The current presidential administration is slashing the lifesaving PEPFAR program for HIV relief, despite earlier public assurances to lawmakers and advocates that funding for the program was secure.
Funding will be cut by half for both this and next year’s federal budgets, before he shuts down the President’s Emergency Plan for AIDS Relief (PEPFAR) completely, according to members of the program’s staff as well as budget documents viewed by The New York Times.
PEPFAR has saved an estimated 26 million lives since it was introduced by President George W. Bush in 2003.
The massive cuts come after PEPFAR’s supporters were lulled into thinking that the program was secure. Last July, the White House relented and restored $400 million in cuts to the program.
That fight, in the face of bipartisan Senate opposition, was a distraction, according to staff members who work for PEPFAR, because they’ve been repeatedly told by the federal Office of Management and Budget (OMB) that the program would be receiving less than half of the $6 billion appropriated by Congress for the 2025 fiscal year — even after the $400 million was officially restored.
But even that money hasn’t been restored, according to a federal budget tracking website that was disappeared by the presidential administration in January and restored by court order just last week.
Failure by OMB Director Russell Vought to appropriate the money is a de facto spending cut, according to Sen. Patty Murray (D-WA), who serves as vice chair of the Senate’s Appropriations Committee.
“Even after promising Republican lawmakers that the program would be protected, Russ Vought has choked off a huge chunk of funding provided by Congress for PEPFAR,” she said. “And he’s managed to hide this cut from lawmakers and the public until now because he took down a key spending transparency website.”
According to PEPFAR staff, they were told that the program would be given a maximum amount of $2.9 billion out of the original $6 billion commitment to the program. PEPFAR staff were told that they should make plans with implementing partners around the globe accordingly. Those staffers spoke on condition of anonymity out of fear of reprisal.
Further dilution of PEPFAR’s mission, mandated by Congress to cover HIV prevention alone, is occurring alongside budgetary cutbacks for preventing other diseases worldwide. Funds are being cut for “Global Health security, Tuberculosis, Malaria, and Polio eradication and prevention,” according to an OMB document.
The massive funding cuts coincide with Secretary of State Marco Rubio’s plan to shut PEPFAR down completely, cutting some countries off within just two years, and shuttering the entire program within eight.
Observers have said that the cuts will worsen HIV epidemics abroad, destabilizing African regions, and making them more susceptible to warlords and other national security risks.
Grazell Howard is a living embodiment of the Black AIDS Institute’s motto of “Our People. Our Problem. Our Solution.” Clear-eyed about the failures of a movement to truly address the needs of those most impacted by the virus, her assessment of this moment in which Black and brown communities are still disproportionately affected by HIV is simple.
“I think what we did, unintentionally, is we went to the largest disease-burdened group, which were men who have sex with men — and that’s fine, that’s what you’re supposed to do,” she said. “However, we never then came back and said, ‘It impacts all of us. We are all in it together.'”
As the Black AIDS Institute, or BAI, celebrates over 25 years of service to the community, Howard’s vision as managing director and chair of the organization’s Board is about meeting the entire Black community where it is now. And though ongoing, politically motivated rollbacks in funding and other support for this vital work may complicate things, she’s undaunted by the journey ahead.
“HIV 40 years ago is not HIV today,” Howard admits. “But what we have to do now is look at the messaging intergenerationally, look at the messaging intraracially, and then lay the truth on top.”
BAI was founded as a nonprofit in 1999 by pioneering activistPhill Wilson to mobilize and educate Black American communities about HIV/AIDS treatment and care. Whereas the prevailing activism at the time was concentrated in gayborhoods that were largely white, Wilson recognized that without addressing the epidemic in Black communities, HIV/AIDS would never be eradicated. As the only “uniquely and unapologetically Black HIV think and do tank in America,” the organization continues to be on the front lines — whether that’s on the campuses of historically Black colleges and universities, at ballroom community gatherings, or at events like Essence Fest and the Pan African Film Festival. And what they are noticing is that there is still work to be done.
“There’s a popular misconception that HIV isn’t a problem anymore or it’s under control, especially since now, we live in a day where HIV isn’t necessarily a death sentence anymore like it used to be back in the day,” said Justin Proctor. As BAI’s senior prevention manager, he’s heavily involved in the group’s testing and other outreach activities. “A big part of what we do is just reminding people that not only is it not gone, but it affects our people majorly.”
According to the most recent CDC data, Black communities accounted for 38 percent of new HIV diagnoses and 37 percent of estimated new infections in 2022. Black women were diagnosed more often than other women, as were Black men as compared to non-Black men. Within trans communities, Black trans women and Black trans men shoulder the highest percentage of diagnoses among racial-ethnic groups, as well, according to 2019 CDC data. Black people are also significantly underrepresented in data about users of PrEP.
Perhaps the biggest persisting challenge to BAI’s efforts is at the intersection of homophobia and stigma, which can also be heavily influenced by religion.
“Sometimes we see people who have had a bad experience with HIV/AIDS [education or care],” said Lauren Grayson, BAI’s community mobilization and HBCU specialist. “Sometimes it’s stigma that’s out here. We see people who aren’t willing to engage with us, and that’s okay, but I’m going to hand you a flyer anyway and have a blessed day.”
Proctor attempts to actively confront such challenges in the field by being an example.
“A lot of the times when we go to these things, people think I’m gay or they think I have HIV or both, and they’re very surprised to find out when I’m not,” he said. “And even though that sense of stigma and the assumption was there, once they find out, it’s the opposite. Their curiosity opens up, and then they’re like, ‘Well, dang, maybe I should pay attention to this more.’”
Then there is the general distrust some people in Black communities have of the health care system at large, considering generations of medical violence and exploitation enacted upon Black people. That distrust is certainly magnified now as the Trump administration significantly alters the U.S.’s national and international HIV response by cutting necessary funding — to the tune of millions — that supports research, community outreach, testing, treatment and more worldwide. Domestically, these cuts have caused local health departments and community groups to end some of the care they previously provided.
“But despite the current administration trying to get in our way, we’re showing up and we’re being bold and Black and loud in all that we do,” Grayson said.
Grazell Howard, board chair and managing director of BAIIrvin Rivera (provided)
Proctor added: “It kind of helps with the community to see that even though they’re doing these things and they’re stripping these programs, the Black AIDS Institute is still out here fighting for us. We’re finding workarounds and loopholes. They close the door, we’re opening a window, and we’re still finding a way to get the work done.”
And in so many ways, that is the history of BAI, Howard insists: finding a way or making one.
“We were the canary in the mine,” she said. “We are the mobilizer. We were the ones who carried the weight during a time when it was uncertain.” Though the path forward right now may look a little different — “radically partnering intergenerationally and multi-generationally, being connected in a message that says HIV education and care is for everyone, and challenging the capitalistic side of pharma,” she added — the mission is the same.
