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Administration budget proposal undermined by concurrent cuts

March 12, 2019

The White House budget proposal for 2020 recommends increases to the domestic HIV programs at the U.S. Centers for Disease Control and Prevention, the Health Resources and Services Administration and Indian Health Services that will be essential to keeping the administration's promise of ending our nation's HIV epidemic in the next decade. Deep cuts planned in the same proposal however, to the Medicaid program, to the National Institutes of Health, and U.S.-led global HIV responses, counter those increases and would gravely compromise efforts to eliminate new infections here, and, as the president said in his State of the Union Address "everywhere."

While the administration plan to end the U.S. epidemic recognizes that the treatment and prevention tools needed to stop transmissions exist now, just a little more than half of people with HIV are accessing treatment that is effective or consistent enough to suppress the virus, protect their health, and prevent transmission. As one result, nearly 40,000 people continue to become infected with the virus each year. The administration's plan, and the budget plan address the need for expanded treatment and prevention access to bring a 75 percent reduction in HIV transmissions by 2025, and a 90 percent reduction by 2030, by proposing $291 million in support for efforts through the CDC, the IHS, and HRSA, including through the Ryan White HIV/AIDS Program. Importantly, the proposal also includes $58 million for CDC to respond to the growing infectious diseases consequences of the opioid epidemic.

These welcome, while modest increases to programs that have largely been flat-funded for a decade however, are insufficient to achieve the goal of ending the HIV epidemic. Coupled with policies that would undermine broader public health and health care systems, the potential impacts of the increases are further weakened. The president's renewed call for repealing the Affordable Care Act including the Medicaid expansion and block granting Medicaid would greatly setback access to healthcare for people living with HIV, hobbling efforts to end the American epidemic. Flat funding for viral hepatitis and sexually transmitted diseases programs will result in these epidemics continuing unabated.

Significant cuts proposed to the National Institutes of Health, would stifle biomedical research innovation. Deep cuts to the President's Emergency Plan for AIDS Relief and to the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria would gravely weaken American leadership of HIV responses and reverse progress in reducing new HIV infections worldwide.

Ending the HIV epidemic will require affordable, comprehensive health coverage that offers access to high-quality providers and services, and a robust and sustainable health care system. Ensuring that progress against HIV is sustained will require continued, committed investment in biomedical research and innovation. The goal the president has set won't be accomplished without continued investment in programs critical to controlling the epidemic globally.

While the discretionary funding increases outlined in the budget are an important start to increase HIV screening and improve access to HIV prevention and care, in its totality the administration's proposal would represent a serious setback to efforts to end the HIV epidemic in the U.S. and around the world. We look forward to working with Congress to advance funding bills that will support the resources and policies needed to make a serious commitment to ending the HIV epidemic.
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Infectious Diseases Society of America

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