Funding for HIV services is the likely victim of a longtime Republican goal of devolving power to the states.
The Trump administration notified the Centers for Disease Control (CDC) last month that it would cease a years-long community grant program funding local organizations that provide HIV testing, referrals for care, PrEP and Doxy PEP, and outbreak response measures. About 96 organizations are currently recipients of the direct federal grants worth $46 million, Roll Call reported.
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The Office of Management and Budget (OMB), under the direction of longtime Heritage Foundation official Russel Vought, has stripped that money from the CDC and is redirecting it as supplemental funding to state health agencies, which will then decide whether or not the money goes to the same HIV-focused local organizations.
“For decades, direct federal investment in community-based HIV prevention has helped trusted local organizations reach people and communities that traditional health systems too often fail to serve,” AIDS United, a DC nonprofit focused on ending the HIV/AIDS epidemic, said in a statement condemning the decision.
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“We cannot end the HIV epidemic by dismantling the trusted community systems that make prevention possible,” Carl Baloney, the group’s CEO, said. “This decision threatens access to testing, PrEP, PEP and care — and will ultimately lead to preventable HIV transmissions, program closures and higher health care costs.”
AIDS United and other HIV/AIDS-focused providers watched with dismay as the Trump administration dismantled similar HIV-prevention efforts overseas, through the dismemberment of USAID and scaling back PEPFAR, the President’s Emergency Plan for AIDS Relief. President Donald Trump’s own stated desire to end the HIV/AIDS epidemic in his first term is another casualty of that slashed funding, and the OMB’s latest action is contrary to that goal, AIDS United said.
“Federal, state and local government partners all have vital roles to play in HIV prevention,” the group continued. “But the United States cannot end the HIV epidemic without significant financial support for community-based organizations that are connected to, trusted by and staffed by people from the communities most affected by HIV.”
Ending the direct grants puts “trusted community services at risk—particularly those serving Black and Latino communities, LGBTQ+ people, people in the South, and others disproportionately affected by HIV.”
Carl Schmid, executive director of the DC-based HIV+ Hepatitis Policy Institute, agreed that handing funding decisions to the states could break a successful chain of prevention efforts. While DC and other blue state governments may already have open lines to local groups, “other states and jurisdictions don’t have that relationship with the community-based organizations,” he told the Washington Blade.
“It depends on the state,” Schmid said, adding, “Not all states send their money to the communities that really need it most. And not all states are fast in getting money to the community-based organizations.”
Another factor that could slow down community groups’ efforts: the loss of steep drug discounts available to recipients of the federal grants.
“They could still qualify as a sub-grantee from a state,” Schmid said. “But what if they don’t get that grant again? They would not be able to qualify to obtain the drugs” at the discounted price, he said.
Even while condemning the administration for the change, AIDS United seemed resigned to the new arrangement, asking “State and local health departments receiving supplemental funds to prioritize continued support for the community-based organizations currently delivering these services and prevent disruptions in care and prevention.”
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