Healthbeat

NYC public health system braces for federal grant cuts under proposed OMB revision

2026-07-30T22:30:44+00:00

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New York City’s public health system is bracing for possible funding cuts from a federal budget rule change the Trump administration is considering.

A proposed revision from the Office of Management and Budget would give the Trump administration broad discretion over how federal grants are awarded, managed, and terminated. Currently, such grants can’t be canceled without cause, but the new OMB rule would permit termination with minimal explanation or opportunities for appeal.

Though a range of federal agencies could be potential targets of the revisions, known as “Uniform Guidance,” the city’s Department of Health and Mental Hygiene and community-based health centers are particularly vulnerable.

Health officials say about $500 million, or 20% percent of the city’s budget for the Health Department, comes from the federal government. This money is earmarked for emergency preparedness and disease surveillance.

The Health Department has already been a mark. Last year, the Trump administration tried to withhold funding across the United States, including some $100 million earmarked for the city’s Health Department, but a coalition of attorneys general sued. A federal judge halted the effort for now.

“It would not necessarily completely disrupt what they’re doing, but it would maybe destabilize the core functions of the Health Department,” Dr. Oni Blackstock, a primary care physician based in New York City who specializes in HIV treatment, said of the proposed rule.

Blackstock is also the founder and executive director of Health Justice, a consulting firm that aims to promote equity initiatives in healthcare and public health. She previously was an assistant commissioner at the New York City Health Department, leading the city’s response to the HIV epidemic.

The OMB changes could be far-reaching, from the states to counties nationwide. According to the National Association of Counties, a nonprofit group advocating for county government across the United States, the proposed rule is the “most significant overhaul of federal grants regulations in more than a decade.” County programs such as transportation, public safety, housing, and disaster recovery could be affected.

According to the department, “OMB is proposing revisions that would improve transparency, accountability, and oversight for Federal awards across the Federal Government.”

A spokesperson could not be reached for further comment.

Russell Vought, the OMB director, is one of the main architects of Project 2025, the 900-page blueprint that articulated a broad conservative vision for the second Trump administration.

The final version of the rule could take effect on Oct. 1. Until then, the OMB is required to consider every public comment it has received since the rule was announced in late May and address or respond to substantive critiques. The agency received nearly 500,000 comments until the comment period ended on July 13.

The topic of the Trump administration possibly withholding funding from the city’s Health Department has come up before. At a March budget hearing, City Council Health Committee Chair Lynn Schulman asked about contingency plans.

“We are currently in active discussions with (the city’s) OMB, with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities,” Health Commissioner Dr. Alister Martin said at the March hearing. “We will assess and make decisions around what will protect New Yorkers’ health and safety the best.”

A Health Department spokesperson didn’t respond to questions about plans for potential cuts.

Blackstock says the proposed OMB rule could target Health Department funding for outbreak responses, HIV prevention, substance use services, emergency preparedness, and chronic disease prevention.

“All of these programs receive federal dollars through discretionary cooperative agreements,” she said.

In the past, the Centers for Disease Control and Prevention or the U.S. Health Resources and Services Administration would evaluate grant applications, but now political appointees will be making key decisions, she said.

“They’re going to be using their own independent judgment and lack of knowledge and expertise to decide whether these discretionary federal awards are granted,” Blackstock said.

Dr. Oni Blackstock

Community-based groups that receive federal funds could also be affected. That means the pot of money will grow smaller, and nonprofits have cut back on hiring, reduced services, postponed raises, and resorted to layoffs. Nonprofits are also looking at ways to forge alliances and share resources.

A preview of the abrupt withdrawal of federal funding played out earlier this year. Community nonprofits working on substance abuse issues experienced the sudden loss of funding — and ensuing chaos — in January when an agency in the Department of Human and Health Services suddenly revoked roughly $2 billion in funding, only to restore the money the following day because of bipartisan lobbying.

Given that the Trump administration has issued executive orders that target health care services for groups serving LGBTQ+ communities, some nonprofits may decide to pass on federal support.

“If it’s a trans-led organization, they may be discouraged from actually applying for any federal funding because they don’t want to be a target of this administration and have their funds withdrawn,” Blackstock said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Scientists find clue to cause of noma, an illness that disfigures children across Africa

2026-04-30T11:00:00+00:00

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Hello from Nairobi.

This week we’re following some remarkable medical advances: a potential breakthrough in a long-neglected disease, and new treatments and tests for the world’s deadliest parasite. We also have an update to last week’s story on American HIV aid, and, at the end, a sci-fi-meets-Ken-Kesey story that combines psychedelic toad-licking, ayahuasca, tobacco, and genetically engineered bacteria.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

‘Astonishing discovery’ for a little-studied, disfiguring disease

Scientists believe they may have finally found the root cause of noma, a disfiguring illness in the sad bucket of “neglected tropical diseases,” The Guardian reports.

