Reevaluating contracts, questioning what public money are paying, and who is receiving them are all part of President Trump and Elon Musk’s vigorous effort to restructure the bloated and unwieldy U.S. government bureaucracy.
As the Trump administration sifts through red tape and freezes or cancels millions in grants, even the public health sector isn’t safe. A great many HHS initiatives, particularly those that aim to combat the transmission and treatment of HIV/AIDS, are or will be under scrutiny.
As a former White House director of national AIDS policy who was one of the chief architects of the President’s Emergency Plan for AIDS Relief (PEPFAR), the first director of the HIV/AIDS Bureau at the Health Resources and Services Administration (HRSA), and as an LGBT conservative with a career in medicine, business, and public health, I believe HIV/AIDS advocates should embrace and support such a review.
Many government programs have not been audited for waste, fraud, or abuse in years, and it is important that the United States’ proven long-term plan to combat the HIV/AIDS epidemic and the funds allocated to it stay in place.
Supporters of the US’s continued hard line against the HIV/AIDS epidemic would do well to welcome the opportunity to assess HIV/AIDS-specific programs for their suitability in light of the present pandemic.
An example would be the Ryan White CARE Act, which provides funding for vital healthcare treatments to uninsured and underfunded persons in the United States who are living with HIV/AIDS. Federal funding for the program was $2.5 billion in FY 2024, but it hasn’t been reauthorized since 2009. During that time, Medicaid expansion greatly cut down on the number of individuals requiring Ryan White assistance for healthcare and medications, but the program’s budget kept growing nonetheless.
Ryan White was conceived before there was extremely effective HIV/AIDS treatment, thus a renewal process would provide an opportunity to examine its spending objectives. It would be wise for the HIV/AIDS community to consider repurposing that money for other important causes, such mental health and drug misuse treatment.
DOGE can also prevent needless redundancy in government processes. As for the Ending the HIV Epidemic campaign, which Trump launched during his first term, it is overseen by the CDC, while the Ryan White program is administered by the HRSA. There is a lot of administrative overhead and perhaps needless spending because the programs are run independently with their own budgets and personnel, even if their aims are complimentary.
Reportedly, the Trump administration is trying to merge the two programs into one HRSA-run project in an effort to save money and make better use of resources. Not wringing their hands or scaring voters, but being open to exploring these types of pragmatic improvements is what advocates for a robust public health response to HIV/AIDS should do.
It would be a catastrophic error in national policy to deprioritize financing for the HIV/AIDS pandemic, even though efficiency is necessary. The number of new instances of the illness has been declining in the United States because to improvements in treatment and preventive measures. However, research shows that reducing these efforts causes new infections to surge, which puts a strain on the healthcare system owing to the higher costs of care and treatments in the future.
Providing funding for HIV/AIDS prevention, treatment, and care on a worldwide scale is PEPFAR, another essential component of the United States’ strategy to combat the pandemic. PEPFAR’s value is not only as a cost-effective success in saving millions of lives but also as a means of exerting significant diplomatic influence with dozens of partner nations.
During Trump’s inauguration, Secretary of State Marco Rubio exempted PEPFAR from the original ban on global health programs. That does not mean that PEPFAR should be immune from an audit for inefficiency.
Like all federal programs, there must be improvements that can be made and waste that can be cut. The strategy and techniques employed by PEPFAR, on the other hand, are clearly yielding an outstanding return on investment. Efficiently funding the program ought to be a goal shared by both parties.
It’s easy to panic over reports of specific cuts or reorganizations to HIV/AIDS programs. Federal money for preventive measures is typically popular, so opponents of the Trump administration have every motive to fearmonger about the matter.
However, it is important to acknowledge that these initiatives, similar to the federal government, do have their flaws if we truly desire to combat the spread of HIV/AIDS. These HIV/AIDS programs are long overdue for auditing, evaluation and perhaps reorganization, and as long as our commitment to fighting the disease remains intact, the United States’ efforts will be stronger for it.