WASHINGTON -- President Donald Trump's administration is calling for $291 million for its domestic campaign to largely halt transmission of HIV in the United States within a decade, proposing significant new resources for programs that have not seen major increases in decades.
The administration's fiscal 2020 budget unveiled Monday follows Trump's State of the Union pledge to end the HIV epidemic by 2030. The proposal calls for $140 million in funding for the Centers for Disease Control and Prevention to reduce new infections through improved testing, prevention and referral to medical care. The funds would be used to connect patients to treatment and to provide pre-exposure prophylaxis, known as PrEP, to people at risk of infection. PrEP is a once-a-day pill that protects users against HIV infection.
In 2017, there were nearly 40,000 new HIV diagnoses in the United States, according to the CDC. An estimated 1.1 million people had the virus that causes AIDS, with about 15 percent of them undiagnosed.
The budget also includes $120 million for the Health Resources and Services Administration to deliver additional care and treatment for people living with HIV. The Indian Health Service division would also receive funding to enhance HIV testing and referrals to care.
Experts said the proposed increases to the programs "are quite significant for those programs, which have essentially had flat funding for the last couple decades," said Jenn Kates, director of global health and HIV policy at the Kaiser Family Foundation.
But the reach of the HIV initiative would be affected negatively by the administration's efforts to dismantle the Patient Protection and Affordable Care Act and to oppose Medicaid expansion, because reducing access to health insurance and medical care reduces access to HIV treatment and prevention. The Trump administration is proposing a sharp slowdown in Medicaid spending.
"If the larger health care forces are to cut back on access, that's going to make it more difficult for people to get in the door, or stay in the door, and will affect the reach of the HIV initiative," the Kaiser Family Foundation's Kates said.
In addition, the administration is proposing cuts to global AIDS programs. The administration is calling for cuts to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and also to the President's Emergency Plan for AIDS Relief, the multibillion-dollar program launched by former President George W. Bush. This is the administration's third budget request that has included cutting global funding. Congress rejected the cuts each previous year.
In the United States, the HIV initiative would focus on the parts of the country that account for more than 50 percent of new HIV diagnoses. They are in 48 hot spot counties; the District of Columbia; San Juan, Puerto Rico; and the rural areas of seven states: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.
In many of these places, it is hard for people at risk of contracting HIV to find the medication critical to protecting them from the virus. The CDC estimates that the decline in HIV infections has stalled because effective prevention and treatment are not reaching those who could most benefit.
The goal of the domestic initiative is to reduce HIV transmission by 75 percent within five years and by at least 90 percent by 2030, which would prevent 250,000 new infections.
A Section on 03/12/2019