Disease breakdown: Noma is a rare but rapidly progressing disease of the mouth and face. It’s largely a children’s disease of poverty, with no single, proven cause, but an estimated 30,000 to 140,000 cases a year. Most cases are in children under 6 years old, across a belt of African countries from Mauritania to Nigeria to Ethiopia. Untreated, it kills 90% of those affected, and even with treatment the heartbreaking disease often leaves lifelong facial deformities and scars.

The new discovery was a bit serendipitous. Researchers at the Liverpool School of Tropical Medicine set out to map the bacteria living in the mouths of 19 children with noma across Nigeria. In the process, they uncovered a previously unknown species of bacteria, now called Treponema A.

The obvious question followed: Could this be the cause of the illness? To make sure it wasn’t a fluke, the researchers went back to “reanalyze older samples from other noma patients” and found the same bacteria there, too.

As The Guardian reports, this “astonishing discovery” doesn’t necessarily prove that the new bacteria cause the disease, but it certainly gives scientists something concrete to chase. As one researcher put it, “we don’t know if [Treponema A] can colonize a noma wound, because of the architecture and the environment, or if it causes the noma wound.”

Still, it’s an incredible starting point.

I reached out to Stuart Ainsworth, an infection biology and microbiome expert at the University of Liverpool, and part of the team behind the discovery. We discussed what this finding means and what it shows about the value of researching neglected diseases.

I started by asking Ainsworth how a disease this severe could still have such basic unanswered questions, and how a lead like this could have gone unnoticed for so long. Ainsworth was frank: “There has hardly been any research on noma at all,” he said.

He pointed to a 2021 review of the history of noma research, which found that there have only been 147 studies done on the disease since the year 1850. “In comparison, there were around 650 papers on rabies in 2021 alone,” he told me.

The core issue is that noma, Ainsworth says, “is the quintessential neglected disease. It only affects the very poorest in society and typically occurs in remote rural regions.” And because those who aren’t killed by the disease are often “left debilitated and scarred and generally hidden from society,” he said, “there is little impetus globally to invest in research.”

It’s a brutal dynamic, and one that cuts to the core purpose of medical research. “The goal with all diseases is to eradicate them, or at least control them to the point where they are no longer an issue.” And yet, “all of these things are impossible if you do not have at least a very basic understanding of what is the cause of the disease,” he said.

But that bleak starting point is also what gives this kind of scientific work such an incredible upside. “We know so very little” about noma that even “simple targeted research could potentially have a huge impact,” he said.

Looking forward, Ainsworth says further research could help move beyond the current treatment for noma, which is a shotgun approach of broad antibiotics, and that “we hope that these types of studies will eventually enable us to develop the targeted prevention, diagnostic, and treatment options to eradicate or prevent noma.”

A stalling fight against HIV, part 2

Last week we covered new data that showed U.S.-funded HIV treatment holding steady on paper, but testing, prevention, and case detection dropped sharply, raising fears about a surge in new infections.

Well, there are a few follow-on stories that are worth your time.

(First, we’re owed a correction. I flagged the State Department’s claim that “20.6 million people” are on HIV treatment, but it appears that the official figures don’t actually match the underlying data, which puts the number closer to 20.3 million.)

Second, the person in charge of the science behind that data just left. Mike Reid, the HIV program’s chief science officer, stepped down. He blames a system where American HIV aid is being “entangled with access to critical minerals or geopolitical positioning,” to the detriment of the work, Reuters reports.

Reid posted a full essay on Substack upon his departure, and there are a few sections worth pulling out to understand why he walked.

Reid starts with the core shift:

“When life-saving health assistance, often beyond the immediate capacity of partner countries, is conditioned on unrelated commercial or strategic objectives, something essential is lost … That is not a marginal adjustment. It is a different model. And I do not believe that model is consistent with the purpose of global health. I do not believe it serves patients, or countries, or ultimately even the long-term interests of the United States.”

He follows with a strikingly blunt assessment, which directly contradicts the State Department’s framing, and echoes what many HIV experts have been warning about.

“We have asked partner governments to take on substantial new responsibilities despite constrained fiscal space, high levels of sovereign debt, and growing demographic pressures, all while programs themselves have been weakened by recent U.S. funding cuts. In places like Zambia, which I care about deeply, the consequences of stepping away too abruptly could be devastating, and avoidable. I have to take that possibility seriously.”

