The United States endangers the world by cutting funding for HIV research and prevention.

Stop me if you’ve heard this one before: An American presidential administration blatantly ignores an ongoing public health crisis caused by the human immunodeficiency virus (HIV) and the deadly disease it causes, acquired immunodeficiency syndrome (AIDS).

This time, I’m not referring to the Reagan administration’s jokes about the “gay plague” but rather the campaign by the second Trump administration to dismantle the world’s ability to prevent, identify, and treat HIV/AIDS. The giant strides we have made since Reagan (more on those below) are under threat. The Trump regime has already canceled nearly $1 billion in NIH research funding into HIV/AIDS, according to the tracker of NIH grant terminations.

Given the historic association between HIV and queer issues in American politics, these cuts fit within the administration’s campaign against queer people. Scientific queerphobia was never truly eliminated, but it has been rearing its ugly head under the new Trump regime. Yet anyone can acquire HIV, and the virus is present globally. According to the World Health Organization (WHO), 65% of people living with HIV are in Africa where spreading awareness about HIV prevention and treatment is more challenging.

WHO has identified 5 groups that are at increased risk of acquiring HIV: sex workers and their clients, incarcerated people, intravenous drug users, gay men with more than one sexual partner, and trans women with more than one sexual partner.1 HIV-positive people can also transmit the virus to their children during pregnancy.

Recognizing the global risk of HIV, President George W. Bush established the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003. Since its inception, PEPFAR has invested over $100 billion to combat HIV/AIDS worldwide. But almost immediately after his inauguration, Trump froze foreign aid, including congressionally allocated PEPFAR money. The future of the program remains in doubt as of this writing.

Against this geopolitical backdrop, an international group of scientists from North America, Europe, and Africa created an predictive model to gauge the impact on children if PEPFAR is discontinued, published in The Lancet. This model predicts that, without PEPFAR, an additional 1 million children will acquire HIV by 2030. Further, 500,000 children will die of AIDS, and 2.8 million children will be orphaned by the death of their parent(s) to AIDS. This model did not even address the full adult death toll upon a resurgence of HIV transmission.

The wanton destruction of life caused by these policies is unconscionable, especially considering WHO’s goal of ending the HIV epidemic by 2030. Before this year, the progress was positive. To stop HIV transmission, it is critical for those infected to know their status so that they can take appropriate prevention and treatment measures. In 2020, 81% of HIV-positive people knew their status. Three years later, that figure was 86%. WHO aimed to continue to increase that proportion to 95% between 2025 and 2030.

Importantly, medical practitioners now have a critical new tool to meet this goal: the medicine lenacapavir, a twice-yearly injectable2 that is 99.9% effective at preventing HIV infection. Science dubbed lenacapavir 2024’s “Breakthrough of the Year,” but its high price tag is a barrier to use especially in the global south. PEPFAR had pledged to dig into its $6.5 billion yearly budget to provide 2 million doses of lenacapavir over the next three years. Now, those pledged funds are frozen, and this highly effective medication sits on the shelves. Without PEPFAR and lenacapavir, WHO’s eradication goals are unlikely.

The human toll of halting PEPFAR goes beyond just the prospect of increased HIV transmission. The Washington Post interviewed Mary, a Nairobi resident who received $100/month from PEPFAR for outreach work to sex workers about HIV testing and treatment. Mary and her children relied on this income, and they are now behind on rent and school fees. Without the reinstatement of PEPFAR payments (including backpay), their living situation will only continue to deteriorate.

The domestic outlook of HIV/AIDS is also grim. Approximately 1.2 million people in the US are living with HIV, and most new diagnoses are in the American South. Queer and trans people of color account for at least 73% of new HIV diagnoses in the US.

And yet, on April 11 Trump and Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. removed all 11 members of the Presidential Advisory Council on HIV and AIDS. The advisory council provides information and recommendations to the HHS Secretary on combatting HIV/AIDS. In late March, Kennedy fired the entire Office of Infectious Disease and HIV/AIDS Policy which focuses not just on HIV but also hepatitis, infections in health care settings, and tick-borne diseases. These shakeups are primed to particularly harm queer elders living with HIV.

