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During his first term, President Donald J. Trump unveiled a bold initiative to end the H.I.V. epidemic in the United States by 2030 by focusing on 57 jurisdictions with the most urgent needs. The plan, which Mr. Trump announced in 2019 at a State of the Union address, surprised advocacy groups. But it was widely lauded, and successful. By 2022, the plan had driven down new infections nationwide by 30 percent in adolescents and young adults, and by roughly 10 percent in most other groups.
The Trump administration’s stance on H.I.V. appears to be much the opposite. The Department of Health and Human Services is now considering shutting down the H.I.V. prevention division of the Centers for Disease Control and Prevention and shifting some of its activities to a different agency, according to federal officials.
The C.D.C. provides funds to states and territories for detecting and responding to H.I.V. outbreaks, prevention, syringe exchange, expanded testing in emergency rooms, and education and awareness. Roughly one in four new diagnoses of H.I.V. is made with agency funds.
The plan has not yet been finalized, and its potential timing is unclear. “It’s not 100 percent going to happen, but 100 percent being discussed,” said a federal official who was not authorized to speak to the media about the matter.
H.I.V. prevention efforts, including clinical trials, in much of the world have already been halted with the gutting of the U.S. Agency for International Development. And some federal funding for prevention and treatment was cut because the grants were related to transgender people, who are among those at highest risk of H.I.V.
In addition, the National Institutes of Health has terminated funding for dozens of related studies, including those on H.I.V. in children; the role of substance use; and increasing the use of preventive therapies among underserved groups, such as Black women.
The first Trump administration’s H.I.V. plan focused on helping many of these groups. The initiative aimed to prevent infections in poor Black communities, and among gay and bisexual men and transgender women, some of the groups with the highest risk of contracting H.I.V.
The initiative aimed to prevent infections in poor Black communities, and among gay and bisexual men and transgender women, some of the groups with the highest risk of contracting H.I.V. “It was not his constituency,” Adm. Brett Giroir, who served as deputy secretary of health and human services in the first Trump administration, said in an interview last fall. But “the president was wildly supportive of that.”
The states where the initiative’s efforts were focused cut new infections overall by more than 20 percent by 2022. “That’s exactly what we were trying to do, and we did it,” Admiral Giroir said on Tuesday.
The administration is considering a tentative plan to move some of the C.D.C.’s prevention programs to the Health Resources and Services Administration. That agency funds state and local health departments and community-based groups providing H.I.V. services, including through the signature Ryan White program.
H.R.S.A. and their Ryan White program are terrific but focus on H.I.V. care and treatment, said Mitchell Warren, executive director of AVAC, an advocacy group. “They do not engage in H.I.V. prevention as a priority, which is why C.D.C.’s prevention focus is so critical.”
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