Ultimately, Reid casts his resignation as a break with the core idea of the field itself. “I’ve believed that global health — at its best — is a form of solidarity. Not charity. Not strategy.” And now, that very belief “is why I am resigning my post as chief science officer at PEPFAR in the U.S. State Department.”

A malaria drug for newborns

For the first time, there’s a malaria drug for newborns, Deutsche Welle reports.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

The treatment was just approved by the World Health Organization for “babies weighing less than 5 kilograms (11 pounds).” Its development closes what was previously a “medical care gap for 30 million babies born each year in malaria-endemic areas" across Africa, which is by far the hardest-hit continent.

Technically, it’s a new formulation of two existing treatments: artemether and lumefantrine, which were developed thanks to a secret Chinese military project in the ’60s and ’70s to aid the North during the Vietnam war. (Really!)

Together, the drugs hijack the malaria parasite’s eating process, so that the blood molecules (hemoglobin) that should feed it actually end up destroying it.

You may be asking: If this is the first ever treatment, how have sick infants been treated until now? Well, routinely “infants have been treated with drugs developed for older children,” an imperfect workaround, as these drugs can “expose newborns to risks of dosing errors and toxicity.”

My takeaway: It’s encouraging that medical science keeps providing tools to fight and treat this disease. Earlier this month, the WHO also approved three new rapid tests for “malaria parasites [that] have evolved to become harder to detect,” as they stopped producing the molecule that older tests relied on.

Very timely! In some countries in the Horn of Africa (like Ethiopia, Djibouti, and Somalia), those tests started missing “up to 80% of cases.”

India’s largest pharma deal

India’s largest drugmaker, Sun Pharmaceutical Industries, has just made the country’s “largest pharma deal,” Reuters reports.

The company has agreed to buy the U.S.-based Organon & Co. It’s an $11.75 billion all-cash deal, the most expensive overseas acquisition ever by an Indian company.

Why does this matter?

Let me pepper in a bit of context: As we’ve written before, India, the “pharmacy of the world,” is where a fifth of all generic drugs and well over half of all vaccines are manufactured. And Sun Pharma is India’s biggest drugmaker by revenue, churning out over a thousand separate medicines and drug ingredients. A true generics giant, those drugs include everything from diabetes treatments and psychiatric drugs to cancer therapies and dermatology medicines.

Meanwhile, Organon (which started as an insulin producer over 100 years ago) makes specialty medicines: contraceptives and drugs for pregnancy and menopause, along with a variety of other hormone-based therapies. Although it’s a minnow in the American market, it produces “70 women’s health and general medicines sold across about 140 countries.”

If you scan through the link you’ll see that the Reuters story is a business one, full of debt figures and deal details. What’s more interesting is what this deal reflects about India’s pharma sector more broadly.

The big takeaway is this: India’s pharmaceutical sector is enormous, and only growing. Many projections have the entire sector doubling in value from 2025 to just 2030. Much of that growth is expected to come from a shift out of cheap generics into specialty medicines, and so this is exactly the kind of deal that will help make that shift real.

Whatever you do, don’t smoke this

Let’s end on a fairly wild story from New Scientist: A research group based at the Weizmann Institute of Science in Israel has "engineered tobacco plants to produce five powerful psychedelic compounds,” all in a single plant.

As the authors argue, this could offer a more sustainable way to produce psychedelic drugs, “which are increasingly in demand for research and medical uses.”

What I find particularly interesting about this story isn’t just the tie dye-inducing tobacco plant. It’s the fascinating technique the scientists used, which lands just shy of permanent gene-editing.

Here’s the explainer from the story:

“[The scientists] modified Nicotiana benthamiana plants using a technique called agroinfiltration, which involves using a bacterium to introduce genes from other organisms into a plant. The modified plant then makes the proteins encoded by those genes, but the DNA isn’t incorporated into the plant’s genome, so the effect is short-lived.”

Ultimately, those bacteria induced the tobacco plants to produce psilocin and psilocybin, two compounds found in “magic mushrooms”; DMT, which is found in the psychoactive drink ayahuasca; and bufotenin and 5-methoxy-DMT, which are secreted by Colorado river toads.

The researchers argue that their method is a much easier way to produce these molecules for medical testing than, say, raising cages full of toads. And it’s doing it across biological kingdoms, creating compounds from fungi, plants, and animals in a single organism.

The takeaway: As the article outlines, “the idea of growing drugs through pharmaceutical farming, or ‘pharming,’ certainly isn’t new.” As far back as 2002, we’ve had corn engineered to produce trypsin, a digestive enzyme. But doing it temporarily, without forever altering the plant’s genome, limits the risk of these traits escaping or persisting in the wild.