Two senior House Democrats, including the first out gay immigrant member of Congress, are demanding records and explanations from Health and Human Services Secretary Robert F. Kennedy Jr. following what they describe as a politically driven dismantling of HIV prevention, treatment, and research programs under the Trump administration’s fiscal year 2026 budget proposal.
In a Thursday letter to Kennedy, Rep. Robert Garcia, ranking member of the powerful House Oversight Committee and representing California, and Rep. Raja Krishnamoorthi, ranking member of the Oversight Subcommittee on Health Care and Financial Services and representing Illinois, accused HHS of systematically abandoning decades of bipartisan progress in the fight against HIV and AIDS in both domestic and global contexts.
The lawmakers said the cuts appear driven by conspiracy theories and misinformation, including Kennedy’s previous false claim that HIV does not cause AIDS. Kennedy has claimed that the AIDS crisis was caused by poppersand a “gay lifestyle,” falsely asserting that the virus was not infectious and instead “environmental.” He has also likened transgender youth to chemically altered frogs, repeating debunked claims that environmental toxins are “forcibly feminizing” boys.
Under Kennedy’s leadership, HHS eliminated the CDC’s HIV prevention division, cancelled a $258 million NIH vaccine initiative, and terminated dozens of research grants, including those focused on prevention among Black and Latino gay men. Providers, the letter states, were left in limbo when HHS failed to notify state and local health departments about grant statuses.
“These disruptions would threaten Americans most at risk of contracting HIV,” Garcia and Krishnamoorthi wrote. “This decision is absolutely reckless and puts millions of lives at risk,” Garcia added in a statement, emphasizing the severity of the impact. “Oversight Democrats refuse to let Secretary Kennedy’s reliance on conspiracy theories and misinformation threaten public health. We will fight back against every attack.”
Krishnamoorthi echoed the urgency, calling the rollback “scientifically indefensible—it’s morally unconscionable,” and warned the United States is reversing decades of bipartisan gains in HIV and AIDS prevention and care. The letter also addresses the administration’s January pause on all foreign aid, including funding for the President’s Emergency Plan for AIDS Relief. While Congress later protected PEPFAR funding amid bipartisan concern, the lawmakers warn that broader global programs remain at risk, with the potential to cause over 100,000 HIV-related deaths in sub‑Saharan Africa in a single year.
The letter warns that the budget’s proposed $1.5 billion cut to domestic HIV programs could result in more than 143,000 new HIV cases and 127,000 deaths within five years. It further expresses concern that funding decisions, which also threaten access to newly approved injectable treatments like lenacapavir, are being made without a clear evaluation of equity or scientific integrity.
“This was our chance to take HIV prevention to a whole new level, and instead we’re hitting the brakes,” Yale researcher Jirair Ratevosian previously toldThe Advocate. “This isn’t just bad policy, it’s a direct threat to public health.”
Garcia and Krishnamoorthi have requested all records and communications about the cuts from HHS by July 31. The department did not respond to The Advocate’s request for comment.
The original rescissions package Trump requested called for $400 million in cuts to PEPFAR, the President’s Emergency Plan for AIDS Relief, which George W. Bush started in 2003.
But in the Senate, Democrats and a handful of Republicans objected to the PEPFAR cuts. Appropriations Committee Chairwoman Susan Collins, R-Maine, said the health program had saved an estimated 26 million lives and allowed nearly 8 million babies to be born healthy to mothers living with HIV.
“There are some cuts that I can support, but I’m not going to vote to cut global health programs,” Collins told reporters last week.
Seeking to tamp down the GOP rebellion, the White House this week agreed to make changes to the package, dropping the PEPFAR cuts to secure GOP votes.
“PEPFAR will not be impacted by the rescissions,” White House budget director Russell Vought told reporters after he huddled behind closed doors Tuesday with Senate Republicans.
Removing those cuts, Vought said, means the package has “a good chance of passing.”
The rescissions package, which would claw back $9 billion in congressionally approved funding for foreign aid and public broadcasting, narrowly passed the Senate early Thursday on a 51-48 vote. Collins was one of two Republicans to vote against the package, lamenting that the White House had not provided details of the cuts and that “nobody really knows what program reductions are in it.”
The House passed the package of cuts early Friday and Trump has vowed to sign it into law.
The White House’s original rescissions request sent May 28 detailed that the cuts would target only HIV/AIDS programs that “neither provide life-saving treatment nor support American interests.”
“This rescission proposal aligns with the Administration’s efforts to eliminate wasteful foreign assistance programs,” the request said. “Enacting the rescission would restore focus on health and life spending. This best serves the American taxpayer.”
But even some deficit hawks in the House said they supported the decision to preserve PEPFAR funding.
“It’s very successful. I think it serves a useful purpose,” said conservative Rep. Gary Palmer, R-Ala., who voted for the rescissions package.
Rep. Tim Burchett, R-Tenn., a member of the Foreign Affairs Committee who also supported the package, said, “It’s half the money we’ve given to Ukraine, and it’s saved 25 million lives.”
Senate Minority Leader Chuck Schumer, D-N.Y., slammed the legislation and said the PEPFAR-related changes were insufficient.
“Cuts to foreign aid will make Americans less safe. It will empower our adversaries,” he said. “The changes Republicans say they’ve made to PEPFAR are not enough, and nobody’s fooled by small tweaks to this package.”
Some advocates were relieved by the removal of PEPFAR cuts but disappointed with the overall package.
“It is always good news when lawmakers prioritize children, especially children who are orphaned or vulnerable to HIV and AIDS. But the larger trend here is not hopeful,” said Bruce Lesley, the president of First Focus Campaign for Children.
“While a few senators persuaded their colleagues to preserve funding for these children in this case,” he said in a statement, “the Senate’s overall decision to hand $9 billion back to the President suggests that what the legislature does actually doesn’t matter.”
It has been said that the first Pride was a riot, sparked by the Stonewall Uprising in 1969. The meaning of Pride Month has expanded and evolved since Stonewall and the subsequent first Pride Parade in 1970. Though Pride was established before the rise of HIV and AIDS, HIV awareness and advocacy have stood at the center of Pride since the early days of the illness.
Though HIV is no longer the death sentence it once was, there are still approximately 1.2 million people living with HIV in the United States and over 30,000 new infections every year. The continued prevalence of HIV means that HIV education and advocacy still play an important role in Pride Month.
Pride Month presents an opportunity to spotlight advancements made in HIV prevention and treatment. It also gives advocates a chance to take the world stage and be heard, letting people know that HIV is still a factor in the lives of many, especially those within the LGBTQ+ community. Pride is a time to remember the fight for equality, to celebrate living authentically, and to deepen bonds within the community. It can also be a time for promoting testing, educating the public, and keeping the fight to end HIV alive.