Since becoming HHS Secretary, Kennedy has quickly move to dismiss anyone who disagrees with the health misinformation he spouts (such as vaccine experts). Kennedy’s views on HIV/AIDS have received less scrutiny than his vaccine views but are equally delusional. He has surrounded himself with AIDS deniers and even erroneously claimed that AIDS is not caused by HIV infection (but rather the party drug amyl nitrate, aka poppers).

For those working on the front lines of HIV/AIDS prevention, the loss of federal support (both financial and intellectual) is devastating. Staff at clinics are getting laid off, making HIV prevention and treatment harder to access. As Dr. Erin Kahle, the Deputy Director for Center for Sexuality and Health Disparities at the University of Michigan, told The Guardian: “This is setting us back decades.”

Given the difficulties in accessing treatment and the misinformation around HIV/AIDS, I want to recap the basic health science for anyone who might be unsure of the options available to them:

First, HIV refers to the virus that can cause AIDS if left untreated. HIV is transmitted through contact with specific bodily fluids, including blood, semen, breast milk, and vaginal secretions. It is NOT transmitted through saliva or body contact like hugging.

Shortly after acquisition, HIV “seroconverts,” meaning that the body begins producing antibodies that target the virus. This phase can be associated with flu-like symptoms. These symptoms will pass, but the virus will continue to replicate in the body, targeting white blood cells.

If untreated, HIV will deplete the body’s white blood cells, thereby weakening the immune system. This leaves the body susceptible to secondary infections and some cancers. Severely depleted white blood cell counts and increased susceptibility to these secondary conditions is referred to as AIDS. Therefore, AIDS itself is not transmissible, but HIV (the virus) is.

HIV testing is available to those who want/need it, but given the geographic breadth of QSL readership I encourage you to do a quick search for a testing site near you. That search will likely yield more up-to-date information than anything that I can provide, especially given the ongoing flux in local clinics.

As described below, there are now ways to prevent every step of this progression if you are proactive about knowing your status and seeking the appropriate care.

If you are taking part in behaviors associated with increased HIV transmission, it is wise to get tested frequently and start pre-exposure prophylaxis (PrEP). These behaviors include but are not limited to:

To start PrEP, talk to your health care provider. They will first test your for HIV, and if the test is negative, then they can give you a prescription for PrEP. PrEP works by interfering with HIV’s ability to enter your cells, integrate its genome into yours, and reproduce addition HIV virions.

PrEP is the most effective way to prevent HIV infection (unless, of course, you can afford lenacapavir). If you are unable to get a prescription for PrEP, then the next best preventative measures are to practice safer sex (including condoms) and/or use clean needles when injecting drugs. Frequent testing will also help you stay up-to-date about your HIV status.

If you are notified that you have recently (within 3 days) been exposed to HIV-positive bodily fluids and are not on PrEP, contact a health provider right away as post-exposure prophylaxis (PEP) may be an option for you. PEP is a drug combination that is taken for at least 28 days after HIV exposure. It functions similarly to PrEP to prevent seroconversion. It is critical to start PEP as soon as possible after exposure, so be sure to take quick action by contacting your doctor, visiting a sexual health clinic, or going to an emergency room.

If you are unable to receive PEP or if a routine HIV test comes back positive, there are ways to effectively manage the diagnosis to live a long and happy life through anti-retroviral therapies. These therapies combine multiple medications to prevent the further replication and spread of HIV in the body. The precise combination of medications are up to your doctor, but generally this approach is highly successful at suppressing the virus. As with any medication, there are associated side effects, so talk to your doctor about what those may be.

These medications are highly successful in lowering the levels HIV circulating in your body if taken consistently. In fact, many people reach the point where HIV is no longer detectable in their blood through diagnostic tests. While this doesn’t mean that the HIV infection has been “cured,” being undetectable does mean that transmission rates of the virus are incredibly low as long anti-retroviral therapy is continued.

Today, HIV exposure is not a death sentence. There are ways to manage each step of the process to ensure minimal disruption to one’s life if one has the access to them. With these advances in biomedical research, WHO’s goal of eradicating HIV is realistic. However, we need continued research in basic science and worldwide public health to maintain the progress made over the last 30+ years. I sincerely hope that this progress is not reversed by the harmful whims of Trump and Kennedy.

In the meantime, we must work together to keep each other safe.