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Potential cuts to HIV work at the Atlanta-based Centers for Disease Control and Prevention have local and national experts worried that recent progress in cutting HIV rates will come to a halt.
If enacted, the cuts could impact the $50 million in CDC funding for HIV work in Georgia, which had the second-highest rate of new cases in 2022, according to the CDC’s most recent data.
While the details, timing, and scope of potential cuts are unclear, several HIV advocates told Healthbeat they are worried following news reports last week that the Trump administration plans to dismantle or substantially reorganize the CDC’s Division of HIV Prevention.
The HIV division does “enormous amounts of important work to make sure that Americans are as best protected as possible from acquiring HIV infection,” said Dr. John Brooks, who retired as chief medical officer of the division about six months ago. The division had a $700 million-$800 million annual budget and about 500 employees.
Cuts would be a reversal of President Donald Trump’s first-term emphasis on reducing HIV rates. In 2019, he launched the Ending the HIV Epidemic in the U.S. initiative with a goal of cutting new infections by 90% by 2030.
The initiative has steered resources to the areas with the highest rates of HIV, including DeKalb, Cobb, Gwinnett, and Fulton counties in Georgia. It has made progress, with a 12% reduction in new infections nationwide from 2018 to 2022, according to the CDC.
Trump’s apparent turnaround has left HIV advocates confused.
“It was so strategic – let’s look at the 48 counties in the United States impacted by HIV [including four in Georgia], and seven rural states, and let’s focus our efforts there. …Then we get halfway there, and now we’re saying this isn’t important,” said Leisha McKinley-Beach, the founder and CEO of the Black Public Health Academy who has worked on HIV for more than 30 years.
“I really am struggling with understanding, why would you risk not funding your own initiative?” McKinley-Beach said.
Public health experts like Brooks emphasized that Americans no longer have to worry about HIV the way they did in the early days of the epidemic. That’s because of the CDC’s work, Brooks said, much of which goes unseen until something goes wrong.
He’s worried those bad old days could be on their way back.
“If these prevention resources … stopped, I have no doubt in my mind that new infections would go up, and given that we have the power now to end this epidemic, that would be a tragedy,” Brooks said.
Here’s how the CDC supports HIV work in Georgia.
Funding the Georgia Department of Public Health HIV services
About half, or $25 million, of the CDC’s fiscal 2023 funding for HIV prevention in Georgia went to the state Department of Public Health, according to a CDC grant report.
The state uses those funds for services including HIV testing at local health departments and lab work needed for people to get drugs that help prevent HIV infection. If funding is cut, those services could be lost, Brooks said.
County health departments like Gwinnett receive funds from a variety of federal and local sources, including money from the CDC through DPH, for prevention and testing activities, said Joseph Sternberg, the chief operating officer for GNR Public Health, which covers Gwinnett, Newton and Rockdale counties.
“At this time, there has been no communication to DPH from the CDC or HHS about potential reductions to HIV funding,” DPH spokesperson Nancy Nydam said Tuesday. “All HIV prevention and treatment services are currently operating normally with no disruption, and we remain focused on providing effective HIV-prevention and treatment services throughout all of Georgia.”
The CDC also has “a world-class HIV laboratory” that can provide services that state labs can’t, Brooks said.
Besides distributing funds, Brooks and other experts said, the CDC works closely with state and local health officials to track infections and outbreaks.
The state health department collects information about HIV, an important surveillance function, with funding from the CDC. That information is then incorporated into publicly available national datasets that help guide policy.
“Although it’s coordinated centrally at CDC, the work takes place in state, local health departments, where they are keeping track of new diagnoses,” Brooks said.
“These surveillance data are used to also help identify where there might be clusters of new infections occurring, where we need to direct as quickly as possible some prevention activity,” he said.
Working together to identify HIV clusters in Atlanta
In 2021, Dr. Carlos Saldana, an Emory University professor, identified clusters of rapid transmission of HIV in Latino men in Atlanta when he was a postdoctoral research fellow at the Fulton County Board of Health.
