Congress Must Not Miss an Opportunity to End HIV

Congress and President Biden recently struck an agreement to keep the government funded through early 2024. Between now and February, lawmakers will have a chance to solve policy disagreements and, at least in theory, pass longer-term spending bills.

One effort that should be able to attract bipartisan support is the worldwide fight against HIV.

We're making progress. Domestically, new infections have been dropping, thanks in part to former President Trump's "Ending the HIV Epidemic in the U.S." initiative, which aims to cut new cases by 90% by 2030.

Internationally, there were 1.3 million new infections in 2022. That's the fewest since the late 1980s. There were also 69% fewer deaths than in 2004, the deadliest year on record. For these achievements, a Republican president also deserves the credit. The George W. Bush administration's PEPFAR initiative remains the world's largest source of HIV research and prevention funding.

Despite this Republican-led success against HIV, some House Republicans have been considering a spending bill that would cut funding for HIV prevention and treatment. Such cuts would not only lead to more preventable infections and deaths -- they'd result in more long-term spending by American taxpayers.

We have the tools to end HIV. We must not abandon our efforts nor the people and communities most impacted by this potentially deadly infectious disease.

Congressional Republicans and Democrats can save lives -- and billions of dollars -- by finishing the fight.

Announced in 2019, President Trump's initiative provided a much-needed jumpstart for our efforts against HIV after years without a significant drop in new infections. With the help of funding from the initiative, the Centers for Disease Control and Prevention distributed 140,000 HIV self-test kits and 600,000 other HIV tests. The CDC also helped provide more than 44,000 people pre-exposure prophylaxis medicines -- better known as PrEP -- that can effectively prevent new infections.

Taking PrEP, which can be a daily oral tablet or a once-every-two-months injection, is only necessary when a person has reason to take it -- and is a much better alternative than a lifetime of HIV treatment. As part of the Trump initiative, over 400 community health centers are providing PrEP to almost 85,000 people who cannot afford it.

And it's not the only federal bipartisan initiative putting us on a path toward eradicating HIV. The Ryan White HIV/AIDS program provides health care and medications to more than 560,000 low-income, uninsured, or underinsured individuals with HIV. In 2021, Ryan White helped nearly 90% of its clients achieve viral suppression, meaning that the levels of HIV in their system were so low that they were undetectable and untransmittable.    

Taken together, these initiatives have helped reduce the annual number of new domestic HIV infections from 36,200 in 2018 to 32,100 in 2021.

But 32,000 new infections per year is still far too many. Only 36% of Americans who could benefit from PrEP take it. Some of the most at-risk individuals are least likely to have a prescription, including people in the South.

Instead of capitalizing on our progress against HIV thus far, a House Appropriations Subcommittee recently drafted a spending bill that cuts $767 million in domestic HIV funding -- including every dollar from President Trump's initiative. Some members tried to cut HIV spending even more, which was solidly rejected by the entire House by a vote of 109 to 324. In fact, on this bipartisan vote, more Republicans voted to save the funding than to cut it.

Lawmakers may think that slashing HIV program budgets will save taxpayers money. But the opposite is true. It's far cheaper to fund prevention efforts up front rather than pay for a lifetime of antiretroviral drugs.

One estimate indicates that HIV tests distributed via self-testing programs cost about $60 per person. That's a good investment, considering studies show people who learn they have HIV take steps to ensure the virus is not passed to others. Each new infection averted can save up to $500,000 in lifetime treatment costs per patient.

Instead of cutting funding, Congress ought to raise it. Former President Trump did, and current President Biden has proposed to do the same.

Fortunately, the U.S. Senate, on a bipartisan basis, has proposed to level-fund existing domestic HIV programs, including the Ending the HIV Epidemic initiative. Higher levels of funding are warranted. But the Senate proposal represents a fiscally responsible investment that would pay dividends for taxpayers down the road -- and save American lives.

Republicans and Democrats have fought side by side to try to eradicate HIV for decades. Let's hope today's lawmakers can come together once again and finish the job.

Carl Schmid is executive director of the HIV+Hepatitis Policy Institute, which promotes high-quality, affordable health care for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions. Follow the HIV+Hepatitis Policy Institute on X, formerly known as Twitter: @HIVHep.