Throughout the 1st year of President Trump’s Ending the HIV Epidemic: A Plan For America, Administration officials have repeatedly reassured HIV advocacy organizations and service providers that they are wholly committed to this initiative and that it is one of The White House’s top domestic priorities. And, at first glance, it would appear as if the release of President Trump’s Fiscal Year 2021 Budget earlier this week confirms this assertion.
The President’s budget for the coming fiscal year includes a significant increase in funding for the Ending the HIV Epidemic, devoting $716 million to the initiative, which is more than double the Administration’s ask last year. According to the budget, the majority of this funding—$371 million—would go to the Centers for Disease Control for HIV prevention efforts, while another significant chunk of money—$302 million—would be allocated to the Health Resources and Services Administration to deliver HIV care through the Ryan White HIV/AIDS Program and to provide HIV testing and PrEP services at community health centers. Smaller funding amounts were set aside for use by the Indian Health Service to end the HIV epidemic in American Indian/Alaska Native communities and the National Institutes of Health for research.
When viewed in isolation, this sort of investment in HIV prevention and treatment looks extremely promising. Unfortunately, as was the case with last year’s presidential budget, the benefits of this fiscal year’s investment in HIV begin to slide away when placed side by side with the Trump administration’s massive cuts to public health, housing and safety net programs.
Overall, the President’s Budget would cut funding for Department of Health and Human Services by 9% and slash spending for the Department of Housing and Urban Development by 15%. Included in those massive cuts are a projected $920 billion in cuts to Medicaid and $451 million in cuts to Medicare over the next decade, as well as an $80 million cut for the Housing Opportunities for Persons With AIDS program (HOPWA) in FY21 and the elimination of the Community Development Block Grant program. U.S. support for the ending the global HIV epidemic was also significantly reduced in the President’s budget, which include more than $1.5 billion in cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) and a $902 million reduction in funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
For 3 years, this administration’s desire to substantially reduce safety net programs for low income individuals while drastically cutting back on humanitarian aid to other nations have been in direct contradiction to the Administration’s rhetoric around their Ending the HIV Epidemic initiative. With this, HIV advocates are well within our rights to feel a bit perplexed.
Time and again HIV advocates have heard the President’s plan described as a “whole of society approach” that utilizes a broad coalition of government agencies to address the constellation of issues that have contributed to the growth of the HIV epidemic in recent years in the U.S. South and in communities of color. When the HIV community has repeatedly spoken to Administration officials about the need for any ending the HIV epidemic plan to address social determinants of health like housing, food insecurity, racism, economic stability, and HIV and LGBTQ stigma, we have been told that our concerns have been heard and that our seat at the table is not merely for show. When looking at the President’s budget, it’s not hard to see that the voices of the HIV community are not reflected in it.
In a statement released shortly after the President’s budget was made public, the Partnership to End HIV, STDs, and Hepatitis—of which AIDS United is a member—said that they welcomed the President’s request for $716 million in new domestic HIV funding, but noted that the, “cuts to Medicaid, HOPWA, and Medicare (among other safety net programs) will also be devastating to people living with and at risk for HIV…[and] will have a disproportionate impact on communities prioritized in the Ending the HIV Epidemic initiative, including low-income Black and Latinx populations, and will only deepen existing HIV disparities.”
AIDS United supports efforts by this Administration to provide new and increased funding for HIV programming, but only in so far as that funding is coupled with strong, whole-health policies that provide for all the needs of people living with and affected by HIV both domestically and abroad. Without support for and increased investment in vital programs like Medicaid and Medicare and the rescinding of policies that are harmful to LGBTQ+ individuals, immigrants and those seeking asylum, and communities of color, we will not be able to end the HIV epidemic.
Check back frequently with AIDS United’s Policy Update for all the latest on the Trump administration’s Ending the HIV Epidemic plan and budget negotiations for the coming fiscal year.