Well, Trump's budget proposal -- ever so charmingly titled "America First" -- is out, and not surprisingly, it includes a massive bump for defense and tons of cuts across agencies that cover the environment, health, housing and science and provide all sorts of crucial programs from affordable housing, to job training, to after-school programs, to work-study support.
It's only a proposal, true, and huge swaths of it will be subject to bitter fights or outright rejection in Congress. Still, it's a (very skimpy) vision of what Team Trump wants, so it carries some weight.
Two programs that Trump appears to leave alone are the Ryan White CARE Act, which covers treatment and services for countless Americans with HIV/AIDS (as a last resort or adjunct, that is, to Obamacare, Medicare and Medicaid, all of which are on the chopping block) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which does the same for people with HIV/AIDS abroad. That's good, and also not particularly surprising, since both programs have enjoyed solid bipartisan support in Congress since their inceptions years ago.
But, lest you think all things related to HIV/AIDS have been spared, it's important to know that (in addition to the ongoing threats to the aforementioned biggest domestic HIV care programs that aren't Ryan White) the budget calls for an 18% cut to Health and Human Services, including a $6 billion cut to the National Institutes of Health (NIH), which could deal a harsh blow to a variety of crucial HIV research efforts from prevention to next-generation drugs, to an outright cure, to HIV-associated coinfections (such as hepatitis C or sexually transmitted infections) and complications (neurological, cardiovascular, cancers).
"At this moment, we're desperately trying to turn the tide of the epidemic, looking at strategies for how to get treatment to our most vulnerable populations," Wendy Armstrong, M.D., chair of the HIV Medicine Association told TheBody.com. "Reducing the research budget by a massive amount would be completely devastating."
She pointed to recent Centers for Disease Control and Prevention (CDC) data showing that, while new HIV infections overall have dropped 18% the past six years, infections have actually increased 35% among young men who have sex with men -- and 20% among Latinx men who have sex with men.
"I'm sitting here in Atlanta where we have a massive HIV epidemic in the southeast compared to the rest of the country," she said. "And, we still don't know the best ways to get vulnerable populations linked into and retained in care."
Moreover, she said, the budget also vaguely calls for major reorganization at the CDC that would give states block grants to do with as they see fit. In recent years, "CDC has taken a leading role in creating guidelines for, encouraging and pushing [pre-exposure prophylaxis] in a really critical way," noted Armstrong.
"CDC also does the Medical Monitoring Project, which gathers critical data over time on people with HIV, such as tracking how many people are receiving medical care, staying in care and undetectable, the impact of Ryan White, disparities in care across race or region or other factors, and how many people are trained to give HIV care.
"So, we're really concerned about talk of major changes at the CDC," she said.
And even beyond HIV, the proposed cuts to health and science research are concerning. As emphasized by Armstrong, "In the current era, it's hard for young scientists to develop their careers because there are already a very small number of NIH grants. So, I'm not exaggerating when I say that more cuts could mean we lose a whole generation of researchers."
All of which leads to the inevitable question: What can you do about all this? The answer is familiar: Congress members need to hear from you, especially if you are a constituent. (Find your reps here.) Call them and tell them how important CDC and NIH funding is to you, and that you don't want to see it cut as proposed in Trump's budget.
And, you have time, says Armstrong, go to your reps' local offices and talk face to face with staffers. It's crucial, she says.
"I speak to people all the time who say, 'Gosh, I thought HIV was pretty much done or under control.' But it's not yet. We can't brush this under the rug. There are far too many vulnerable young Americans who need our advocacy, as well as long-term survivors. We just cannot forget about this epidemic."