During his first term, President Donald J. Trump revealed a bold initiative to end the HIV epidemic in the United States by 2030 by focusing on 57 jurisdictions with the most urgent needs.
The plan, which Trump announced in 2019 to a speech on the state of the Union, surprised the defense groups. But it was widely praised and successful.
By 2022, the plan had demolished new infections at a national level of 30 percent in teenagers and young adults and about 10 percent in most other groups.
This time, the position of the Trump Administration on the HIV seems to be much otherwise.
The Department of Health and Human Services is now considering closing the HIV prevention division of the Centers for the control and prevention of diseases and moving some of its activities to a different agency, according to federal officials.
The CDC provides funds to states and territories to detect and respond to HIV outbreaks, prevention, exchange of syringes, expanded tests in the emergency room, education and awareness. About one in four new HIV diagnoses is made with agency funds.
The administration plan has not yet been finalized and its potential timing is not clear.
“It’s not 100 %, but 100 % is discussed,” said a federal official who was not authorized to speak to the media about the matter.
The discussions were reported for the first time by the Wall Street Journal.
HIV prevention efforts, including clinical studies, have already been interrupted in most of the world with the misfortune of the US agency for international development.
And some federal funding for prevention and treatment were cut because the subsidies were linked to transgender people, who are among those at the greatest risk of HIV
In addition, the National Institutes of Health has interrupted funding for dozens of related studies, including those on the HIV in children; the role of the use of substances; and increasing the use of preventive therapies between undergoing groups, such as color women.
The first HIV floor of the Trump administration focused on helping many of these groups.
The initiative aimed to prevent infections in the poor black communities and between gay men and bisexuals and transgender women, some of the groups with the highest risk of contracting HIV
“It was not his electoral college,” admiral Brett Giroir said in an interview, who was deputy secretary of health and human services in the first Trump administration. But “the president supported us wildly”.
The states in which the efforts of the initiative have been concentrated have cut the new infections overall of over 20 % by 2022. “That’s exactly what we were trying to do, and we did it,” said Admiral Giroir Tuesday.
Trump’s first administration has also imposed patents held by the government on preventive drugs to negotiate better agreements from the producers.
“These actions really made the difference,” said Jeremiah Johnson, executive director of the defense organization prep4all. But, he added, “it does not seem that the current administration is motivated by previous results”.
The administration is taking into consideration a provisional plan to move some of the CDC prevention programs in the administration of resources and health services. That agency finances the state and local health departments and groups based on the community that provide HIV services, also through the Ryan White signature program.
“HHS is following the guide of the Administration and takes a careful look at all the divisions to see where the overlap that could be simplified to support the largest efforts of the president to renovate the federal government overlap,” said Emily G. Hilliard, deputy press secretary of the department.
No final decision was made, he added.
Some organizations have welcomed the possibility of moving prevention programs to HRSA, which could provide complete health and health services, as long as the CDC continued to conduct surveillance efforts and guidelines for treatment.
“Providing new funding in HRSA opens new possibilities for efficiency in the biomedical prevention of HIV and other sexual transmission infections,” said David C. Harvey, executive director of the national coalition of the STD directors.
But other experts were deeply concerned about the potential loss of involvement of the CDC.
“Hrsa and their Ryan White program are fantastic but focus on the care and treatment of HIV,” said Mitchell Warren, executive director of Avac, a defense group.
“They do not commit themselves to the prevention of HIV as a priority, which is why attention to CDC prevention is so critical.”
Michael Ruppal, executive director of the Aids Institute, said that Hrsa officials did not have experience in the way the prevention of public health was administered and measured.
“The leadership that is part of the CDC and all the institutional knowledge there, we need it on the field: states need it, the communities have it,” said Ruppal.
Its organization helps the counties of Florida, including seven of the 57 high risk jurisdictions included in the 2019 initiative, Plan HIV Services. “It seems that it is counterproductive for his personality to let this happen to this program after putting it his name,” he said, referring to Mr. Trump.
Some public health experts have worried about Nih cutting grants for stigma studies and prevention, in particular those involving some LGBTQ populations. Most of the new HIV infections are among gay and bisexual men and transgender women.
“That’s where it is the epidemic, and if you are not there, you are not facing the epidemic,” said dr. Chris Beyrer, director of the Duke Global Health Institute.
About 7 % of the Nih budget is looking for the HIV, but some republican legislators suggested that funding for HIV should be commensurate with its national prevalence of less than 0.4 percent.
“This certainly would not be enough to continue the research towards a vaccine, which we need, and towards a cure,” said dr. Beyrer, who is a councilor of the test test on the vaccine against HIV.
Given the changes to the HIV programs within the United States and abroad, public health organizations will need a new paradigm to continue their work.
This may involve companies that negotiate purchase agreements directly with states and large non -profit organizations, or it can involve completely new partnership models.
“We have to get out of any paralysis or disbelief or shock, and we really have to look at what must be built in the future,” said Warren.
“One of the greatest tragedies in all this would be if we let this narrative be written entirely by people who do not understand science or health care or research or foreign care or” he added.