The federal government is poised to undo years of hard-won progress in the fight against HIV-a deadly and highly infectious disease that seems to have lost its urgency due to our successes in prevention and treatment. But that could all change.
Firings at the CDC by DOGE and the Trump administration's 2026 budget request marked the start of this surprising and dangerous retreat. The administration proposed to eliminate all $800 million in funding for the Centers for Disease Control and Prevention's Division of HIV Prevention -- the backbone of the nation's HIV response that funds testing, outbreak tracking, and access to PrEP, which are drugs that prevent HIV.
Next, House Republicans approved in Committee their proposed 2026 health spending bill that goes even further. In addition to eliminating all HIV prevention at the CDC, it would defund President Trump's own "Ending the HIV Epidemic" (EHE) initiative, which he launched in 2019 with the aim of reducing new HIV infections by 90% by 2030. And, it would slash the Ryan White HIV/AIDS Program -- which provides vital support for low-income people with HIV -- by 20%.
These are reckless, short-sighted cuts that would not make America healthy again -- they would reignite the HIV epidemic in America and drive up U.S. healthcare spending in the long run.
If enacted, the House bill would cut domestic HIV care, treatment, and prevention programs by at least $1.7 billion -- far larger than the president's proposed reduction -- including $1 billion in domestic HIV prevention funding at the CDC.
Almost 90 percent of that prevention funding flows through the CDC's Division of HIV Prevention to state and local health departments, which are on the front lines of the response. Most of these agencies have no dedicated state funding and depend entirely on federal dollars to run HIV programs.
The CDC's Division of HIV Prevention supports nearly two million HIV tests each year, refers over 113,000 people to PrEP, and enables health departments to track and respond to outbreaks. Axing this critical division -- and eliminating all HIV prevention funding -- would be disastrous, wiping out decades of bipartisan progress.
The House bill also zeroes out funding for the EHE program for community health centers to provide PrEP in target jurisdictions and slashes the Minority HIV/AIDS Fund from $65 million to just $20 million, reducing critical support for the most impacted populations.
Together, these funding decisions would dismantle the very infrastructure that makes it possible to test, prevent, and treat HIV in this country. They would shut down clinics, end surveillance programs, and halt education and outreach efforts in communities that need them most.
We know the value of prevention. Every infection averted saves more than $1,299,000 in lifetime medical costs. One analysis projects that eliminating CDC's prevention programs would result in more than 143,000 additional infections and 14,700 deaths by 2030 -- and over $60 billion in added medical costs. At a time when we have the tools to prevent HIV -- including new long-acting forms of PrEP -- abandoning this effort would be nothing short of catastrophic from both a public health and economic standpoint.
The proposed cuts to the Ryan White HIV/AIDS Program are also alarming. The program provides care and medication to more than 500,000 low-income, un- or underinsured individuals with HIV.
Cutting one-fifth of its funding -- roughly $525 million -- would mean fewer patients receiving lifesaving treatment, more people falling out of care, and a greater risk of transmission..
It bears remembering that the United States has made tremendous strides against HIV in recent years. From 2018 to 2022, new infections declined by 12% nationwide -- and by 21% in the communities targeted by the Ending the HIV Epidemic initiative. However, there were still 39,000 new diagnoses in 2023, with over half of them in the South.
Eliminating HIV prevention funding now would squander that progress and contradict President Trump's original commitment to end HIV by 2030. In fact, earlier this fall, National Institutes of Health Director Jay Bhattacharya reaffirmed that goal, noting the elimination of HIV as one of his top priorities. These devastating proposed cuts would make that impossible to achieve.
The Senate, to its credit, has recognized this reality. In a bipartisan vote, Senate appropriators rejected the proposed elimination of HIV prevention programs and instead maintained funding for prevention, treatment, and PrEP. That's the fiscally responsible and morally right choice.
The path forward should be clear. The House and Senate must work together to pass a final spending bill that preserves funding for HIV prevention and treatment – so that we do not retreat to the days of the past and keeps the United States on track to end the epidemic once and for all.
Carl Schmid is executive director of the HIV+Hepatitis Policy Institute.
