Towards the end of his first administration, Donald Trump pledged his support for a plan to end all new transmissions of HIV by 2030. But six years later, what was once an ambitious but achievable goal has been reduced to a fantasy: it’s not going to happen. Thanks to a wave of funding cuts, the US is heading backwards in the fight against HIV, both at home and internationally.
Shortly after Trump returned to office in January, the White House announced that it would be slashing the vast majority of the US’s overseas aid budget, including the President’s Emergency Plan for Aids Relief (PEPFAR), a programme which has saved an estimated 25 million lives and prevented millions of HIV transmissions since it was launched in 2003. Some of these cuts have since been reversed, but they have already caused incalculable harm: as the New York Times reported, several children in sub-Saharan Africa have died as a result of being deprived access to life-saving treatment. This figure is set to rise. A recent study in The Lancet predicated that, by 2030, these cuts could be responsible for the deaths of as many as 2.9 million people. “This is a genocidal act against people living with HIV and AIDS in low-income countries,” Charles King, the CEO of Housing Works, a non-profit which focuses on both HIV and homelessness, tells Dazed.
In the US itself, Elon Musk’s Department of Government Efficiency (DOGE) has its sights set on Medicaid, a programme which provides healthcare for people who can’t afford private insurance and is the largest source of coverage for people living with HIV, many of whom depend on it to access medication. Republican leaders have proposed lowering the income threshold at which people are eligible for the programme, which could leave millions of Americans without health insurance. During his presidency, Obama introduced an expansion to Medicaid which aimed to cover low-income people who had previously slipped through the net. Some states never signed up to this in the first place. Others have trigger laws which require them to automatically opt-out if the income threshold passes below a certain level, which means up to 3.6 million people in these states – which include Illinois, Arizona and North Carolina – risk losing their healthcare if the cuts go ahead.
This would be devastating for anyone, but HIV in particular is a condition which requires daily medication – even relatively short-lived disruptions can have a significant impact on someone’s health. Beyond the issue of Medicaid, there are enormous regional disparities in HIV funding in the US. “Some states, including New York, have invested a significant share of their own money into combating HIV and AIDS, so in areas like prevention we are likely to be less harmed,” says King. “But there are states in the South which rely totally on federal funds, and unless they are prepared to take on some of that cost, this is going to be devastating for people living with HIV in those jurisdictions.” Several non-profits in Southern states like Mississippi, Alabama, Louisiana, and Tennessee have already been forced to reduce spending on HIV outreach and testing.
The proposed cuts to Medicaid would also affect people who rely on the programme to access PrEP, a preventative medication which has been wildly successful in reducing transmission rates of HIV, particularly among the communities – such as white, cisgender gay men – where it is most accessible. While there is a federal-funded programme which provides services to low-income people living with HIV, there is no equivalent for PrEP, and without insurance, the medical tests necessary to begin a course can cost thousands of dollars. “You’re not going to keep coming to the doctor to deal with these bills, especially if you’re unemployed or underemployed,” Maximillian Boykin, campaign manager of non-profit Prep4All and the Save HIV Funding campaign tells Dazed. “And the administration’s continued attacks on Black folks, immigrants and trans people – some of the communities that are most impacted by HIV – make it harder for them to access employment and health insurance in the first place.” The people who need PrEP the most, because they belong to communities which face a disproportionately high prevalence of HIV, face the highest barriers to accessing it.
The effort to tackle the HIV epidemic has always relied on outreach campaigns tailored to the needs and circumstances of the communities most likely to be impacted. But this approach is in direct conflict with Trump’s crusade against ‘Diversity, Equity and Inclusion’, which sees any and all efforts to engage specific minority groups as an illegitimate use of federal funds. As part of this, the government recently wiped all references to trans people from the websites of several federal agencies, including the Centre for Disease Control, and cut funding to several HIV research projects specifically because they were focused on ethnic minorities and LGBTQ+ communities. By getting rid of HIV programmes aimed at the people who need them most, and effectively banning federal agencies from even mentioning the existence of trans people, Trump is ensuring that the US’s already rampant health inequalities will only get worse.
