jobs, scientific breakthroughs and the future of the human race.”
In a separate release, five nonprofit nonpartisan AIDS groups issued a joint statement “to oppose the draconian cuts proposed by the administration including many programs that are essential for the treatment and prevention of HIV/AIDS and STDs.” Those groups include AIDS United, the National Alliance of State & Territorial AIDS Directors (NASTAD), the National Coalition of STD Directors (NCSD), the National Minority AIDS Council (NMAC) and The AIDS Institute.
“I fear that these cuts signal the administration’s lack of empathy for people living with or at risk for HIV,” Paul Kawata, executive director of NMAC, said in that statement. “President Trump’s proposal to eliminate or dramatically cut many of these programs will increase the racial and socio-economic disparities we see in communities disproportionately affected by HIV/AIDS. This budget will hurt the most vulnerable, and Congress must consider it a non-starter.”
Fenway Health serves the LGBT and HIV/AIDS communities in Boston. Its statement on Trump’s budget not only underlines specific cuts and their detrimental affects, but also puts the budget proposal in a larger U.S. context.
“The Trump-Pence Administration’s proposed budget would dismantle the public health infrastructure first put in place by Lyndon Johnson’s Great Society Program in 1965,” said Sean Cahill, PhD, director of health policy research at the Fenway Institute, in the statement. “Black and Latino people, people living with HIV, and children living in poverty experience poorer health and health outcomes than the general population. They rely disproportionately on Medicaid and CHIP. These cuts will be devastating to some of the most vulnerable people in our society.” In fact, he added, “this budget proposes a radical rejection of the social compact that has sustained our country for half a century. It would also undermine important progress we have made in preventing and treating HIV here and in Africa. It casts our most vulnerable people aside and leaves them to fend for themselves without the resources they need to succeed.”
AVAC, a nonprofit organization supporting efforts for a global AIDS vaccine and other HIV prevention efforts, also urged Congress to reject the budget and continue supporting HIV efforts. “The budget proposal asserts the U.S. government will continue treatment for ‘all current HIV/AIDS patients’ under PEPFAR,” reads part of the AVAC statement. “Simply maintaining current treatment rolls is poor science and a poor investment of US resources. We know an increase in antiretroviral treatment (ART) programs with a parallel unstinting investment in additional HIV prevention programs, including voluntary medical male circumcision, condom programs and oral PrEP, will have significant impact on the pandemic. The proposed budget approach, which threatens prevention as well as treatment, will not.”