And heck, it makes the infamous “Simpsons” “tomacco” plant look as everyday as a steamed ham.

Until next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

PEPFAR snapshot after funding cuts: Less HIV testing means more cases

2026-04-23T11:00:00+00:00

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Hello from Nairobi.

This week we’re heavy on the Africa news. We’ll cover two important HIV stories, one about new U.S. data, and one on South Africa. Together, they offer a clearer read on the global HIV response and, I hate to say it, they undo some of the cautious optimism I’d started to feel. We’ve also got a hopeful malaria story from Eswatini, and a broad snapshot of vaccination across the continent.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

New data: a stalling fight against HIV

The U.S. State Department finally released new data Friday on PEPFAR, the two-decade-old U.S. President’s Emergency Plan for AIDS Relief at the center of the global fight against HIV/AIDS.

As Reuters reports, this was the first public update in 16 months, and the only official snapshot of the program after the widespread disruptions in 2025 and a roughly 30% drop in funding. (Worth noting: The data are also incomplete. The update only covers the final quarter of 2025.)

What’s the topline?

The Trump administration is pointing to a single figure: that 20.6 million people are still on HIV treatment. Taken alone, that’d be fine news, because it’s nearly level with the figures from both 2024 and 2023.

But, as Reuters notes, that treatment figure relies on some funky accounting. It includes about “3 million people whose care was provided by their own governments.” And even setting that aside, advocates are worried for a simpler reason: Treatments may be steady, but the data indicate significantly more new HIV infections are slipping through.

The data paint a clear picture.

From 2024 to 2025, 4.7 million fewer people were tested for HIV (a drop of about 22%). About 78,000 fewer people were diagnosed with HIV (20%). And 2 million fewer people were taking preventive treatment (10%).

It’s a fairly shocking downturn, and portends a future of more HIV, not less.

As Charles Kenny, a senior fellow at the Center for Global Development who has been tracking the data, told Reuters: “If people aren’t tested, they can’t know if they’re positive. If we don’t know they’re positive, they cannot be put on drugs … We’re building up problems for the future."

Or, as Kenny told the New York Times, “the long-term trajectory could be back to as depressing as I thought it was going to be last year.”

Inside South Africa’s HIV slowdown

Ok, so that new PEPFAR data give a global view.

But this week Physicians for Human Rights, a U.S.-based non-profit, also zeroed in on what these changes look like with a report from one country: South Africa, home to the largest HIV epidemic in the world.

South Africa is a fascinating case to focus on, because there are several reasons you could expect it would be better positioned to absorb the shock of the HIV funding cuts than many other countries.

Why? For one, it’s an upper-middle-income country that spends a hefty 16.8% of its budget on health. And in recent years, the United States covered just 17% of its overall HIV response, with the majority managed domestically. (That’s far less than in countries like Uganda, Tanzania, or Lesotho, where international funding has historically paid for the vast majority of those programs.)

But in the report, the interviews with health workers, researchers, and patients across South Africa tell a different story: a system where “a future surge in otherwise preventable new HIV infections [is] all but inevitable,” and where “catastrophic” cuts to HIV research are already having global effects.

I reached out to the co-authors of the report: Karen Naimer, the director of programs at Physicians for Human Rights, and Emily Bass, an author and HIV/AIDS expert, to understand what’s actually breaking here.

First, we talked about the hit to laboratories.

As Naimer explained, for years South Africa has been a global center for HIV research, with both a large number of cases and the advanced, scientific infrastructure to study them. That’s one reason why before 2025, South Africa was the largest foreign recipient of funding from the U.S. National Institutes of Health — America’s federal medical research agency. Roughly $400 million went into studies that shaped how HIV is treated worldwide.

But, as she explained, much of that work has been cut off.

Alongside a pullback in dollars, a new NIH rule has blocked U.S. funding from reaching overseas research partners, leaving “terminated studies, the loss of clinical trial capacity, and the attrition of skilled personnel,” she said. And this isn’t just a South Africa problem, “that dismantling of the clinical research infrastructure in South Africa will have global implications.”

What about on the ground – how is everyday HIV prevention and care in South Africa faring?

The report really paints the picture of why testing is falling and fewer HIV cases are being found.

As Bass explained, while the United States funded a minority of South Africa’s overall HIV response, it covered a majority share of the front-line prevention work, especially the more intensive and expensive programs like community testing and outreach. “And virtually all of that investment ended overnight in South Africa,” she said, adding that much of it still hasn’t been replaced.