We’re going to ask them nicely, and if we continue to see legislators not doing what we’re asking for, then there will be a step-up in actions
At the same time, Robert F Kennedy Jr – Trump’s Health Secretary and a man who once blamed AIDS on “the gay lifestyle”, rather than a virus – has threatened to fire the entire staff of the government department which oversees efforts to end the HIV epidemic. He has pledged to cut $700 million of funding from the Centre for Disease Control’s (CDC) HIV prevention programmes, which include testing, syringe exchange programmes, education, outreach and PrEP. As the federal government cancels hundreds of grants towards HIV research, scientific progress towards treating the condition is likely to stall. Not only that, but it will be an uphill struggle to secure federal support for the promising new treatments which already exist, such as Lenacapavir – a new form of PrEP which only requires twice-yearly injections. “Gilead [the company which produces the drug] recently applied for FDA approval,” Jason Rosenberg, a writer, organiser and HIV advocate tells Dazed. “But what does that mean if we have a secretary general who doesn't believe that AIDS is real? What do advancements in HIV medicine actually mean if we don't have the investment to promote access to them?”
According to estimates from the Foundation for AIDS Research, eliminating federal funds for HIV prevention could lead to 143,000 additional people in the US acquiring HIV within the next five years, and 127,000 additional deaths from AIDS-related causes. It is a bleak future, but there is some cause for hope: the HIV movement – one of the most successful social movements in US history – is already swinging into action. Since the cuts to USAID were first announced, there has been a wave of protests. “On February 1, we organized our first action, where we had a rally outside the US State Department and then a sit-in on Constitutional Avenue,” Rosenberg says. Two weeks later, five activists were arrested after disrupting a House Foreign Affairs Committee hearing on USAID, chanting “PEPFAR saves lives. Restore AIDS funding now” and holding signs which read “Trump kills people with AIDS worldwide.” On February 27, a coalition of veteran activists and fired USAID workers staged a ‘die-in’ protest inside an office building in Capitol Hill. “That’s what was really inspiring about that action: these federal workers were willing to put their bodies on the line, not because they themselves were losing income, but because they knew what the effects of these cuts would be”, says Rosenberg.
The movement is deploying a range of strategies, including legal challenges, political lobbying and civil disobedience. Boykin, along with the Save HIV Funding campaign, has been encouraging people to talk to their legislators, attend town halls, and pressure to push back against any HIV funding cuts. The campaign has also been working with different providers, from clinical settings to community-based organisations, to make sure they have a plan for how people living with HIV can still have access to treatment and other forms of support including housing and food. But he is also a firm advocate for escalating tactics. “First thing we're gonna talk to legislators. We’re going to ask them nicely, and if we continue to see legislators not doing what we’re asking for, then there will be a step-up in actions,” he says.
King, who was a member of activist group ACT UP during the 1980s, agrees on the importance of direct action. “There was a time when I was getting arrested pretty much every other week, and I think we need to go back to that period of activism,” he says. “We need to be making it very uncomfortable for Republicans in Congress to support cutting Medicaid. We need to be making them feel the heat, whether it’s through demonstrations at their offices, disrupting town hall and engaging in civil disobedience that confronts them directly.”
The current political moment is not dissimilar to the 1980s, when the AIDS crisis was at its peak: like today it was a time of moral panics and resurgent social conservatism, and while Ronald Reagan wouldn’t have approved of Trump’s tariff policies, he would have been a big fan of DOGE. We can learn a lot, suggests Rosenberg, by how activists responded to the challenges of that earlier period. “I think that’s how we really meet the moment: by looking at our history, and by building a movement that is intersectional, inclusive and intergenerational,” he says. “We look at our past, we look at our veterans and elders in the movement, and we see what was effective. We also need to look for new and creative ways – because what worked in the past might not work in the present.”
The HIV movement has a long and proud track record of forcing the US government to bend to its demands. In 1988, ACT UP successfully pressured the FDA to accelerate its drug approval system, a change which allowed people with HIV to access potentially life-saving experimental treatments. It forced the CDC into expanding the definition of AIDS so that it included women’s symptoms, and New York City authorities into legalising needle exchanges. It stood up to some of the most powerful forces in society, from the Catholic church to Wall Street corporations. In the decades since, the HIV movement has fought to ensure access to treatment and made significant progress in bringing the epidemic to an end. If this history is anything to go by, the Trump administration will not have an easy time in dismantling these accomplishments.
To find out more about access to HIV treatment and PrEP in the US, check out the websites for AVAC (AIDS Vaccine Advocacy Coalition); AIDSVu; PrEP4All and PrEpWatch.