Some lawmakers and advocates are increasingly uncertain whether critical HIV and AIDS services will survive the federal government’s funding fight.

The GOP’s House-passed budget bill seeks to cut over $1.5 billion in services for people living with and vulnerable to human immunodeficiency virus (HIV) in the U.S. — far greater than the cuts proposed by President Trump and the Senate.

It’s unclear whether the Senate or White House will support the bill once it’s considered after the government shutdown ends. But some warn passing the House’s proposed cuts would result in increased infections and deaths.

Rep. Rosa DeLauro (D-Conn.), the senior Democrat on the House Appropriations Committee, called these efforts a “callous move” in a statement to The Hill.

“People across the country rely on the testing, PrEP access, early diagnosis, and lifesaving treatment these resources provide,” DeLauro said.

Eliminating these programs, she added, is not an option, and Americans living with HIV concur.

“Anyone old enough to remember the start of the AIDS epidemic here in the U.S. remembers what government neglect produced,” said Javier Muñoz, an actor living with HIV and affiliate of the #SaveHIVFunding campaign, a coalition of organizations advocating against HIV funding cuts. “Hundreds of thousands died. An entire generation is gone.”

“Protecting and sustaining current funding levels is a matter of life and death,” he said.

Clashing funding proposals

The House’s full-year funding bill proposes over $1 billion in cuts to domestic HIV/AIDS prevention and research services. Also at risk is $525 million for the Ryan White HIV/AIDS Program, a flagship federal program that helps provide treatment for people living with HIV.

The bill’s additional proposed cuts to global initiatives bring total reductions to HIV-related services in the House budget to almost $2 billion.

Jeremiah Johnson, executive director of PrEP4All, an organization that advocates for universal access to HIV prevention and treatment, said the “brazen way” that the Trump administration had gone after international HIV programs led to a lot of immediate coverage of cuts to global programs.

He said cuts to domestic programs have only recently begun to make headlines, despite their potential to be devastating.

“This is something that’s going to immediately translate into…fewer HIV tests, more people being diagnosed late and presenting with opportunistic infections and dying,” he said.

Rep. Mark Pocan (D-Wis.) tried to change the House bill to prevent $1.4 billion in funding cuts, but his amendment failed on party lines.

“Unfortunately…we’ve had to make some very tough choices among programs that are located in this bill,” Rep. Robert Aderholt (R-Ala.), chair of the Appropriations Subcommittee on Labor, Health and Human Services, said during the bill’s markup in September.

Aderholt said he would not vote for the amendment because it didn’t offer a way to offset costs and would cause the bill to breach its allocation.

“That said, we have maintained a significant investment in over $2 billion in funding of the Ryan White program in this bill,” he said at the time.

Both he and Rep. Tom Cole (R-Okla.), chairman of the Appropriations Committee, didn’t respond to a request for comment.

Aderholt’s remarks point to the GOP’s attempts to follow the White House’s mandate to reduce excessive spending — though that hasn’t always translated to cutting the programs or funding the executive agency has requested, especially for health-related agencies.

One example is the Housing Opportunities for Persons with AIDS (HOPWA) program, which Aderholt referred to in his speech. The House’s bill maintains a $505 million budget for HOPWA even though the White House recommended eliminating the program entirely.

Meanwhile, the Senate’s version of the full-year government funding bill — passed in September — fully maintains funding for HOPWA and Ryan White. It also provides billions to the CDC for prevention of sexually-transmitted diseases, including HIV/AIDS.

This reflects the Senate’s wariness in cutting HIV/AIDS programs, which Senate Republicans have acknowledged have been impactful.

Sen. Susan Collins (R-Maine), chair of the Senate Appropriations Committee, called PEPFAR “an enormous success” to defend taking it off the chopping block in a recissions package earlier this year, which the House had urged the Senate not to do at the time.

“I can’t imagine why we would want to terminate that program,” she said.

The Department of Health and Human Services (HHS) spokesperson told The Hill that critical HIV/AIDS programs would “continue through the Administration for a Healthy America” in response to a request for comment about proposed cuts to domestic HIV services.

The Trump administration proposed reorganizing the HHS to create the Administration for a Healthy America — but the agency currently remains theoretical. Congress has taken no steps to approve or create it.

**Cuts ‘mean death’ **

The differing proposals for funding HIV services has both angered and saddened advocates, who are unable to gauge the federal government’s interest in continuing to fund formerly bipartisan programs.

“It’s a wide swath of different threats that we’re facing as a community, and it feels particularly targeted to the HIV community at this point, given the disproportionate amount of focus that we are seeing on our funds,” Johnson, PrEP4All’s executive director, said.

HHS layoffs earlier this year led to several divisions dedicated to HIV services, including the Office of Infectious Disease and HIV/AIDS Policy, being gutted or eliminated.

Over the summer, the Trump administration passed the “big, beautiful bill” — a large tax and spending bill that took billions of dollars away from Medicaid, a federal and state insurance plan that is the largest source of insurance coverage for approximately 1.2 million people living with HIV in the U.S.

Medicaid covers treatment costs for about 40 percent of adults accessing HIV treatment, Lyndel Urbano, the senior director of public policy and government relations at insurance company Amida Care, said.

This includes costs for including pre-exposure prophylaxis (PrEP) and the newly-approved “miracle drug” lenacapavir, a twice-yearly injectable lauded by experts for its potential to revolutionize HIV care.

“The thing about these drugs is that they’re not cheap,” Urbano said. HIV medications typically cost thousands of dollars and lenacapavir’s current price stands at around $28,000 per year.

Without Medicaid, Urbano said that people at risk for HIV or living with it — who are disproportionately low-income — wouldn’t have access to any form of treatment.

If either Trump’s lesser cuts or the House’s more substantial ones come to pass, Urbano said, this would further erode progress toward ending the HIV epidemic in the country. Programs disseminating HIV testing kits, providing training to medical professionals, and access to medical care in rural communities would all be cut.

“A lot of the guidance for how insurance companies cover things like these HIV prevention treatments start with the [Centers for Disease Control and Prevention (CDC] and the way that they approve the drug for prevention,” Urbano said.

The CDC PrEP Guidelines Work Group assessed lenacapavir and provided a “clinical recommendation” for its use in mid-September — a little over a week after Republicans on the House Appropriations Committee pushed forward the bill with HIV cuts.

Urbano worries the CDC’s increased politicization may result in yanked approvals for treatments such as lenacapavir.

“It’s just concerning to me what happens in the future,” he said. “We want a situation where people don’t have to jump through hoops to get something that could actually change lives.”

Jenny Collier, CEO of Collier Collective, which advises the #SaveHIVFunding campaign on policy said patients are upset and confused amid the turmoil.

“People aren’t sure if they’re going to be on waiting lists, or they can get their meds fully paid for, or their co-pays will be covered, or if their other support services, like transportation, will be provided,” she added.

Muñoz, the #SaveHIVFunding campaign affiliate, said his access to medication would likely end without federal support or programs.

The actor, who has worked on Broadway shows like “Hamilton,” said his health insurance is based on his employment. In periods without health insurance coverage, he relies on community organizations and health centers — many of which receive federal funding — to access HIV medication.

“Cuts to HIV funding means death,” he emphasized. “That is not an exaggeration. These drastic cuts mean death for anyone who needs assistance to afford life-saving and life-sustaining medications.”

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