In his 2019 State of the Union address, President Donald Trump pledged to boost HIV spending, with the lofty goal of bringing the nation’s epidemic to heel by 2030. Last year, this federal initiative, Ending the HIV Epidemic, demonstrated progress.

This year, however, Republicans are seeking deep cuts to HIV prevention and treatment funding. The Trump administration proposed in its 2026 budget request to eliminate the Centers for Disease Control and Prevention’s HIV-prevention division, and House Republicans are seeking nearly $2 billion in HIV-related cuts in their federal health spending bill. The Senate, on the other hand, proposes to keep HIV funding essentially at current levels in its corresponding proposal.

To become law, any funding bill must pass both chambers of Congress, which would require the backing of at least some Senate Democrats, and have Trump’s support. 

But while these are just proposals at this point, they are a reflection of where many Republicans — who control the White House and both chambers of Congress — stand on the issue and would result in a dramatic disinvestment in funding that has often received bipartisan support. 

“Donald Trump and House Republicans are cutting lifesaving programs to the bone so they can give tax breaks to billionaires and big corporations,” said Sen. Tammy Baldwin, D-Wis., who co-wrote the bipartisan health spending bill in the Senate.

Neither the White House nor the office of House Speaker Mike Johnson, R-La., responded to requests for comment. 

After decades of benefiting from robust federal funding, much of it bipartisan, HIV advocates have watched as the current Trump administration has targeted prevention and treatment efforts for the disease with steep cuts, including sweeping terminations of National Institutes of Health research grants andinternational aid.

However, leadership at the National Institute of Allergy and Infectious Diseases, an NIH division, heard an optimistic address from NIH Director Dr. Jay Bhattacharya on Thursday. In his taped speech, Bhattacharya listed as a top priority achieving the goals of the Ending the HIV Epidemic program.

“We have now in our capacity the ability to actually end the HIV epidemic by 2030, to reduce HIV transmission to very, very low levels. And we just need to figure out how to do it,” he said.

Bhattacharya pointed in particular to the recent approval of Yeztugo, a long-acting injectable form of HIV-prevention medication, or PrEP, that all but eliminated HIV risk in clinical trials, and he promised NIH research into how to best roll out Yeztugo as well as into improving the nation’s rate of successful HIV treatment. He did not, however, mention the Trump administration’s sweeping cancellation of existing HIV-prevention research grants earlier this year or the efforts by the White House and House Republicans to gut the Ending the HIV Epidemic program and the CDC’s HIV-prevention work. 

In response to NBC News’ question about the apparent contradiction between his address and the aims and actions of the Trump administration and House Republicans, Bhattacharya responded in a text message: “There’s no contradiction. At the NIH, we’re working on an initiative to accomplish the president’s goal of reducing HIV transmission to near zero by the end of the decade. This is now technically possible thanks to new innovations in PrEP. What is needed is excellent implementation science, which the NIH will conduct.”

HIV advocates said they remain concerned that the destabilization the Trump administration has brought to the HIV prevention and research fields will blunt Yeztugo’s impact.

HIV policy experts expressed cautious optimism that the Senate’s funding bill would prevail, though they said the mood among them remains grim.

“Folks are devastated,” said Drew Gibson, director of advocacy at AIDS United. “But we’re not going to sit back and accept this as fate.”

Even if the Senate’s flat funding wins out, worry persists among HIV advocates that Trump’s Office of Management and Budget will, as it has in other circumstances, refuse to distribute funds Congress has allocated to combat the virus.

Kathleen Ethier, who left the CDC in early January and whose long tenure included time in the STD-prevention division, said the Trump administration’s actions concerning the adjacent HIV division, including mass layoffs and then reinstatements, had already compromised the CDC’s HIV-prevention mission. 

“Everyone I’ve talked to who’s still inside at CDC is frightened for their jobs, demoralized by the leadership, not able to get very much work done,” she said.

Ernest Hopkins, a veteran policy strategist at the San Francisco AIDS Foundation, said that, in a departure from tradition, OMB had shut out HIV lobbyists such as him from meeting with them during this budget cycle.

Eliminating the CDC’s HIV budget, which the House bill proposes, “would have an absolutely disastrous impact,” Hopkins said. “We would see a significant spike in HIV infections across the board.”

The OMB did not respond to a request for comment. 

Last year, the CDC estimated that from 2018 to 2022, annual HIV transmissions declined by 12%, to 31,800. (No updated estimate was issued this year due to layoffs among staffers who conduct these calculations.) Notably, in the 48 hot-spot counties and other jurisdictions targeted by the Ending the HIV Epidemic funding, cases declined by an estimated 21% since the program’s baseline year of 2017.

The lion’s share of the CDC’s HIV-prevention budget goes to support state and local health departments and community-based organizations in conducting on-the-ground work against the epidemic. Many of these departments depend entirely on these federal grants for their HIV work, and experts said many smaller nonprofits could fold absent such funding.

According to an analysis published in April in the journal AIDS and Behavior, halting the CDC’s HIV-prevention efforts would, from 2025 to 2030, increase the total number of new cases of the virus by more than 213,300 and the number of HIV-related deaths by over 10,600. 

The increased lifetime medical expenses of those new cases, the study projected, would be $52.4 billion — a cost that dwarfs the proposed federal spending cuts and that would likely be shouldered considerably by taxpayers through Medicaid.

“Ending HIV prevention efforts means the epidemic will get worse, lives will be lost, and not only will money not be saved but the net additional medical costs will rapidly increase,” wrote the study’s author, David R. Holtgrave, a senior policy adviser at the New York State Department of Health.

Dr. Anthony T. Fojo, an HIV researcher at Johns Hopkins University School of Medicine, pointed to what could be the loss of myriad HIV-related functions currently backed by CDC funding. This includes providing HIV tests; identifying infection clusters; facilitating referrals for HIV-prevention drugs and for HIV treatment; and coordinating outbreak responses, such as for the recent large cluster among drug users in Maine.

House Republicans also seek to cut $525 million, or 20%, of the budget for the Ryan White Program, which covers comprehensive care and treatment for low-income people with HIV. Fojo said these cuts would compromise many people’s HIV-treatment outcomes. Because successful treatment eliminates transmission risk, he projected this cut alone would raise the number of new infections by 12% by 2030.

Dr. M. Chase Cates, medical director at the Alamo Area Resource Center, a Ryan White-funded clinic in San Antonio, said, “If we lose that funding, we lose resources to help those with HIV, like making sure they have access to their medications that are literally keeping them alive and healthy.”

When asked about the proposed HIV-prevention budget cuts and the concerns of HIV experts and advocates, a spokesperson for Health Robert F. Kennedy Jr. said, “Secretary Kennedy remains firmly committed to science-based public health policy.”

“Critical HIV/AIDS programs, in particular, will continue under the Administration for a Healthy America,” the spokesperson added.