Ultimately, HIV prevention depends on reaching people who feel fine and aren’t thinking about HIV. They’re not seeking medical care, so the system has to go to them. (Think mobile testing vans or having social media influencers chat about HIV prevention).

Take that away, and you’re left with clinics. And if that’s the whole strategy, it’s no wonder it’s falling short. As Bass put it, “people are not going to regularly elect to go to a clinic and wait hours to get a test, just to find out if they are HIV negative.”

One final note: These cuts to preventive care are hitting just as lenacapavir (the breakthrough HIV prevention drug we’ve been covering extensively) was about to be rolled out.

So, instead of hitting the ground with speed, Bass tells me, the very systems meant to deliver this new drug have been dismantled. “We destroyed that platform, and it really is destruction,” she said.

Holding the line on malaria

The Guardian has an interesting story out of Eswatini (the small, landlocked country between South Africa and Mozambique) that is seemingly close to eliminating malaria altogether.

How close? Well, in 2024, the country of 1.2 million recorded only “362 confirmed malaria cases.” A feat all the more impressive given that “cases have risen globally for six consecutive years,” even in neighboring countries.

As the story shows, part of what’s made the malaria response so effective is the tight disease surveillance system in Eswatini, where individual infections are treated with immediate house-to-house testing and spraying.

There is some peculiarity here worth mentioning. The last mile is often the hardest and most expensive in disease control (polio is a classic example). But malaria is a little different because the symptoms are so visible, and the disease spreads very locally.

What this means is that once malaria cases get very low, a country can concentrate resources on each infection with remarkable efficiency. (This is the very dynamic that allowed the United States to pull off malaria elimination in 1951.)

Unfortunately, Eswatini’s progress nevertheless sits right up against a very different reality in neighboring Mozambique, where there are more than 11 million cases a year. It’s an ever present challenge that, well, mosquitoes don’t care much for borders.

And there are other looming challenges, too. As Mark Edington, the head of grant management at the Global Fund, told the Guardian:

“If you look at the combination of decreased malaria funding, from us and probably from the U.S.; you look at increased resistance towards both drugs and insecticide; you look at population growth; you look at extreme weather events, which are increasing; and you put that all in a mixing bowl, the result is not good … It is worrying.”

What’s the takeaway?

Certainly Eswatini deserves kudos for this heroic effort. But the real question is whether it can hold the line. With 11 million cases just across the border, a lasting elimination of the disease is just not possible, and keeping numbers this low will require the same constant, expensive vigilance year after year.

Immunization across Africa

The World Health Organization has released a new snapshot on the state of vaccinations across the African continent. As the AP reports, it’s both the “first-ever comprehensive analysis” of its type and a mixed bag of news.

Let’s start with the positive, which is the long view. The data in the report make a strong case that vaccination efforts on the continent have been one of the most consequential humanitarian achievements in modern history.

Think I’m overselling it?

Consider that over the last 50 years, vaccination efforts have “saved more than 50 million lives.” Even just since 2000, routine programs have reached “more than 500 million children,” preventing more than “4 million deaths each year.”

Zooming in a bit, there have been some very specific successes, too. Wild polio has been eliminated from the continent (the last case was in 2016). And tetanus infections during childbirth, once a major killer, have also been largely eliminated as a public health threat.

What’s the worse news?

The report outlines that most vaccine-preventable diseases have been mired in stalled vaccination coverage, and in many cases for more than a decade.

For example, only half of children on the continent are receiving two doses of the measles shot, which is the only sure-fire preventative for the disease. HPV vaccination sits at just 28%. And the hepatitis B shot, which is given at birth, reaches only 17%.

The WHO’s target for all these vaccines is 90%. We’re not even close.

And, unfortunately, we’re on track to see things worsen.

The funding behind these programs is shrinking, with the AP noting that “the U.S. withdrawal from WHO in January resulted in the loss of about 40% of the agency’s overseas development funding,” and the Gavi Vaccine Alliance is also “experiencing a financial crunch.”

What’s the takeaway? I have mixed feelings. It’s worth appreciating the extraordinary amount of human suffering we’ve reduced through vaccination. But it’s not enough, and it’s frustrating to realize we may be stuck at an arbitrary high-water mark well short of what we’re capable of.

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Rutgers dean argues public health circles need to better understand humans’ role in outbreaks

2026-04-21T18:35:29+00:00

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Public health has long focused on the biology of pathogens — how viruses spread, how vaccines save lives, and how treatments can prevent disease — but Perry Halkitis believes the field should take a closer look at the role that humans play in public health.

Such is the focus of his new book: Humanizing Public Health: How Disease-Centered Approaches Have Failed Us.

