Treatment Action Group (TAG) opposes the President’s Fiscal Year (FY) 2020 budget proposal, which makes a mockery of the administration’s purported strategy to end AIDS in the United States over the next decade. TAG welcomes additional investments in HIV prevention and treatment towards eliminating HIV in the U.S. However, the federal budget’s defunding equally important areas across domestic and global health programs, social services, and research raises tremendous doubt about the administration’s commitment to end HIV. We are also concerned about the fate of related epidemics such as hepatitis C (HCV) and tuberculosis (TB).
Simply put: increases to HIV across domestic programs cannot come at the cost of life-saving global programs and research investments. According to our allies at Health GAP, lifesaving programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund are subject to the largest cuts in their history. Despite efforts made by Congress to fund the U.S. Agency for International Development’s (USAID) TB program to the highest level in its history, the Trump budget proposal rolls back progress on ending the world’s leading infectious killer of people living with HIV (PLHIV) by cutting the program by $41 million. Investing in the HIV, TB, and HCV response is not a zero-sum game: these infectious diseases do not respect national borders, and ending HIV, TB, and HCV requires ending them everywhere.
“This budget demonstrates that U.S. ‘leadership’ is going backwards on global health. PEPFAR and Global Fund finance life-saving healthcare; they must be expanded, not cut,” commented Erica Lessem, TAG’s Deputy Executive Director of Programs. “Slashing USAID’s TB program, especially after the first-ever UN High-Level Meeting on TB generated commitments to mobilizing resources to address the global TB epidemic, gravely undermines the U.S.’s supposed leadership on TB elimination.”
Despite increases made to domestic HIV at the Department of Health and Human Services (HHS), several other programs serving PLHIV are on the chopping block – calling into question the value and the seriousness of the administration’s supposed $291 million in new funding to end the epidemic. These include reduced spending and block-granting Medicaid, when in many states the program has become the largest provider of healthcare for PLHIV. Support for housing is a vital component of ending the epidemic in New York State, yet dramatic cuts are proposed to the Housing Opportunities for People with HIV/AIDS (HOPWA) program. Weakening these vital safety-nets undercuts the administration’s overall strategy to address the HIV epidemic by restricting access to critical treatment, prevention, and social services for vulnerable, low-income communities.
“The administration is myopic in its thinking that giving HIV a marginal funding increase, while subsequently cutting other programs, could possibly help lead us to the end of the epidemic in the U.S.,” said Mark Harrington, TAG’s Executive Director. “The administration’s initiative cannot end the domestic HIV epidemic unless it reverses attacks on the Affordable Care Act, Medicaid, and other social services, and makes sound and comprehensive policies to rein in drug prices and to reinvest the savings in prevention and treatment programs.”
Research vital to ending the epidemic is also under siege in the President’s budget. While the budget proposal includes a scant increase of $6 million to the Centers for AIDS Research (CFAR) as a component to the administration’s End the Epidemic initiative, much larger cuts negate this tiny gain. These include excising nearly $5 billion from the National Institutes of Health (NIH), including a counterproductive $769 million cut from the National Institute of Allergy and Infectious Diseases (NIAID), and the administration’s continued attempt to target the Fogarty International Center. With amazing momentum—including highlights from last week of steps forward towards a cure, and long-acting formulations of antiretroviral medicines— now is the time to invest more, not less, in science to end the epidemic.
The President’s proposed budget increases towards HIV prevention are insufficient due to the current unreasonably high cost of PrEP. Meaningful action on drug pricing, rather than grandstanding or throwing the blame on other countries, to rein in pharma greed is essential. We also remain concerned about the jurisdictions left out of the national HIV plan. Persistent opposition to federal funding for purchasing clean syringes and safe injection facilities jeopardizes progress and flies in the face of the large evidence base supporting harm reduction.
While additional funding for ending HIV is welcome and essential, it will only have an impact if these new funds are paired with canceling the proposed devastating cuts, and if this administration reverses harmful stances that attack human rights and access to healthcare — especially among women, immigrants, people of color, and transgender people, and people who use drugs, who are disproportionately affected by HIV. The administration must strongly consider the policies and recommendations in the community’s Ending the Epidemic roadmap, and commit to meaningful action. We look forward to working with Congress, the Act Now End AIDS coalition, and our partners to catalyze the real level of resources needed to end the epidemics of HIV, TB, HCV here and abroad.