By Carmen Heredia
Rodriguez MARCH 12, 2019
The
Trump administration took another step toward fulfilling its goal of ending the
HIV epidemic in the United States Monday by requesting $291 million for
its initiative in the White House’s annual budget.
But
within the budget, the
administration also proposed actions that could undermine efforts to control
the virus’s spread, HIV experts and advocates said, including carving out funds
from programs that aim to eradicate HIV in other parts of the world. Among
those moves was a $1.35 billion cut in
the President’s Emergency Plan for AIDS
Relief (PEPFAR), according to an analysis by the Kaiser Family
Foundation. (Kaiser Health News is an editorially independent program of the
foundation.)
That
widely touted program, begun by President George W. Bush, provides
antiretroviral medication and other services to patients in more than 50
countries. Last year, 14 million people around the world relied on the program
for HIV medication.
Greg
Millett, vice president and director of public policy at the HIV research
foundation amfAR, described the administration’s budget as “schizophrenic.”
“There’s
just so many opposites within this budget of things that are truly helpful and
useful,” he said. “And then, they are counterbalanced by things that just erase
that goodwill.”
The
budget proposal is for the fiscal year beginning Oct. 1. Congress is not
obligated to fulfill any of the requests in the budget proposal. The
administration has asked for similar cuts to global HIV initiatives in the past
without success.
The
allocation to combat HIV in the U.S. would be split between multiple
programs. The Centers for Disease Control and Prevention would receive $140
million to work with state and local health departments to reduce new
infections. Another share — approximately $120 million — would be directed to
the Ryan White HIV/AIDS Program,
which provides HIV-related medical care, support services and medications to
patients.
President
Donald Trump pledged in his State of the Union speech last month to eradicate the transmission of
HIV in the United States in the next decade.
Jennifer
Kates, vice president and director of global health and HIV policy at the
Kaiser Family Foundation, said these funds “are actual real increases to those
programs if they should go through.”
However,
the budget also seeks to change funding for Medicaid — the federal-state
partnership that provides health insurance for the poor and indigent — from
unlimited federal matching to a block grant. It would also give states more
flexibility to change Medicaid eligibility rules and shift certain costs toward
beneficiaries. Advocates say those changes could directly impact access to
services for HIV patients because Medicaid is the largest source of coveragefor
them.
In
addition, the budget proposes cuts to the Housing Opportunities for Persons with AIDS program,
which provides housing for those with HIV/AIDS.
HIV
advocates also highlighted their concerns about the cut to global programs.
Nearly 37 million people around the world lived with HIV or AIDS in 2017,
according to UNAIDS. Roughly
one-quarter of them did not know they were infected with the virus.
Countries
receiving aid from these programs are unlikely to be able to continue these
programs on their own, experts said.
The
move to divest from overseas efforts and focus on domestic issues aligns with
the Trump administration’s “America First” doctrine, said William McColl, vice
president for policy and advocacy at AIDS United, an HIV advocacy organization.
But
ending U.S. efforts undercuts the United States’ place as a global leader in
combating the virus, he said.
The
change also overlooks the fact that the virus will continue to circulate
without regard to national borders.
“I
hesitate to give anybody ideas, but unless you put a bubble over the United
States, this is not going to really solve this issue,” McColl said.
Carmen Heredia
Rodriguez: CarmenH@kff.org,
@ByCHRodriguez
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