Halkitis has served as the dean of the Rutgers School of Public Health since 2017. Prior to that he worked as a professor at the Center for Health, Identity, Behavior and Prevention Studies at New York University; the center has since moved to Rutgers, which he still leads. Halkitis conducted research on HIV/AIDS, drug abuse, and mental health. He is also an epidemiologist, applied statistician, and public health psychologist.

His academic area of expertise is people who have been infected and affected by HIV — a topic he explored in an earlier book, The AIDS Generation. It may come as no surprise that Halkitis saw parallels between the AIDS epidemic and the Covid pandemic and felt compelled to write his latest book on the need for a public health sector that puts humans front and center.

In a conversation with Healthbeat, Halkitis, 63, a New York City native who lives in Manhattan, discussed how public health might “humanize” itself, how the LGBTQ community can serve as a model for tackling public health challenges, the importance of public health influencers, and the reality that five tequila shots might compromise our better judgment.

This interview has been edited and condensed for clarity and length.

Your new public health book has just come out. Can you tell us about it?

It talks about the need for us to understand public health with humans at the center of all diseases. It means that we have to show humanity to each other as members of communities, and it means that we have to attend to the human elements of disease, i.e. people’s emotions or psychological states, their identities — all the things that make people people — and stop treating people like they’re laboratory rats running around mazes.

The book interweaves a story around HIV and Covid, mpox, Ebola, and the 1918 flu — everything from the history of pandemics and diseases that shows that human beings are a problem, for lack of a better term.

Human beings make irrational decisions that seem rational to some of them. They make decisions based on what feels good.

Spurred by Harlem Legionnaires’ disease outbreak, new rules for NYC cooling tower testing to take effect

I remember sitting in a room with a bunch of really prominent researchers, and I was just a new guy. They were talking about the model they were going to develop — the model was if we gave people confidence in using condoms, they would use condoms.

The little young Perry said, ‘not if they’ve had five tequila shots.’ That, for me, summarizes what this book is about, which is, yes, those models work if people are making decisions based on reason and logic.

Public health depends on those models, but people do not make decisions based on reason and logic, and therefore the models are tenuous at best. You need to create emotion-based models in order to change people’s behavior.

Ultimately, if you’re trying to enhance the people’s empathy and altruism, you have to show that there’s a benefit in there for them too.

Public health leaders are trying to get their messaging out, but they’re up against some powerful forces, the mighty algorithm being the latest. How can public health leaders push back against that?

There’s two answers to that question. If you go back and check on all the major networks that had been presenting information during Covid, it was mostly by medical doctors. It wasn’t public health people. That’s public health’s fault.

Number one: We should have demanded that they should have been talking to us, because we know how to talk to people. Number two: We need to be training our students how to use these tools to be able to be effective leaders.

Which means that we need to be engaging with social media companies, to have them come in and train our students just like we train students to do statistics, epidemiology, policy analysis and outbreak investigation. We need to teach them how to be able to message to the top communities that they work with through social media.

The simple answer is that we need to teach people to be public health influencers, and we’re not doing that. At Rutgers, we are trying to do that, we’re changing our curriculum to address this very issue, because our students are telling us, ‘I need these tools to become a public health influencer.’

Your ‘humanizing’ title also seems to be acknowledging that artificial intelligence is in the room, no?

You can bet you can use AI in effective ways to tailor messages. What’s going to work for a 70- year-old or a 50-year-old is going to be different from an 18-year-old. When I say ‘humanizing,’ I’d say use all the tools at your disposal, including industry, which includes AI. And develop those messages that are humanistic, or tell me how to say [certain things].

There’s a new administration in New York City, and public health is being broadly linked to an affordability agenda. What are your thoughts on that approach?

Affordability is a very, very, very, very important characteristic of health disparities, a very important driver of health disparities that we see in New York City. Case in point: If you look at the HIV map in New York City, you will see a lot of people infected in Chelsea, a lot of people infected in the south Bronx and central Brooklyn.

If you put it next to it a map of where people are dying of AIDS, they’re not going to see people dying in Chelsea. But they are dying in central Brooklyn and south Bronx. What’s that about? That’s about affordability and access. It’s about access to care. It’s about access to services, affordability of medications, affordability of good food, affordability to see the best doctors. I agree 100%.

Are there any public health issues in the city that keep you up at night, or that are overlooked?

Obviously homelessness, because we see it everywhere. People are sick. They’re on the street. During this hard winter we had, which was the first rough one in a long time, people were just out there.

What also keeps me up at night is the next viral outbreak. One of the things I write about in the book is you want a model of something that works really well in a population that comes together. Look at what happened in response to mpox. We got that under control.