Saldana worked with the state DPH, CDC, and three other Atlanta county health departments to investigate the five clusters. The CDC provided help with training and human resources. The team interviewed 29 Latino people and 65 service providers to better understand the challenges Latino men face getting HIV testing and care.
The project used dashboards and machine learning to process data quickly, and found that people were not accessing testing and prevention services due to a serious shortage of Spanish-speaking health care providers, transportation challenges, fears over immigration status, and other reasons, Saldana said.
It would have been difficult to do that work without the CDC’s support, Saldana said. The research has since informed policy measures to try to stem the tide of infections in Atlanta’s Latino community, including Spanish-language media campaigns and programs to link people to bilingual health navigators.
Latino people in Georgia had higher rates of new diagnoses than the general state population, according to 2022 data from AIDSVu, an AIDS data tracker sponsored by Emory and Gilead Sciences, an HIV drug manufacturer.
Saldana continues to work on the problem, and he’s garnered two additional CDC grants to investigate methods of tracing HIV clusters and community projects to reduce HIV rates. One four-year, $1.4 million grant funds a bilingual telehealth program for HIV prevention and treatment, along with mobile STI testing services.
He said he’s worried that those services could come to a halt.
Funding HIV services at Atlanta clinics
The CDC’s HIV prevention programs also fund Atlanta-area organizations that provide HIV services, like Someone Cares, a Marietta nonprofit that serves transgender people.
The CDC funds two multi-year projects providing testing, prevention, and HIV care to transgender people of color at Someone Cares. Together, the two grants total $3.3 million, according to USASpending.Gov, a government tracker.
Transgender people make up 0.6% of the state’s population but had a new diagnosis rate of 2% from 2014 to 2022, according to the DPH.
Another Atlanta nonprofit, Positive Impact Health Center, received about $842,000 in funding in 2023 from the CDC. Larry Lehman, the organization’s CEO, said he did not want to comment on the proposed cuts.
Other Atlanta groups funded by the CDC, including AID Atlanta, the Empowerment Resource Center, and the Georgia Harm Reduction Coalition, did not respond to requests for comment.
“The impact of these dollars completely going away will devastate prevention efforts, and the South will be greatly impacted. The fearmongering and conflicting messages exacerbate concerns we have long worked to mitigate as an organization,” said Mardrequs Harris, deputy director of Southern AIDS Coalition.
“The South being underfunded and now grappling with the potential idea of no funding requires us to continue to be innovative, strategic and ever vigilant.”
The CDC’s HIV division also funds a free home HIV testing program administered by Emory. The five-year, $35 million award supports Together Take Me Home, which provided more than 444,000 testing kits in all 50 states and Puerto Rico in its first year, from 2023 to 2024.
Emory worked with four other organizations to implement the program, with the goal of increasing access to HIV testing.
An Emory School of Public Health spokesperson said the institution would not comment on the potential cuts.
Advocates preparing for challenges ahead
Many advocates said while the details are unclear, they feel certain cuts are coming.
“They’re definitely looking at rationalizing and streamlining and efficiency, and those are all … not bad things to do,” said Mitchell Warren, the executive director of AVAC, an international nonprofit focused on AIDS prevention. The organization is suing the Trump administration over the dismantling of another federal agency, the U.S. Agency for International Development.
“What is worrisome is that what we haven’t heard is a commitment of what they won’t give up,” Warren said. “We need to understand, not the acronyms, not the institutions, but what the core values are. Is this administration committed to doing prevention with impact?”
If the cuts result in layoffs at the CDC, that could have a detrimental economic impact on Atlanta, Warren said.
The cuts, which would be made through executive actions rather than the legislative process, will likely face legal challenges, said Jose Abrigo, an attorney at Lambda Legal, which focuses on the rights of LGBTQ+ people and those living with HIV. He said he could not comment on whether Lambda Legal would help in that effort.
In the meantime, advocates are worried – and preparing for upcoming challenges.
“We are going to have to prepare and pivot and prioritize our 2025 efforts, because these cuts are coming,” McKinley-Beach said.
Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.
