What we're reading: Thoughts on the White House budget proposal against a plan to eliminate U.S. HIV incidence

Since the president's Feb. 5 State of the Union address pledge to end transmissions of HIV in the United States in the next 10 years, and the release of a strategy the next day outlining plans to target the hardest hit counties and states, the most critical immediate unanswered questions have concerned funding for the plan. They included whether the dollars committed to the plan would be sufficient to overcome the impacts of administration policies and stances, including ones maintaining obstacles to health care and marginalizing vulnerable populations. The questions also included whether funding for the plan would come at the expense of other efforts including global HIV responses, and domestic programs essential to people living with HIV in America. On Monday, the release of the White House "Budget for a Better America" answered some of those questions. Not even close - Proposals that include increasing funds for the Ryan White HIV/AIDS program by $120 million next year while cutting Medicare and Medicaid by more than $2 trillion in the next 10 years, are among the incompatible elements of the White House budget plan that keep it from being "remotely sufficient" to meet the HIV epidemic-ending goals set out in the administration's strategy, according to experts quoted here. Steps . . . slowed by concurrent cuts - People on the frontlines of the nation's HIV epidemic also weigh in here, in a response to the budget proposal from the HIV Medicine Association (one of the producers of this blog), that notes small increases to programs long flat-funded will not overcome the impacts of cuts to programs people living with HIV count on, to biomedical research, and to international HIV responses. Some investment, but inadequate commitment - The Infectious Diseases Society of America (which with HIVMA produces this blog) also notes that short-changing programs and research critical to a strong public health system as well as to global health security readiness builds a shaky foundation for an epidemic-ending strategy. Largest ever cuts to global HIV programs - The "deepest cuts ever proposed by Trump," including to the U.S. President's Emergency Plan for AIDS Relief and to the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (when radical, but less draconian cuts proposed in 2017, were projected, if imposed, to cause the deaths of 1 million people living with HIV), are among the reasons Health GAP calls the proposal "antithetical to ending the AIDS pandemic." The statement also notes proposed cuts to domestic programs that include the Housing Opportunities for Persons With AIDS (HOPWA) program, and the Supportive Housing Program for Persons with Disabilities. Makes a mockery out of plans to end AIDS - Treatment Action Group notes the proposal included in the plan to cut USAID's TB program -- which addresses the leading infectious disease killer of people with HIV -- by $41 million, and points out: "Investing in the HIV, TB, and HCV response is not a zero-sum game: these infectious diseases do not respect national borders, and ending HIV, TB, and HCV requires ending them everywhere."