Deepening the meaning of Pride
Since its inception, Pride has grown year by year into a worldwide celebration. During the height of the HIV/AIDS epidemic in the mid-1980s through the early 1990s, Pride celebrations were intermingled with protests and rallies advocating for more attention to prevention and care for those living with HIV and AIDS. Activists pushed for government intervention at a time when many government officials refused to say the word “AIDS” and the spectre of the disease – and the neglect of people living with it – overshadowed much of the Pride movement for well over a decade.
Today, while Pride Month remains focused on justice and equality for the LGBTQ+ community, HIV advocacy should still take a front seat. This is particularly true in the South, which carries a disproportionate burden of HIV infections.
Regional statistics mixed with a persistent stigma and higher rates of HIV infections among groups such as Latino and Black gay and bisexual men compound the need for more attention on HIV during Pride Month. Working to combat the stigma surrounding HIV and AIDS and promoting information about prevention and care can deepen the meaning behind Pride, making the entire month even more impactful.
Promoting community-led care
Pride Month opens doors for inclusive, community-led advocacy and care in 2025, especially for those in areas of the country with higher rates of HIV infections and a greater need for access to prevention methods. HIV advocacy and care in 2025 looks like cultural understanding, expanded accessibility, and leadership in individual communities and the broader LGBTQ+ community. Partnerships between advocacy groups, community leaders, and health organizations are crucial for achieving the goals we must set each Pride Month. These goals should include reducing stigma and expanding educational resources, especially in areas heavily impacted by the disease, such as the Southern United States.
New care models highlighted during Pride Month must be inclusive of the communities most impacted by HIV today and tailored to diverse experiences across those communities. One mission of Pride Month is the building of trust between community leaders, advocacy groups, and health organizations and those who need the most attention, such as those living with HIV or AIDS.
Pride must not only be a month for education and advocacy, but also for recognizing those who have participated in making HIV an increasingly manageable condition. So many in the LGBTQ+ community are living long, healthy lives with HIV. That in and of itself is worthy of celebration.
Honoring the roots of Pride Month
Pride indeed began as a riot – a collective uprising against discrimination, hate, and inequity. As the HIV/AIDS epidemic took hold, the continued need for collective work toward a better future was evident.
Today, Pride is still an uprising. Keeping HIV awareness and prevention at the heart of Pride Month deepens its mission and continues the promise that no one in the LGBTQ+ community will be left behind or forgotten, in June or any other time.
As we celebrate flying the rainbow flag, marching in parades, and participating in all that makes Pride wonderful, it’s crucial to remember that Pride Month can also be a time of deeper significance. The reality of HIV persists, and Pride Month can be a time to shine a greater spotlight on what still needs to be done to protect the LGBTQ+ community and take greater strides toward eliminating HIV once and for all.
By weaving stigma-fighting prevention campaigns and collaborative efforts between community leaders and health organizations into the celebratory mission of Pride Month, more progress can be made in prevention and care.
Since 1989, the LGBT Life Center in Norfolk, Virginia, has built up what CEO Stacie Walls calls a “test and treat” model. For every patient that walked through the doors of their HIV clinic after working up the courage to get tested, there had been the promise that, if they tested positive, all they’d need to do to get treatment was walk down the hallway.
But since the Trump administration’s sweeping cuts to HIV funding took place earlier this year, that’s no longer the case. “The grant money that pays for people who are uninsured is the grant money that they have canceled,” Walls told Uncloseted Media. “That’s so disheartening and scary and goes against everything that we’ve ever wanted to embrace as a nonprofit service agency.”
With these cuts, staff now have to send uninsured patients to the next nearest community HIV program in Hampton, a 30-minute drive away. Walls says they’ve already had to transfer 19 existing patients, including some of their frequent client base of low-income LGBTQ people of color, who are disproportionatelyimpacted by the virus. While the center has been able to shift to covering at least their initial treatment appointment, they are unable to cover further care, and Walls says that even this is not sustainable.
The LGBT Life Center is just one of the many U.S.-based HIV organizations and programs that have fallen victim to the billions of dollars worth of cuts by Trump and his newly created Department of Government Efficiency.
HIV funding has been hit particularly hard: Uncloseted Media estimates that the National Institutes of Health (NIH) has terminated more than $1 billion worth of grants to HIV-related research.1 In addition, the U.S. Agency for International Development (USAID) has terminated 71% of all global HIV grants, and the President’s Emergency Plan for AIDS Relief (PEPFAR) has been the subject of temporary suspension and major proposed cuts.
Additional cuts are also on the horizon, with the Trump administration’s budget proposal for Fiscal Year (FY) 2026 calling for the closure of all Centers for Disease Control and Prevention (CDC) HIV programs.
The effects of these cuts are deadly. Researchers estimate that PEPFAR’s funding freeze alone may already be associated with more than 60,000 deaths in sub-Saharan Africa, and numerous experts say that the entire global health system could be upended if the administration’s HIV cuts continue as planned. Mathematical models show that the worst-case scenario is apocalyptic: nearly 11 million new infections, 3 million deaths, and an infection rate outpacing the virus’s peak in the 1990s.
“This is not something that’s just a matter of the scientists losing funding; the community is losing funding, and in the long term, losing ground in the fight against HIV,” says Noam Ross, executive director at research nonprofit rOpenSci.
The Domestic Impact
Cuts to HIV funding in the U.S. have been a significant casualty of the Trump administration’s efforts to reduce spending and attack Diversity, Equity and Inclusion (DEI). Researchers behind Grant Watch, an independent third-party database of grants terminated by the NIH and the National Science Foundation, have identified HIV-related funding as one of the most common targets for termination. As of June 17, Uncloseted Media has calculated roughly $1.353 billion in HIV-related terminations in Grant Watch’s NIH database, accounting for more than a third of the $3.7 billion in recorded NIH cuts overall.
List of terminated HIV-related grants in Grant Watch’s database | Screenshot
“They’re certainly casting an enormously wide net in this,” says Ross, who is also Grant Watch’s co-developer. “It doesn’t matter that they’re not explicitly saying that ‘it’s a war on HIV’ because if they’re gonna have a war on sexual minorities and transgender people, it’s a war on HIV too.”
The Department of Health and Human Services (HHS) has explicitly told HIV groups across the country that funding was cut because it believes health research for LGBTQ people and racial minorities is unscientific. Researchers across the country have received letters and emails from the NIH with nearly identical statements informing them of their grant terminations:
“Research programs based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness.”
One of the programs subjected to cuts is the Adolescent Medicine Trials Network (ATN), an HIV program that has been active since 2001. Its goal is to prevent, diagnose, and treat HIV in young people.