I do worry about bird flu and a mutating H1N5. I worry about a new clade of mpox. I worry about measles outbreaks now, because [New Yorkers] are not just staying confined in the city.

Greater New York is going to see its share of visitors — more than a million, it’s expected — when the region hosts the World Cup. In light of the dramatic changes to the Centers for Disease Control and Prevention and the World Health Organization, which have traditionally been responsible for disease surveillance, what are your thoughts on how all these local agencies might be able to handle these duties?

I have every confidence that the city will stay on top of it. When people ask where to go for information right now, [I don’t send them] to the CDC site. It’s all garbage. [I send them to] the [New York State Department of Health], which is doing a really good job. It remains a reliable source and a vigilant organization that is very much on the pulse of what’s going on with health issues and is very good about communicating in effective ways about that.

New Jersey is okay, too. They have a pretty good health care system and a public health care system there.

It’s the rest of the country I’m worried about. We’re going to have to be even more on alert in the next few months than before.

Anything else you want to add?

The gay population can serve as a model of how a community comes together and cares for each other. That, to me, is about altruism and care and concern. Maybe it’s because we’re all traumatized for 45 years of AIDS. The thought of Covid, the thought of something else destroying our lives, [compels us to] rally. There is a lesson that hasn’t been played up enough.

This story was updated to clarify that the Center for Health, Identity, Behavior and Prevention Studies is at Rutgers.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

The next U.S. aid disruption: HIV, malaria drugs for Africa and Asia

2026-04-09T11:00:00+00:00

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Hello from Nairobi.

We had a lovely, long Easter weekend. (Both Good Friday and the Monday after Easter are national holidays here.) And later this week, I’m planning on driving some visiting family upcountry to the foothills of Mount Kenya, where we’ll see the last two northern white rhinos in the world.

This week’s stories cover some (déjà vu triggering) disruptions to U.S. medical aid, the rollout of a promising HIV prevention drug, the growing damage that war is inflicting on Iran’s health system, among a few other stories.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A proposal for more U.S. medical aid disruption

The United States is preparing a major, disruptive overhaul in how it delivers HIV and malaria aid, Reuters reports. The proposed changes represent an “upheaval likely to cause more medicine shortages” and risk “a second dislocation of life-saving services in just over a year,” across Africa and Asia.

Some background: For the last 10 years, the United States has routed a fairly astonishing volume of medical supplies through one large program called the Global Health Supply Chain Program – Procurement and Supply Management, which is run by the for-profit company Chemonix. Just how much? Between 2016 and 2024, that program “delivered a total of more than $5 billion of HIV and malaria products to 90 countries,” making the United States by far the largest funder of these tests and medicines worldwide.

But, according to the Reuters investigation, State Department leadership has asked “staff in 17 African countries and Haiti in an email [on March 31] to cease implementing the supply program by May 30.”

The program will theoretically be replaced by new systems set up under “bilateral agreements with other countries” and private distributors, which would have to be negotiated extremely quickly.

All told, the month-and-a-half timeline is raising concerns about “immediate risks to service continuity if the transition is rushed or incomplete,” with potential shortages of HIV drugs, malaria treatments, and other basic health supplies that millions of people rely on. As the article outlines, ordering and shipping medical supplies to remote clinics can take many months.

The directive “did not lay out a clear transition plan, instead asking each U.S. country office to set out how it would implement the handover, and to inform Washington of any risks or need for more time.”

I reached out to a senior, overseas State Department official with direct knowledge of the program, who agreed to speak on background to provide context.

My source confirmed the broader uncertainty around the transition. To their knowledge, even basic guidance on the proposed upheaval (including the email referenced in the Reuters report) has not yet circulated across all countries served by the program.

They echoed the strong concerns in the Reuters report that such a severe and rapid disruption could leave patients without lifesaving medicines. But what I found most interesting is that they noted that even if the United States ultimately shifts medical procurement to the international organization the Global Fund (an option that we reported on last week) simply purchasing medical supplies is only part of the coming challenge.

What remains dramatically unclear is the rest of the supply chain: warehousing, logistics, and actually getting drugs into clinics.

At the risk of getting too in-the-weeds: These risks may be especially acute in countries where the State Department did not inherit parallel supply systems from the now-defunct U.S. Agency for International Development that could temporarily absorb the shock. (In other words, some countries have backup systems to keep medicines flowing. Others do not.)

My takeaway: It’s still unclear how much of this proposal will actually move forward, or whether the State Department may walk back the plan or timeline. I’ll be following this story closely.

Is there enough of this game-changing HIV prevention drug?

