Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do

Copy link to quick take

The just leaked budget document for the Department of Health and Human Services (HHS) adds new details to the Trump administration’s planned restructuring of HHS and confirms earlier reports that major changes are in store for the nation’s HIV response. While not a final budget submission, and whatever is submitted to Congress will need its approval, the bottom line is that while the proposal would maintain most but not all of the nation’s HIV care and treatment safety net, it would scale back (or potentially eliminate) federal HIV prevention efforts and leave HIV research with an uncertain future.

President Trump’s signature, cross-cutting HIV initiative from his first term, the Ending the HIV/AIDS Epidemic (EHE) Initiative, would be eliminated. The EHE had provided the first new infusion of funding for HIV in years, helping to reduce new HIV infections in targeted jurisdictions. Also eliminated would be the cross-cutting Minority AIDS Initiative (MAI), which worked to address the disproportionate impact of HIV on racial and ethnic minorities.

The Ryan White HIV/AIDS program, which provides care and treatment to low-income people with HIV, would be moved from HRSA to the new “Administration for a Healthy America” (AHA), with other HRSA programs that the administration intends to retain. The budget includes level funding for grants to cities and states, including for the AIDS Drug Assistance Program (ADAP), and other key aspects of the program, but it eliminates support for dental services, AIDS Education and Training Centers, demonstration programs, and Ryan White’s portions of the EHE and MAI, dropping Ryan White’s budget by $239 million, to $2.4 billion, in FY 2026 (compared to FY 2025). Cuts to Medicaid being considered by Congress could also affect access to HIV treatment, as 40% of people with HIV are covered by Medicaid.

The fate of the nation’s HIV prevention response at CDC is unclear. The document states that funding for the EHE and the Division of HIV Prevention (almost $1 billion in FY 2024) would be eliminated (much of its staff had already been let go). But to give states flexibility to address local needs, it states that funding would be consolidated for “Infectious Disease and Opioids, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis Programs into one grant program”. HIV is not mentioned in the new budget line, which would be funded at $898 million, or almost $500 million below FY 2025 levels. What is unclear is whether states would be able to use funding from the new and smaller consolidated grant program to address HIV, should they choose to do so, if HIV prevention would move somewhere else at HHS, as some reports have suggested, or if it is gone altogether. 

NIH, which has supported the largest HIV research portfolio in the world, would see its overall budget cut by approximately 40%. While there is no specificity on how this would translate into individual centers or disease areas, funding for HIV research at the National Institute of Allergy and Infectious Diseases (NIAID) and other parts of the agency had been approximately $3.3 billion in FY 2024.

Taken together, if approved, these proposed budget cuts and other changes would fundamentally alter the nation’s HIV response which, along with the many other changes being proposed at HHS, does not bode well for making further gains in the fight against HIV.