Research under ATN’s umbrella has seen promising developments, including progress towards a product that could combine PrEP and birth control into one pill as well as new methods for reducing HIV transmission in young men who use stimulants. Despite this, NIH cut $15 million worth of grants to ATN because of its focus on high-risk LGBTQ youth populations. The program’s funds were later restored, but only after ATN agreed to cut off a study on transgender youth of color.
“There are particular issues around Black women, LGBTQ people, [and] the type of treatment that they need … that’s the social side of medicine, which is a very important part of medicine—it’s not just molecules, it’s people,” Ross says, adding that grantees focused on “delivery and participation and how to keep people in care,” such as programs that help vulnerable populations stay on PrEP or undetectable folks maintain their antiretroviral therapy regimen, are “very undervalued by [the] administration.”
“So that stuff feels like it’s faster to get canceled,” he says.
Rowan Martin-Hughes, senior research fellow at the Burnet Institute in Australia, says cutting programs that support prevention and long-term treatment is dangerous.
“With other infectious diseases, you treat people and then they’re recovered; with HIV, people require lifetime treatment,” he told Uncloseted Media. “Most of those people infected with HIV are still alive, and if you take treatment away from them, many people will die. And because treatment is also the best form of preventing transmission, many millions of additional infections will occur.”
Many advocates and lawmakers are pushing back against the cuts. Earlier this month, a federal judge in Boston ruled that the NIH’s DEI-related grant terminations—including many HIV programs—are illegally racist and discriminatory toward LGBTQ people, saying that in his four decades as a judge, he had “never seen a record where racial discrimination was so palpable.” HHS officials say they will consider an appeal.
NIH is far from the only agency issuing massive cuts to HIV. The CDC has terminated large grants to numerous HIV clinics across the country. Los Angeles-based St. John’s Well Child and Family Center lost $746,000, and the LGBT Life Center in Norfolk has lost over $962,000 and could potentially lose a whopping $6.3 million, which makes up 48% of their operating budget. Walls says it’s not just their treatment model that’s taken a hit—the center had to cancel 16 free mobile testing events in June alone, which she fears could cause many more people to contract the virus without knowing, contributing to its spread.
“When we’re out in the community in our mobile testing van, it’s super convenient for people. We’re parked there, they can just walk through, get their test and keep on going, and so that is a low-barrier way to test,” says Walls, who says that easy access is critical for low-income LGBTQ people of color. “[Without it], thousands of people that we test every month or every year are not going to be tested.”
The Vaccine Impact
DEI isn’t the only reason the government has given for HIV-related cuts. The Center for HIV/AIDS Vaccine Development (CHAVD), a consortium of researchers at Scripps Research and Duke University, was informed last month that, after seven years of funding from NIH, their grant would be terminated next year.
Dennis Burton, the program’s director, says they are close to a major breakthrough, with promising technology based on broadly neutralizing antibodies that can disable thousands of different strains of HIV being nearly ready for clinical trials in humans. But without NIH funding, the project may be unable to continue.
“It would put back the development of an HIV vaccine by a decade or longer,” Burton told Uncloseted Media. “We begin to see the light at the end of the tunnel … it’s just the wrong time to stop.”
A senior NIH official told the New York Times that “NIH expects to be shifting its focus toward using currently available approaches to eliminate HIV/AIDS.”
And while Burton says that existing HIV treatment medicine like antiretroviral therapies is “a miracle,” the decision to jettison vaccine research in its favor is misguided.
“The drugs are fantastic … but they’re expensive and people have to take them—the great thing about a good vaccine is that with one or a limited number of shots you can get lifelong prevention,” says Burton. “We want people to live without the fear of HIV, and vaccines are the proven way of preventing viral infections and viral disease.”
The Global Impact
The most sweeping cuts to HIV funding have been to foreign aid. On his first day in office, Trump ordered a 90-day freeze on all foreign aid funding as well as a stop-work order for PEPFAR. While Secretary of State Marco Rubio issued a waiver to continue some critical operations, department memos specifically prohibited funding for PrEP for all populations except pregnant and breastfeeding women.
This move, coupled with the dissolution of USAID and a proposal to cut an additional $1.9 billion from PEPFAR in the FY26 budget request compared to the prior year, has created a perfect storm with staggering results.
The PEPFAR Impact Tracker, a project by Boston University infectious disease modeler Brooke Nichols, estimates that over 60,000 adults and over 6,000 children have died due to PEPFAR-related disruptions between January 24 and June 17. And a survey conducted over the first week of the stop-work order found that 86% of PEPFAR recipient organizations reported that their patients would lose access to HIV treatment within the next month, more than 60% had already laid off staff, and 36% had to shut down their organizations.
The impact hits the hardest in sub-Saharan Africa, the region with the highest HIV concentration, accounting for an estimated 67% of HIV positive individuals globally as of 2021. Numerous long-running and influential LGBTQ health clinics in South Africa have been forced to close, and an investigation by The Independent found that communities in Uganda and Zimbabwe are rapidly being torn apart as more people risk death from lack of access to HIV treatment due to the cuts.
Numerous LGBTQ people told the Daily Sun, a South African digital newspaper, that the closure of long-running clinics like Engage Men’s Health in Johannesburg and Wits Reproductive Health and HIV Institute was devastating.
“I take PrEP, but you can’t go to any clinic as a queer person and ask for it without people looking at you weirdly,” one trans person told the Daily Sun. “At the trans clinic, it was different. Everything was smooth, everything flowed.”
The U.S. has historically been the biggest contributor to fighting HIV, accounting for more than 70% of international funding, but they’re not the only ones making cuts. Following Trump’s example, U.K. Prime Minister Keir Starmer announced 6 billion pounds in funding cuts to foreign aid, including HIV, and France and Germany also announced multi-billion euro cuts.
“HIV has received a lot more funding than any other health area,” says John Stover, vice president for modeling and analysis at Avenir Health. “So it’s a likely target just because the money is so large.”
Martin-Hughes of the Burnet Institute thinks these cuts are dangerous for the entire global health system. He co-authored a study modeling the potential impacts of HIV funding cuts from the major global funders, and the results are grim.
In the worst-case scenario, where PEPFAR is discontinued with no replacement or mitigation alongside the proposed cuts from the top five biggest-spending countries, the study projects that there could be nearly 11 million new infections and nearly 3 million deaths by 2030, which would raise the annual infection rate higher than its 3.3 million peak in 1995.
This is not necessarily the most likely scenario, as PEPFAR is expected to be reinstated in at least some form. However, even the most optimistic estimates show that substantial cuts like the one proposed in the Trump administration’s FY26 budget could still put an end to 15 years of declining infection and death rates—especially since prevention and testing would likely be sacrificed first.
