Our progress in ending the HIV/AIDS epidemic shows the importance of federal support

It is almost unimaginable how far we have come from the earliest days of the AIDS epidemic in the United States. The first cases of AIDS were reported in 1981, and the mortality rate increased every year until it peaked in 1995. In that year, more than 40,000 people died from complications related to AIDS. To date, more than 700,000 Americans have died from AIDS. The good news is that there has been a steady decrease in HIV deaths. Today, HIV medications have made it possible to live a long, healthy, and productive life with HIV.

We now have the tools we need to end the epidemic — antiretroviral therapy (ART) medications that can reduce a person’s viral load to undetectable, meaning they will never develop AIDS and they can no longer transmit HIV to their sexual partners or unborn children. We also have pre-exposure prophylaxis (PrEP) which, if taken regularly, prevents a person from acquiring HIV. 

These are biomedical miracles. We have a strong public health infrastructure to prevent HIV transmissions and deaths by reaching people who are most disproportionately impacted by HIV. This progress would not have been possible without investments from the U.S. government.

However, this whole system is in jeopardy. A federal funding freeze - or any cut to HIV funding in an attempt to align with recent executive orders - could be devastating. Any lapse or reduction in funding for life-saving HIV programs will not only threaten this progress but have negative economic impacts throughout the country.

Federal support for HIV/AIDS has always been bipartisan. In 1990, Congress passed the Ryan White CARE Act, named after a teenage boy living with HIV from Indiana who faced stigma and discrimination. The CARE Act invested federal funds necessary to develop lifesaving services for people living with HIV to access HIV treatment, care, and support. The Care Act has also been enthusiastically supported by both sides of the aisle since 1990. Republican administrations have a long history of developing HIV/AIDS programming — such as President Trump’s Ending the HIV/AIDS Epidemic (EHE) initiative and President Bush’s President's Emergency Plan for AIDS Relief (PEPFAR).

The Trump administration’s EHE initiative directed the U.S. Department of Health and Human Services (HHS) to reduce new HIV transmissions in the United States by at least 90% by 2030. The initiative focuses on the 57 jurisdictions with the highest rates of HIV transmission and provides additional resources to these areas for them to develop and implement local plans to end the HIV epidemic. States, counties, and territories that have received EHE funding saw a 21% lower HIV transmission rate than non-EHE jurisdictions.

Federally-funded HIV programs also have a positive economic impact across the nation. Between 2012 and 2022, approximately 27,900 new HIV transmissions were prevented, which saved over an estimated $15 billion in lifetime medical costs. While cases averted provide cost savings, approximately 31,800 new HIV transmissions took place in the U.S. in 2022, leading to lifetime treatment costs of $15.9 billion just for those new cases. These are costs that our economy can no longer afford. Yet the 1.2 million people in the U.S. who are already living with HIV, who reach an undetectable viral load, can live long, productive lives in the American workforce and as thriving members of their communities. Investing in the health of people living with HIV and in preventing new transmissions would generate significant savings and potential growth for our economy.

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Funding for HIV prevention, treatment, and care also supports a vast infrastructure of more than 300,000 public health first responders to the HIV epidemic. This includes doctors, nurses, pharmacists, phlebotomists, clinical staff, laboratory technicians, and community health workers across the nation especially at the state and local levels. There is a growing public health workforce shortage in the U.S. and the continued funding of HIV programs will help maintain critical staff to continue doing their lifesaving work.

Any lapse or reduction in federal funding for HIV programming jeopardizes our progress in addressing HIV, and transfers the burden of HIV prevention, care and treatment to overwhelmed state governments. Most of the 57 EHE jurisdictions are in the South, which has the greatest burden of HIV transmission and deaths of any U.S. region. Those states rely heavily on federal funding to implement their programs because their state does not have the infrastructure to support them.

The end of the HIV epidemic – something that we could not even imagine in the 1980s and 1990s – is in sight. The health care infrastructure that has made this all possible has strengthened our nation and developed our public health workforce. Continuous investment is needed to prevent the hurt of disease and the cost to our economy. We must ensure that we sustain the progress that we have made in ending the HIV epidemic in the United States. The health of our people and economy depends on it.