Elimination of Division of HIV Prevention Could Have Consequences for HIV Response

A public health crisis akin to the HIV pandemic in the 1980s could be on the horizon, experts say, should the Trump administration go through with its reported idea of ridding the CDC of the Division of HIV Prevention (DHP), which is dedicated to promoting “health and quality of life by preventing HIV infection and reducing HIV-related illness and death in the United States.”¹

Fate of the DHP in Question

Reports of the Trump administration considering eliminating the DHP started on March 18, when news outlets reported that the administration was interested in moving the division to the purview of HHS instead, with these plans being in early stages at the time of reporting.² However, this news sparked immediate concern among experts on the HIV epidemic, as this particular division of the CDC is in charge of many responsibilities that help to track the spread of HIV throughout the country.

According to the CDC, the DHP focuses on numerous aspects of HIV prevention, including health equity, community engagement, addressing social determinants of health that can affect the risk of HIV, and adopting a status neutral approach to keep those with HIV and who require HIV prevention within care.³ The strategic plan for 2022-2025 featured goals including expanding access to and use of funding by partner organizations.

Repercussions of Elimination Are Widespread

The elimination or restructuring of the DHP would immediately affect that funding, according to Terri Wilder, MSW, HIV/aging policy advocate at SAGE. “There will be a lack of HIV funding that would go into states to provide things like HIV testing, access to postexposure prophylaxis, and pre-exposure prophylaxis,” she told AJMC^®.

Wilder also said that the CDC is a main source when it comes to tracking the number of cases of HIV and overall prevention: “They can come in and provide resources to a state on [figuring out] how did this happen? How do we prevent something like this from happening again?”

In a recent example, Duluth, Minnesota, had a syphilis and HIV outbreak, first reported in 2021,⁴ that has increased the number of HIV cases in the area. Wilder said that the DPH’s work has helped in tracking the cases from an epidemiological standpoint. The DPH is also able to provide resources to states to encourage testing, including providing testing kits to clinics in states that do not have the resources to provide them solely using state funds.

Wilder pointed out that the CDC was also the first organization to publish results about what would later be known as AIDS on June 5, 1981, in its Morbidity and Mortality Weekly Report.⁵ The CDC would later become the lead federal agency to inform the nation about AIDS in 1986.⁶ Wilder questioned the reasoning behind moving the DPH out of the CDC’s purview and into HHS instead, as the CDC has been a leader in HIV for decades.

The elimination or transfer of the Division of HIV Prevention could have major consequences on the response to HIV in the US | Image credit: Nadzeya - stock.adobe.com

“If we don’t have the CDC tracking these things and have a place for public health and health professionals to call in or to report in these public health findings, then we don’t have a chance to respond,” said Wilder.

Vulnerable Populations Most at Risk of Adverse Effects

Although the elimination or transfer of this division would be detrimental to all, there are some more vulnerable populations that will feel the effects of the decision more. HIV can affect anyone who has been exposed to the virus, but various factors have led men who have sex with men, Black and Hispanic individuals, and individuals who inject drugs to be the most vulnerable to HIV due to disproportionately higher rates of HIV.⁷ Wilder also pointed out that individuals living in the South are also at increased risk due to less Medicaid rollout compared with other states.

“If you live in an area of the country where there’s not a lot of jobs, there’s not access to health care…if you live in a state that is rolling out transphobic and homophobic pieces of policy that go against the right to live and navigate your life with the rights that you deserve, you’re going to be more vulnerable to things like HIV,” said Wilder.

The most vulnerable populations, she said, are those that are discriminated against the most because the system is stacked up against them. Without access to preventive services, these populations will likely see the brunt of any changes to the DPH.

Another population that could be affected is the older population of people with HIV. People 55 years and older make up 41% of all cases of HIV in the United States of nearly 1.1 million people living with HIV.⁸ The CDC also estimates that 34% of those with HIV 55 years and older had AIDS when they received their diagnosis. Individuals living with HIV who are aging are also more vulnerable to aging more rapidly and having other related complications. Cutting off potential means of prevention and methods of diagnosing individuals could lead to an increase in deaths, especially in a group already in late-stage disease when they are diagnosed.

“We’re in this beautiful situation where, because of the miracle of antiretroviral medications, people have this beautiful opportunity to live longer,” said Wilder. “However, there’s this piece of this accentuated and accelerated aging…if we don’t have places like the CDC or the NIH [National Institutes of Health] or some of the other federal institutions looking in this or funding universities to do this research, how are we ever going to be able to respond to the needs of people aging with HIV and making sure that we’re using science to help improve the quality of their life.”

Financial and Prevention Consequences of Eliminating the DPH

Ultimately, either eliminating or repurposing the DPH could affect a variety of people who rely on its services to keep up to date on the number of HIV infections each year and access different methods of prevention through the country, be it through pre-exposure prophylaxis or encouraging education in vulnerable populations.

“If people didn’t want to think about it from a human rights perspective…then maybe they should look at it fiscally, because prevention actually saves us money,” said Wilder. Studies have estimated that it can cost more than $400,000 to treat 1 person living with HIV over their lifetime.⁹

Between the price that it can incur and the potential harm it can cause to people most at risk for HIV, shuttering the DPH or limiting its capacity to provide preventive education and methods to the country will leave those most at risk without vital care.

“I am not trying to be dramatic, but if what we’re hearing happens where the division shuts down or it moves to a different place or these funding cuts happen…we’re going to have a public health crisis [and] the ultimate consequence is going to be [that] people are going to die,” Wilder concluded.

References

1. About Division of HIV Prevention. CDC. Accessed March 24, 2025. https://www.cdc.gov/nchhstp/divisions/hiv-prevention.html
2. Bonavitacola J. Elimination of HIV prevention division being considered by Trump administration. AJMC. March 20, 2025. Accessed March 24, 2025. https://www.ajmc.com/view/elimination-of-hiv-prevention-division-being-considered-by-trump-administration
3. HIV prevention priorities. CDC. Accessed March 24, 2025. https://www.cdc.gov/nchhstp/priorities/hiv-prevention.html
4. Butterbrodt L. Duluth area HIV, syphilis outbreaks continue to impact community. Duluth News Tribune. April 28, 2023. Accessed March 24, 2025. https://www.duluthnewstribune.com/health/duluth-area-hiv-syphilis-outbreaks-continue-to-impact-community
5. CDC. Pneumocystis pneumonia---Los Angeles. MMWR Morb Mortal Wkly Rep. 1981;30:250-252.
6. The AIDS epidemic in the United States, 1981-early 1990s. CDC. Updated July 8, 2024. Accessed March 24, 2025. https://www.cdc.gov/museum/online/story-of-cdc/aids/index.html
7. Who is at risk for HIV? HIV.gov. Updated February 7, 2025. Accessed March 24, 2025. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/who-is-at-risk-for-hiv
8. HIV and older people. HIVinfo. Updated March 12, 2024. Accessed March 24, 2025. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-older-people
9. Bingham A, Shrestha RK, Khurana N, Jacobson EU, Farnham PG. Estimated lifetime HIV-related medical costs in the United States. Sex Transm Dis. 2021;48(4):299-304. doi:10.1097/OLQ.0000000000001366