“The world has made really amazing progress on HIV,” Martin-Hughes told Uncloseted Media. “That kind of increase [in infections and death rates would be] a major reversal.” He says that major foreign aid cuts would leave programs for at-risk populations, such as gay and bisexual men, trans women, sex workers and people who inject drugs, particularly vulnerable to being shut down.
Cuts to PEPFAR, a program started by Republican president George W. Bush in 2003, have been controversial even among Republicans, with Senate Appropriations Chair Susan Collins publicly opposing them. While many researchers and policymakers advocate for funding and leadership on HIV to shift away from foreign aid and more towards local governments, Stover and other experts argue that that transition can only be possible with support from PEPFAR in the interim.
“Overall, we all have a vision of more local ownership and control over the resources and how they’re allocated,” Stover says. “[But] it takes time to make this transition, so it’s gonna be practically impossible if funding is just cut off abruptly.”
Cuts on All Sides
Walls says cuts are also happening at the state level. Virginia’s Republican governor Glenn Youngkin slashed hundreds of thousands of dollars for HIV programs, and Walls’ center recently lost multiple corporate donors, including Target, due to pressure from the Trump administration to roll back their DEI efforts.
She says that the fear of backlash for supporting LGBTQ initiatives is so pervasive that even some of their continued donors are now requesting that their contributions remain anonymous.
“Now, if Target was to advertise that they were giving money to the LGBTQ community center in their neighborhood or city, they would have consequences from the administration or even shoppers,” she says. “They’re not gonna take that risk.”
Meanwhile, Walls says the LGBT Life Center is staying afloat thanks to the local community stepping up, with an unprecedented number of people signing up to be volunteers and local restaurants and other businesses providing their assistance, whether that’s by participating in citywide fundraising events or offering to help paint the clinic.
“It is amazing to see, and I know that through all of this the community will help carry us through, because we have brought value to this community for 36 years and I feel confident that people see value in our services,” she says.
Still, experts, advocates, and infectious disease modelers agree that if HIV funding doesn’t continue, the effects will be devastating.
“I think it’s hard for people to look at these numbers and not feel like it’s important to prioritize,” says Martin-Hughes. “There needs to be, to avert these worst-case scenarios, sufficient funding for those programs.”
This story was originally published in Uncloseted Media. For all their LGBTQ-focused journalism, consider becoming a free or paid subscriber at UnclosetedMedia.com.
The Supreme Court on Friday granted the HIV-prevention field a historic win — yet with a major caveat — as it upheld a federally appointed health task force’s authority to mandate no-cost insurance coverage of certain preventive interventions, but clarifying that the health and human services secretary holds dominion over the panel.
The 6-3 decision in Kennedy v. Braidwood Management, Inc. essentially leaves in place a popular pillar of the Affordable Care Act, which mandates that most insurers cover various task force-recommended preventive screenings, therapies and interventions, with no out-of-pocket costs imposed on patients. The case reached the high court after a group of Christian businesses in Texas objected to being compelled to cover certain drugs used for HIV prevention, known as PrEP, given their claims that it “promotes homosexuality.”
“Since our efforts to address HIV in the U.S. are under attack on so many levels, preserving insurers’ requirement to cover preventive services, including PrEP, will help ensure access to people who need it,” said Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, a patient advocacy group in Washington, D.C.
But the court clarified the scope of the task force’s independence, thus potentially compromising its impact. Addressing concerns that the 16-membervolunteer task force’s power over insurers was unconstitutional, the justices asserted that the health secretary holds the authority to appoint and dismiss the panelists and to block their new recommendations from mandating insurance coverage. The secretary could also possibly direct the panel, including one stocked with his or her own hand-picked members, to revisit previous recommendations that have already gone into effect.
Given the unpredictable nature and unconventional approach to health policy of the current health secretary, Robert F. Kennedy Jr., HIV advocates are concerned that he might undermine the task force’s current or future endorsements of HIV-prevention medications, known as PrEP.
The ruling “is a victory in the sense that it leaves intact the requirement to cover task-force recommendations,” said attorney Richard Hughes, a partner with Epstein Becker Green in Washington, D.C., who represented a group of HIV advocacy organizations in submitting a friend-of-the-court brief in the casel. “It was always going to be a double-edged sword, as the political accountability that salvaged its authority comes with the ability to alter its recommendations.”
The U.S. has secured only a modest decline recently in HIV cases, and HIV advocates stand at a crossroads amid the Trump administration’s dramatic withdrawal of support for their cause.
Promisingly, the Food and Drug Administration last week approved a long-acting injectable form of PrEP, Yeztugo, made by Gilead Sciences. Injected every six months, Yeztugo overwhelmingly bested Truvada, a daily-pill form of PrEP also made by Gilead, at lowering HIV transmissions in clinical trials.
But Yeztugo has debuted as the Trump administration is gutting the Centers for Disease Control and Prevention’s HIV-prevention division and after it canceledscores of HIV-related research grants.
The plaintiffs’ initial religious-liberty complaint was ultimately dropped from the case. The court more narrowly considered the constitutionality of an ACA provision that lent effective authority to a longstanding volunteer medical task force to mandate no-cost insurance coverage to preventive interventions that the expert group rated highly, including PrEP.
The plaintiffs argued that because the task force was not appointed by the president and confirmed by the Senate, granting it such power over insurance markets violated the Constitution’s appointments clause. The justices grappledwith the task force’s balance of independence versus accountability. In particular, they sought to determine whether the task force members were appointed by the Senate-confirmed Health and Human Services secretary.
In addition to PrEP, the task force has issued high scores, for example, to screening for lung cancer, diabetes, and HIV; treatment to help quit smoking; and behavioral counseling to prevent heart disease.
Had the Supreme Court fully sided with the plaintiffs, insurers would have been free to drop such popular benefits or, at the very least, to impose related co-pays and other cost sharing.
Writing for the majority, Justice Brett Kavanaugh found that the health secretary has the power “to appoint Task Force members, and no statute restricts their removal.” He was joined by an ideological mix of colleagues, including Chief Justice John Roberts and Justice Amy Coney Barrett on the right, and Justices Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson on the left.
Concerns and uncertainty about Kennedy
HIV advocates expressed concern that Kennedy might undo the task force’s recommendation for PrEP, or at the least deprioritize ensuring that Yeztugo receives a clear coverage mandate.
Earlier this month, Kennedy dismissed the entire CDC Advisory Committee on Immunization Practices, or ACIP, and replaced them with his own hand-picked selections, including one notable anti-vaccine activist. At the first meeting of the newly formed committee this week, ACIP dropped recommendations for some flu vaccines over claims, widely debunked by researchers, that one ingredient in them is tied to autism.
