What Do Federal Staffing Cuts and HHS Restructuring Mean for the Nation’s HIV Response?

On March 27^th, the Trump administration announced that the U.S. Department of Health and Human Services (HHS) would implement “a dramatic restructuring” in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.” This included plans to reduce the Department’s workforce by 10,000 employees. As a result, thousands of federal HHS employees were given “reduction in force” announcements (or RIFs) or otherwise learned that their roles had been eliminated when they were denied access to their offices. Others were offered reassignments. In addition, several HHS offices and functions have reportedly been reduced or ended. These actions seem to be particularly focused on the federal government’s work on HIV and have the potential to negatively affect the nation’s HIV response. While there continues to be some uncertainty about the full extent of these actions, and there are some reports that certain personnel may be reinstated, here is what is known thus far about the implications of these actions on HIV efforts:

• Centers for Disease Control and Prevention (CDC): A near 20% cut to CDC staff and elimination of divisions and offices:
  • This includes cuts within the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), the division that handles most federal HIV prevention efforts, with several branches being effectively eliminated, and it’s director, Jonothan Mermin, reassigned. For HIV, these include the elimination of the following divisions:
    • Prevention Communication Branch
    • Division of Behavioral & Clinical Surveillance Branch
    • Capacity Development Branch
    • Quantitative Sciences Branch
    • HIV Research Branch
  • These divisions within the CDC have provided leadership, subject matter expertise, tools and campaigns for communication with the public (important for a providing evidence-based information on a communicable and often stigmatizing disease), generated and analyzed data, helped develop capacity among grantees, supported outbreak investigation, and conducted research across a range of areas to improve HIV prevention, care engagement, and response efforts.
  • Beyond these HIV specific divisions, cuts also occurred within branches or divisions related to public health concerns that have a disproportionate impact on people with HIV or relate to conditions that increase vulnerability to HIV, including those focused on addressing tuberculosis, viral hepatitis, and sexually transmitted diseases (STD). For example, the disease intervention and response branch within the STD division faced eliminations, an office whose role it is to identify STD case and outbreaks and mitigate spread through linkage to care and provision of technical assistance.
• HHS: Elimination of the Office of Infectious Disease Policy (OIDP) within the Office of the Secretary at HHS:
  • The OIDP office was eliminated and most staff were terminated or reassigned. This includes staff who supported coordination of the Ending the HIV Epidemic Initiative (EHE) which spans multiple HHS agencies and the Executive Director of the President’s Advisory Council on HIV/AIDS (PACHA), who was an employee within the office.
  • OIDP provides infectious disease leadership, expertise, and coordination across the federal government, with HIV being a special focus of the office. This includes coordinating multiple national strategies aimed at addressing infectious diseases including, the National HIV/AIDS Strategy (NHAS), Vaccines National Strategic Plan (Vaccine Plan), Viral Hepatitis National Strategic Plan (Viral Hepatitis Plan), and the STI National Strategic Plan (STI Plan), in addition to providing EHE leadership.
• National Institutes of Health (NIH): Key officials in NIH leadership were placed on administrative leave and some offices were eliminated:
  • Specific to HIV, Jeanne Marrazzo, the director of the National Institute of Allergy and Infectious Diseases (NIAID) was reportedly placed on administrative leave. The role was previously held by Anthony Fauci.
  • Additionally, there have been reports that the Workforce Operations, Communications, and Reporting Branch (WOCRB) at the Division of AIDS (DAIDS) within NAID has been eliminated. WOCRB’s role is to coordinate division-wide operational activities.
  • NIAID conducts and supports research related to infectious, immunologic, and allergic diseases, including HIV. Specifically related to HIV, NIAID has worked to “better understand HIV and how it causes disease, find new tools to prevent HIV infection, develop new and more effective treatments for HIV-infected people, and find a cure.” NAID’s HIV research has focused on HIV treatment, prevention, cure and vaccine.
• Beyond those offices dedicated to HIV, several others that have reportedly faced staff or complete elimination conduct activities relevant to addressing the needs of people with and at risk for HIV. These offices address communities disproportionately represented among people with HIV, including those focused on the needs of people of color, LGBTQ people, those with lower incomes, those with comorbidities, including mental health substance use problems, and those that address aging issues.
  • Examples of where such cuts/elimination have reportedly occurred include following offices/agencies: the Centers for Medicare & Medicaid Services (CMS)’s Office of Minority Health, the Substance Abuse and Mental Health Services Administration (SAMHSA) (including multiple offices such as the National Mental Health and Substance Use Policy Laboratory and the Office of Minority Health), and the Administration for Community Living (including the Center for Policy and Evaluation). In addition to NIAID at NIH described above, the National Institute on Drug Abuse with NIH was also reportedly The Office of Minority Health at HHS has also reportedly been told to prepare for elimination.

There are also plans for a new agency, the Administration for a Healthy America (AHA) to be created, consolidating activities from the Office of the Assistant Secretary for Health (OASH), the Health Resources Services Administration (HRSA) (home to the health center and Ryan White HIV/AIDS programs), SAMHSA, and others. AHA will consist of multiple divisions, including one on HIV/AIDS. It is not known whether AHA will seek to reinstitute some of the terminated positions or eliminate additional roles from within the agencies it consolidates.

Regardless of what happens with AHA, the elimination of directors, staff, and departments across HHS to date, represents a significant loss to HIV research, prevention efforts, leadership, expertise, and coordination of the HIV response across the federal government. In addition to cuts described above, it has also been reported that there may be cuts to CDC’s HIV prevention budget, that funding for NIAID’s HIV Prevention Trials Network and HIV Vaccine Trials Network (HVTN) has been suspended, and that some NIH grants focused on HIV have been rescinded. Taken together these actions could all hamper the nation’s ability to address HIV in the immediate term, jeopardize innovation, and lead to increased HIV incidence. In addition, expertise built by these officials and offices has been utilized in public health arenas outside of HIV, as was the case with the development of the COVID-19 vaccine which was built on HIV vaccine research. Given this, erosion of HIV expertise, research, and infrastructure could have ramifications for public health more broadly.