Policy and funding changes during the first several weeks of Donald Trump’s administration are imperiling people living with HIV. On the day of his inauguration, Trump signed executive orders to withdraw the United States from the World Health Organization and halt funding for foreign aid, including PEPFAR, the President’s Emergency Plan for AIDS Relief, which provides HIV treatment for more than 20 million people worldwide. The Centers for Disease Control and Prevention, the National Institutes of Health (NIH), the Food and Drug Administration and other health agencies were told to suspend external communications, and their websites were scrubbed of content related to “gender ideology.” This was followed by employee layoffs across federal agencies.

 

Funding for domestic health efforts, such as the Ryan White HIV/AIDS Program, is also threatened. Trump has expressed support for a congressional budget proposal that includes deep cuts to Medicaid, which covers some 40% of people with HIV. The NIH—the nation’s major funder of biomedical research—said it would slash grant support for universities and medical centers.

 

Some of these moves have been walked back or halted by lawsuits, but the situation remains dire as POZ goes to press. PEPFAR was granted a waiver for lifesaving medical care, but pre-exposure prophylaxis (PrEP) was limited to pregnant and breastfeeding women. Despite the waiver and a court order, providers in Africa have reported clinic closures, staff layoffs and suspension of HIV clinical trials. According to UNAIDS, a 90-day funding freeze could lead to 8.7 million new infections and a tenfold increase in AIDS-related deaths over time.

 

Interrupting antiretroviral therapy even briefly can lead to viral load rebound, raising the risk for HIV transmission and drug resistance. Going without treatment long-term leads to declining immune function and disease progression. “People are going to die because lifesaving tools have been taken away from them,” says UNAIDS director Winnie Byanyima.