Mitchell Warren, executive director of the HIV advocacy nonprofit AVAC, expressed concern about “what happened with the CDC ACIP this week, as it could be a harbinger of what a secretary of HHS can do to twist committees and task forces that should be composed of experts guided by science to ones that are guided by ideology and politics.”
In an email to NBC News, Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School, characterized Kennedy’s potential approach to overseeing the health task force as unpredictable.
“RFK has been skeptical of the medical approach to HIV/AIDS in the past, and that may color his attitude to revising PrEP guidance,” Shachar said.
A spokesperson for HHS said in an emailed statement that Kennedy “supports science-based public health policy and remains fully committed to HIV prevention.”
“Under his leadership, critical HIV/AIDS programs will continue as part of the newly established Administration for a Healthy America (AHA),” the spokesperson added.
In 2019, the health task force granted Truvada as PrEP a top rating. The drug was already widely covered by insurers. But under ACA rules, the task force’s recommendation meant that by January 2021, insurance plans needed to cease imposing cost-sharing for the drug.
The Centers for Medicare and Medicaid Services, or CMS, then clarified that insurers were also forbidden to impose cost sharing for the quarterly clinic visits and lab tests required for a PrEP prescription.
A CDC study published in October found that about 200,000 people were using PrEP at any point in 2023.
In 2019, the FDA approved another Gilead daily pill, Descovy, for use as PrEP. In late 2021, ViiV Healthcare’s Apretude — an injection given every two months — was also green lit.
The health task force gave top ratings to both of the newer forms of PrEP in 2023, which triggered a mandate for no-cost coverage to begin in January.
A generic version of Truvada emerged in 2020 and now costs as little as $30 per month. The list prices of the three brand-name PrEP drugs range from about $2,200 to $2,350 a month.
How the court’s ruling could play out for HIV prevention
Were Kennedy to appoint task force members who ultimately voided the PrEP coverage mandate, generic Truvada, at the very least, would still likely remain widely covered by insurance. But insurers would be free to demand cost-sharing for all forms of PrEP, including for required clinic visits and lab tests. And they could restrict access to the more expensive versions, including by imposing prior authorization requirements and higher cost sharing.
Research suggests that even a small increase in monthly out-of-pocket costs for PrEP can depress its use and that those who accordingly forgo a prescription are especially likely to contract HIV.
Johanna Mercier, Gilead’s chief commercial officer, said even before the health task force’s 2023 insurance mandate for Descovy went into effect in January, the drug’s coverage was still pretty solid. Private insurers provided unrestricted coverage of Descovy for PrEP to 74% of commercially insured people, and 40% of prescriptions for the drug had no co-pay. After the mandate went into effect — including after CMS released a clarification on the PrEP-coverage mandate in October — those rates increased to 93% and 85%, respectively.
This experience, Mercier said, has left the company optimistic that an increasing proportion of health plans will cover Yeztugo during the coming months.
Health-policy experts are not certain whether the existing PrEP rating from the task force automatically applies to Yeztugo, or whether the drug will require its own rating to ensure coverage comes with no cost sharing.
If Apretude’s history is any guide, a requirement for Yeztugo to receive a specific rating could delay a no-cost insurance-coverage mandate for the drug from going into effect until January 2027 or 2028.
It’s also possible that CMS could release guidance clarifying that the existing mandate for PrEP coverage applies to Yeztugo, which would likely have a more immediate impact on coverage.
However, Elizabeth Kaplan, director of health care access at Harvard’s Health Law and Policy Clinic, said in an email that “given this administration’s and RFK’s stated priorities,” the publication of a guidance on Yeztugo coverage by an HHS division “appears unlikely.”
Since 1989, the LGBT Life Center in Norfolk, VA has built up what CEO Stacie Walls calls a “test and treat” model. For every patient that walked through the doors of their HIV clinic after working up the courage to get tested, there had been the promise that, if they tested positive, all they’d need to do to get treatment is walk down the hallway.
But since the Trump administration’s sweeping cuts to HIV funding took place earlier this year, that’s no longer the case. “The grant money that pays for people who are uninsured is the grant money that they have canceled,” Walls told Uncloseted Media. “That’s so disheartening and scary and goes against everything that we’ve ever wanted to embrace as a nonprofit service agency.”
With these cuts, staff now have to send uninsured patients to the next nearest community HIV program in Hampton, a 30-minute drive away. Walls says they’ve already had to transfer 19 existing patients, including some of their frequent client base of low-income LGBTQ people of color, who are disproportionatelyimpacted by the virus. While the center has been able to shift to covering at least their initial treatment appointment, they are unable to cover further care, and Walls says that even this is not sustainable.
The LGBT Life Center in Norfolk, VA. Photo courtesy: Corey Mohr.
The LGBT Life Center is just one of the many U.S.-based HIV organizations and programs that have fallen victim to the billions of dollars worth of cuts by Trump and his newly created Department of Government Efficiency.
HIV funding has been hit particularly hard: Uncloseted Media estimates that the National Institutes of Health (NIH) has terminated more than $1 billion worth of grants to HIV-related research.¹ In addition, the U.S. Agency for International Development (USAID) has terminated 71% of all global HIV grants, and the President’s Emergency Plan for AIDS Relief (PEPFAR) has been the subject of temporary suspension and major proposed cuts.
Additional cuts are also on the horizon, with the Trump administration’s budget proposal for Fiscal Year (FY) 2026 calling for the closure of all Centers for Disease Control and Prevention (CDC) HIV programs.
The effects of these cuts are deadly. Researchers estimatethat PEPFAR’s funding freeze alone may already be associated with more than 60,000 deaths in sub-Saharan Africa, and numerous experts say that the entire global health system could be upended if the administration’s HIV cuts continue as planned. Mathematical models show that the worst-case scenario is apocalyptic: nearly 11 million deaths, 3 million new infections, and an infection rate outpacing the virus’s peak in the 1990s.
“This is not something that’s just a matter of the scientists losing funding; the community is losing funding, and in the long term, losing ground in the fight against HIV,” says Noam Ross, executive director at research nonprofit rOpenSci.
The Domestic Impact
Cuts to HIV funding in the U.S. have been a significant casualty of the Trump administration’s efforts to reduce spending and attack Diversity, Equity and Inclusion (DEI). Researchers behind Grant Watch, an independent third-party database of grants terminated by the NIH and the National Science Foundation, have identified HIV-related funding as one of the most common targets for termination. As of June 17, Uncloseted Media has calculated roughly $1.353 billion in HIV-related terminations in Grant Watch’s NIH database, accounting for more than a third of the $3.7 billion in recorded NIH cuts overall.
List of terminated HIV-related grants in Grant Watch’s database.
