Cutting HIV Prevention Funding at CDC: What Would it Mean?

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On March 18^th, reports began to emerge that the Trump administration is exploring cuts to the Centers for Disease Control and Prevention (CDC), including in the HIV prevention budget. CDC is the primary source of federal funding for HIV prevention in the U.S. and was the very first government agency funded to address the emerging HIV epidemic in the early 1980s. While CDC is the cornerstone of domestic HIV prevention efforts, representing 91% of all federal funding for HIV prevention, prevention funding represents a small share (3% in FY 2022) of what the federal government spends on HIV and a minuscule share of the federal budget overall. The FY24 appropriation for HIV prevention at the CDC totaled about $1 billion.  

Most CDC HIV prevention funding is provided to state and local jurisdictions, allowing them to conduct health surveillance activities and appropriately target communities. Additionally, grants to state and local health departments and national and community-based organizations (CBOs) fund HIV testing, prevention interventions, and linkage to care, which improves individual and public health outcomes. For example, in 2022 nearly 2 million HIV tests were conducted by 60 CDC-funded state and local health departments and 119 CBOs, resulting in about 8,000 people being newly diagnosed with HIV. State and local governments could theoretically make up for federal cuts in HIV prevention, but they may also be facing their own budget constraints and other significant cuts in federal funding, including in Medicaid. Under this scenario, states are likely to make different decisions based on their budgets and policy priorities, which could make access to HIV prevention resources more uneven across the country.

Eliminating this funding could jeopardize recent successes in addressing the nation’s HIV epidemic, including those related to the Ending the HIV Epidemic (EHE) Initiative, which the first Trump administration created, and among other activities, bolstered HIV prevention efforts at the CDC by providing additional funding to a subset of targeted “EHE” jurisdictions.  There has been a 12% decline in HIV incidence (new infections) nationally from 2018 to 2022 and a 21% decline in EHE jurisdictions between 2017 and 2022. CDC states that “increases in preexposure prophylaxis prescriptions, viral suppression, and HIV testing likely contributed to the decline,” activities that the agency has a core role in supporting. 

While some reports  suggest that some or all of CDC’s HIV prevention funding could be moved to another part of HHS, such as the Health Resources and Services Administration (HRSA), there is no formal proposal at this point so the future of any HIV prevention funding is uncertain. Additionally, HRSA’s historical role has primarily been in the delivery of medical care. While it is involved in HIV prevention through the delivery of PrEP at community health centers, it is not a prevention agency, and its HIV expertise lies primarily within the Ryan White HIV/AIDS Program, which is a federal safety net program for HIV care and, by statute, is prohibited from providing most HIV prevention services.

Diminished prevention efforts would likely lead to an increase in HIV incidence, with negative implications for individual well-being, public health, and health costs. CDC estimates that approximately 9,000 HIV infections were averted between 2017 and 2022, saving an estimated $5 billion in lifetime medical costs.