Proposed cuts could reverse decades of progress, warns Presidential HIV council

Carole Treston began her career as a nurse and recalls a formative visit to Washington, D.C., with her mother to see the AIDS Memorial Quilt displayed on the National Mall. First presented in 1987, the quilt serves as a powerful tribute to lives lost to the AIDS epidemic. Walking among the rows of intricately stitched panels, Treston remembers the silence that enveloped her mother, who paused in front of panels bearing birth years similar to Trestons own.

She said, most of these have birth dates around the same as you, Treston recounted nearly forty years later. She described the early years of the epidemic as a time marked by overwhelming despair, where hope was scarce, and loss was omnipresent.

For younger generations, the early trauma of the epidemic is largely historical, framed through documentaries or textbooks. Todays youth have grown up with antiretroviral treatments, preventative medications, and the possibility of maintaining an undetectable viral load. Yet as World AIDS Day approaches, advocates caution that forgetting those early years can obscure the fragility of current progress.

With Congress still negotiating next years budget, proposed cuts to HIV programs have raised alarms. Several members of the Presidential Advisory Council on HIV and AIDS (PACHA) issued a letter urging lawmakers and the White House to maintain funding, warning that reductions could reverse decades of progress.

The council, composed of researchers, clinicians, and community leaders, advises the Department of Health and Human Services on HIV policy. Members have noted the council has not convened this year, raising concerns about its ability to fulfill its advisory role. In their letter, they highlighted that the United States continues to see over 30,000 new HIV cases annually. Without sustained investment, they warned, new infections could rise and public health could suffer.

The council referenced the bipartisan Ending the HIV Epidemic initiative, launched in 2019, which helped achieve a 12% reduction in new cases. Full funding could potentially save up to $100 billion in health care costs by 2030. Proposed House budget cuts threaten domestic and global HIV programs, reduce funding to the CDC by over $1 billion, and scale back key components of the Ryan White Program that supports people living with HIV.

White House spokesman Kush Desai dismissed the council as largely symbolic, stating that its efforts are unrelated to the administrations initiatives on HIV and AIDS. He emphasized that HHS is advancing prevention and treatment, improving viral suppression through the Ryan White program, and expanding access to accurate HIV information.

For Treston, who has treated patients since 1986, the threat of losing momentum is deeply personal. Tori Cooper, another PACHA member and director of community engagement for the Human Rights Campaign Foundations Transgender Justice Initiative, stressed that the stakes are life-and-death. Untreated HIV leads to serious illness and often painful deaths, impacting people from all walks of life.

Cooper warned that restricted access to testing and care could increase preventable infections. Detectable viral loads make it easier to transmit HIV sexually, perinatally, or through accidental exposure. Dr. Philip Chan, an HIV physician who drafted the PACHA letter, echoed the concern, emphasizing that HIV does not discriminate by politics, religion, or identity. He stressed that continued investment is essential to maintain the progress of Ending the HIV Epidemic, which aims to reduce new infections by 75% by 2025 and 90% by 2030.

The AIDS Memorial Quilt remains for Treston a poignant reminder of lives lost, but she believes the nation can still prevent repeating history. Highlighting the bipartisan achievements in HIV policyfrom early federal legislation to PEPFAR and the Ryan White Programshe argued that the United States has the tools to end the epidemic. We can stop new HIV infections and maintain the health of those already living with HIV, Treston said. Achieving an end to the epidemic requires continued federal support that has made these gains possible.

Analysis: The Fragility of HIV Progress and the Looming Budget Cuts

The ongoing debate surrounding funding for HIV programs highlights a critical moment in the fight against the epidemic. While recent advancements in treatment and prevention have drastically reduced the impact of HIV for many, the battle is far from over. With the U.S. government negotiating its budget for the coming year, proposed cuts to essential HIV programs raise serious concerns among advocates and health professionals alike.

The Presidential Advisory Council on HIV and AIDS (PACHA) has been outspoken in its opposition to these cuts, warning that they could reverse decades of progress. Despite this, the White House has downplayed the significance of the council, signaling a shift away from comprehensive advisory roles in favor of administrative initiatives. This disconnect points to a broader issue: the need for sustained, bipartisan support for HIV prevention and treatment to ensure continued progress.

While younger generations may perceive the early years of the AIDS epidemic as historical, the lessons learned during those dark times should not be forgotten. Treston's reflection on the AIDS Memorial Quilt serves as a reminder of the lives lost in an era when hope was scarce. The fight to end HIV/AIDS continues to demand attention, funding, and collaboration from all sectors of society to avoid falling backward.

As the situation unfolds, it is clear that while medical advancements provide a hopeful outlook, the risk of complacency is real. Only through continued commitment to public health initiatives can the momentum achieved in reducing new HIV infections be maintained. The stakes are high, and the cost of inaction could be the loss of invaluable progress made in the last few decades.

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• Presidential HIV council warns proposed cuts could reverse decades of progress