“They’re certainly casting an enormously wide net in this,” says Ross, who is also Grant Watch’s co-developer. “It doesn’t matter that they’re not explicitly saying that ‘it’s a war on HIV’ because if they’re gonna have a war on sexual minorities and transgender people, it’s a war on HIV too.”
The Department of Health and Human Services (HHS) has explicitly told HIV groups across the country that funding was cut because they believe health research for LGBTQ people and racial minorities is unscientific. Researchers across the country have received letters and emails from the NIH with nearly identical statements informing them of their grant terminations:
“Research programs based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness.”
One of the programs subjected to cuts is the Adolescent Medicine Trials Network (ATN), an HIV program that has been active since 2001. Its goal is to prevent, diagnose and treat HIV in young people.
Research under ATN’s umbrella has seen promising developments, including progress towards a product that could combine PrEP and birth control into one pill as well as new methods for reducing HIV transmission in young men who use stimulants. Despite this, NIH cut $15 million worth of grants to ATN because of its focus on high-risk LGBTQ youth populations. The program’s funds were later restored, but only after ATN agreed to cut off a study on transgender youth of color.
“There are particular issues around Black women, LGBTQ people, [and] the type of treatment that they need … that’s the social side of medicine, which is a very important part of medicine—it’s not just molecules, it’s people,” Ross says, adding that grantees focused on “delivery and participation and how to keep people in care,” such as programs that help vulnerable populations stay on PrEP or undetectable folks maintain their antiretroviral therapy regimen, are “very undervalued by [the] administration.”
“So that stuff feels like it’s faster to get canceled,” he says.
Rowan Martin-Hughes, senior research fellow at the Burnet Institute in Australia, says cutting programs that support prevention and long-term treatment is dangerous.
“With other infectious diseases, you treat people and then they’re recovered; with HIV, people require lifetime treatment,” he told Uncloseted Media. “Most of those people infected with HIV are still alive, and if you take treatment away from them, many people will die. And because treatment is also the best form of preventing transmission, many millions of additional infections will occur.”
Many advocates and lawmakers are pushing back against the cuts. Earlier this month, a federal judge in Boston ruled that the NIH’s DEI-related grant terminations—including many HIV programs—are illegally racist and discriminatory toward LGBTQ people, saying that in his four decades as a judge, he had “never seen a record where racial discrimination was so palpable.” HHS officials say they will consider an appeal.
NIH is far from the only agency issuing massive cuts to HIV. The CDC has terminated large grants to numerous HIV clinics across the country, including a $746,000 cut to Los Angeles-based St. John’s Well Child and Family Center and a whopping $6.3 million termination to the LGBT Life Center in Norfolk. Walls says it’s not just their treatment model that’s taken a hit—the center had to cancel 16 free mobile testing events in June alone, which she fears could cause many more people to contract the virus without knowing, contributing to its spread.
“When we’re out in the community in our mobile testing van, it’s super convenient for people. We’re parked there, they can just walk through, get their test and keep on going, and so that is a low-barrier way to test,” says Walls, who says that easy access is critical for low-income LGBTQ people of color. “[Without it], thousands of people that we test every month or every year are not going to be tested.”
The Vaccine Impact
DEI isn’t the only reason the government has given for HIV-related cuts. The Center for HIV/AIDS Vaccine Development (CHAVD), a consortium of researchers at Scripps Research and Duke University, was informed last month that, after seven years of funding from NIH, their grant would be terminated next year.
Dennis Burton, the program’s director, says they are close to a major breakthrough, with promising technology based on broadly neutralizing antibodies that can disable thousands of different strains of HIV being nearly ready for clinical trials in humans. But without NIH funding, the project may be unable to continue.
“It would put back the development of an HIV vaccine by a decade or longer,” Burton told Uncloseted Media. “We begin to see the light at the end of the tunnel … it’s just the wrong time to stop.”
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A senior NIH official told the New York Times that “NIH expects to be shifting its focus toward using currently available approaches to eliminate HIV/AIDS.”
And while Burton says that existing HIV treatment medicine like antiretroviral therapies is “a miracle,” the decision to jettison vaccine research in its favor is misguided.
“The drugs are fantastic … but they’re expensive and people have to take them—the great thing about a good vaccine is that with one or a limited number of shots you can get lifelong prevention,” says Burton. “We want people to live without the fear of HIV, and vaccines are the proven way of preventing viral infections and viral disease.”
The Global Impact
The most sweeping cuts to HIV funding have been to foreign aid. On his first day in office, Trump ordered a 90-day freeze on all foreign aid funding as well as a stop-work order for PEPFAR. While Secretary of State Marco Rubio issued a waiver to continue some critical operations, department memos specifically prohibited funding for PrEP for all populations except pregnant and breastfeeding women.
Photo: Screenshot/ DW News
This move, coupled with the dissolution of USAID and a proposal to cut an additional $1.9 billion from PEPFAR in the FY26 budget request compared to the prior year, has created a perfect storm with staggering results.
The PEPFAR Impact Tracker, a project by Boston University infectious disease modeler Brooke Nichols, estimates that over 60,000 adults and over 6,000 children have died due to PEPFAR-related disruptions between January 24 and June 17. And a survey conducted over the first week of the stop-work order found that 86% of PEPFAR recipient organizations reported that their patients would lose access to HIV treatment within the next month, more than 60% had already laid off staff, and 36% had to shut down their organizations.
The impact hits the hardest in sub-Saharan Africa, the region with the highest HIV concentration, accounting for an estimated 67% of HIV positive individuals globally as of 2021. Numerous long-running and influential LGBTQ health clinics in South Africa have been forced to close, and an investigation by The Independent found that communities in Uganda and Zimbabwe are rapidly being torn apart as more people risk death from lack of access to HIV treatment due to the cuts.
Numerous LGBTQ people told the Daily Sun, a South African digital newspaper, that the closure of long-running clinics like Engage Men’s Health in Johannesburg and Wits Reproductive Health and HIV Institute was devastating.
“I take PrEP, but you can’t go to any clinic as a queer person and ask for it without people looking at you weirdly,” one trans person told the Daily Sun. “At the trans clinic, it was different. Everything was smooth, everything flowed.”
The U.S. has historically been the biggest contributor to fighting HIV, accounting for more than 70% of international funding, but they’re not the only ones making cuts. Following Trump’s example, U.K. Prime Minister Keir Starmer announced 6 billion pounds in funding cuts to foreign aid, including HIV, and France and Germany also announced multi-billion euro cuts.
“HIV has received a lot more funding than any other health area,” says John Stover, vice president for modeling and analysis at Avenir Health. “So it’s a likely target just because the money is so large.”
Martin-Hughes of the Burnet Institute thinks these cuts are dangerous for the entire global health system. He co-authored a study modeling the potential impacts of HIV funding cuts from the major global funders, and the results are grim.
In the worst-case scenario, where PEPFAR is discontinued with no replacement or mitigation alongside the proposed cuts from the top five biggest-spending countries, the study projects that there could be nearly 11 million new infections and nearly 3 million deaths by 2030, which would raise the annual infection rate higher than its 3.3 million peak in 1995.
This is not necessarily the most likely scenario, as PEPFAR is expected to be reinstated in at least some form. However, even the most optimistic estimates show that substantial cuts like the one proposed in the Trump administration’s FY26 budget could still put an end to 15 years of declining infection and death rates—especially since prevention and testing would likely be sacrificed first.
“The world has made really amazing progress on HIV,” Martin-Hughes told Uncloseted Media. “That kind of increase [in infections and death rates would be] a major reversal.” He says that major foreign aid cuts would leave programs for at-risk populations, such as gay and bisexual men, trans women, sex workers and people who inject drugs, particularly vulnerable to being shut down.
Cuts to PEPFAR, a program started by Republican president George W. Bush in 2003, have been controversial even among Republicans, with Senate Appropriations Chair Susan Collins publicly opposing them. While many researchers and policymakers advocate for funding and leadership on HIV to shift away from foreign aid and more towards local governments, Stover and other experts argue that that transition can only be possible with support from PEPFAR in the interim.
“Overall, we all have a vision of more local ownership and control over the resources and how they’re allocated,” Stover says. “[But] it takes time to make this transition, so it’s gonna be practically impossible if funding is just cut off abruptly.”
Cuts on All Sides
Walls says cuts are also happening at the state level. Virginia’s Republican governor Glenn Youngkin slashed hundreds of thousands of dollars for HIV programs, and Walls’ center recently lost multiple corporate donors, including Target, due to pressure from the Trump administration to roll back their DEI efforts.
She says that the fear of backlash for supporting LGBTQ initiatives is so pervasive that even some of their continued donors are now requesting that their contributions remain anonymous.
“Now, if Target was to advertise that they were giving money to the LGBTQ community center in their neighborhood or city, they would have consequences from the administration or even shoppers,” she says. “They’re not gonna take that risk.”
Meanwhile, Walls says the LGBT Life Center is staying afloat thanks to the local community stepping up, with an unprecedented number of people signing up to be volunteers and local restaurants and other businesses providing their assistance, whether that’s by participating in citywide fundraising events or offering to help paint the clinic.
“It is amazing to see, and I know that through all of this the community will help carry us through, because we have brought value to this community for 36 years and I feel confident that people see value in our services,” she says.
Still, experts, advocates and infectious disease modelers agree if HIV funding doesn’t continue, the effects will be devastating.
“I think it’s hard for people to look at these numbers and not feel like it’s important to prioritize,” says Martin-Hughes. “There needs to be, to avert these worst-case scenarios, sufficient funding for those programs.”
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The Food and Drug Administration has approved a breakthrough medication that reduces the risk of contracting HIV by 96 percent.
Gilead’s Yeztugo, generic name lenacapavir (LEN), has been approved for prevention after highly successful trials in September found that it nearly eliminated the spread of the virus among patients, showing a 96 percent relative risk reduction versus bHIV. The drug had already been approved for treatment of multidrug-resistant HIV.
The drug is meant to be given as an injection by health care workers in clinics every six months. It is currently priced at $14,109 per injection, or $2,352 per month, according to NBC News, making it unclear whether or not it will be covered by insurance.
“The approval of LEN is a much-needed boost for HIV prevention, given the strength of the science and the simultaneous disruption in HIV programs globally,” Mitchell Warren, executive director of AVAC, said in a statement. “But US FDA approval is just one in a series of steps needed to ensure that injectable LEN can help reduce the 1.3 million new HIV infections that occur each year.”
“LEN for PrEP is poised to re-shape the HIV response, but only if today’s approval is accompanied by bold, strategic, effective and equitable rollout that reaches the populations that need access,” Warren continued. “Otherwise, the world risks squandering this PrEP opportunity, as it has with other PrEP options too often over the past 12 years.” PrEP is pre-exposure prophylaxis, a strategy using drugs to prevent HIV-negative people from contracting the virus during sex.
Lenacapavir’s trials, known as Purpose 1 and Purpose 2, examined the frequency at which patients contracted HIV without the use of PrEP. Purpose 1 took place in June and measured the effectiveness of lenacapavir among cisgender women in sub-Saharan Africa.
Purpose 2 included cisgender and transgender men, trans women, and nonbinary individuals who engage in sexual relations with partners assigned male at birth in Argentina, Brazil, Mexico, Peru, South Africa, Thailand, and the U.S. To compare effectiveness, 2,180 participants used lenacapavir and 1,087 participants used Truvada, another drug from Gilead approved for prevention. There were only two reported incidents of HIV in the lenacapavir test group versus nine in the Truvada group.
Ian L. Haddock, founder and executive director of the Normal Anomaly Initiative, participated in Purpose 2 as a trial subject. He said in a statement that he is “honored to be part of this journey, and even more excited to help our communities navigate what comes next.”
“Being a part of the PURPOSE 2 trial was about more than just my own health, it was about opening a door for others like me,” Haddock said. “In a region where stigma and systemic health inequities too often limit access to care, this injectable PrEP has the potential to transform how people protect themselves and reclaim agency over their sexual health.”
Researchers have taken a giant leap in the search for an HIV cure by discovering a way to identify the virus even as it is camouflaged among other cells.
HIV spreads by invading and multiplying within white blood cells, which fight disease and infection. One of the main roadblocks in developing a cure has been finding a way to isolate and kill the virus without also killing white blood cells and harming the body’s immune system.
Researchers from the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia have now cultivated a method to identify the virus among white blood cells, as demonstrated in a recent paper published in Nature Communications, isolating the virus for potential treatment.
The technology involves mRNA — molecules isolated from DNA that can teach the body how to make a specific protein — which were also used in the COVID-19 vaccines. By introducing mRNA to white blood cells, it can force the cells to reveal the virus.
Using mRNA in this way was “previously thought impossible,” research fellow at the Doherty Institute and co-first author of the study Paula Cevaal told The Guardian, but the new development “could be a new pathway to an HIV cure.”
“In the field of biomedicine, many things eventually don’t make it into the clinic – that is the unfortunate truth; I don’t want to paint a prettier picture than what is the reality,” Cevaal said. “But in terms of specifically the field of HIV cure, we have never seen anything close to as good as what we are seeing, in terms of how well we are able to reveal this virus.
A cure is still years away, as Cevaal said it would still need to be tested on animals and then humans to see if it can be done safely on living beings before they can test whether or not a potential treatment would even work. However, she added that that “we’re very hopeful that we are also able to see this type of response in an animal, and that we could eventually do this in humans.”