Late last year, a new injectable drug to prevent HIV infection called lenacapavir began rolling out in several African countries. The drug has generated enormous excitement because a single injection protects people for about six months, and it provided close to perfect protection in clinical trials.

But that early rollout is already raising questions. In Eswatini, which received the drug first and has the world’s highest rate of HIV, clinics are already running through their tiny initial shipments, The Guardian reports.

One clinic only “received 130 doses.” Nationally, only a few thousand people have started the drug so far. (Keep in mind, a quarter-million people in Eswatini are HIV+). As one source in the story put it, “The coverage so far has been very, very, very low. But my impression is that interest is extremely high.”

The story raises an obvious question, and also had me wondering if this goes beyond one country: Is lenacapavir’s wider rollout already being hampered by supply limits? To ask, I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition, who we last spoke to about lenacapavir in October.

To start, Warren told me to pump the brakes. It is still early days. While “the initial deliveries are quite small to each country … it is actually too early to tell about the actual supply constraints (if any),” he said.

Warren noted that countries like Kenya, Nigeria, and Zimbabwe only just received their first shipments last month. “So we don’t yet know that demand is truly outstripping supply – yet.”

Still, Warren said the bigger picture for HIV prevention is far from reassuring amid the broader pullback in global health aid.

As he put it: “This continues to be a moment of cruelest irony – our best opportunity in HIV prevention coming at the worst time politically and economically.” While there is enormous potential for this new drug, “the foundational programs [which would deliver it] have been severely curtailed, and in some cases entirely decimated.”

Warren also left me with one note that’s often missing from lenacapavir coverage. HIV prevention, he says, “has always been more than a product — it is a program.” And without outreach, testing, and health systems that bring people back every six months, even a “miracle drug” (as the Guardian piece put it) won’t stop the epidemic.

Iran’s civilian health system under fire

For the third week in a row, we’re returning to the Iran war. Granted, it’s been evolving on a fairly volatile timeline, so much of what we know will likely change in the coming days.

Early Wednesday, a fragile cease-fire was holding after U.S. threats to attack Iranian power plants, bridges, and other civilian infrastructure if Iran did not reopen the Strait of Hormuz. Iran had threatened similar retaliation to neighboring countries. Under international law, these are war crimes, and the potential consequences for civilian health and survival could be enormous.

To some extent, that damage is already underway. Al Jazeera reports that U.S. and Israeli strikes have already hit major parts of Iran’s health system. This includes a psychiatric hospital, a pharmaceutical company, and the Pasteur Institute of Iran, “the oldest and most prestigious research and public health center in Iran,” which has “played a central role in fighting endemic diseases such as smallpox and cholera.”

The World Health Organization says it has verified “over 20 attacks on health care in Iran,” resulting in “at least nine deaths,” including an infectious diseases health worker and a member of the Iranian Red Crescent.

More broadly, WHO Director-General Tedros Adhanom Ghebreyesus warned that “the conflict in Iran, and the region, is impacting the delivery of health services and the safety of health workers, patients, and civilians present at health facilities.”

Argentina: easier monopolies for medicines?

After pulling out of the WHO last month, Argentina has made another significant policy shift. The government has scrapped guidelines that limited which medicines could qualify for pharmaceutical patents, according to an essay in Health Policy Watch by leaders in the affordable-medicines advocacy arm of Doctors Without Borders.

Put simply, the essay argues that Argentina has essentially made it easier for pharmaceutical companies to stretch out monopolies by re-patenting small tweaks to existing drugs. (Imagine a company simply rejiggering a new dose of an existing drug, and then re-patenting it just as the original patent was about to expire.)

Ultimately, these patent extensions push generic competitors out of the market for longer, and keep prices much higher. As an example, the authors reference a hepatitis C treatment that dropped from “$147,000 to $120 per person” once generics were allowed to compete.

You may be asking: Why is this (admittedly niche) policy shift for a single country worth covering?

Well, the authors argue that Argentina’s previous “more disciplined system” of patent rules showed how governments could apply strict standards, while still rewarding real innovation. By rolling those rules back, they warn, Argentina risks weakening a model other countries have looked to when trying to limit pharmaceutical monopolies.

As for my takeaway? This story touches on a tension I run into constantly covering global health. Alongside government-funded R&D, private companies are our greatest engine of drug innovation. The big question is how and where we should draw the line between incentivizing companies to invent lifesaving medicines … and demanding those medicines remain affordable once they exist.

Honestly, I’m reluctant to even, say, cast drug patents as a “necessary evil.” As uncomfortable as they are, monopolies ultimately allow companies to recoup the enormous cost of developing new medicines. And there’s nothing shameful in that. When there’s no profit to be made (as we see constantly with the entire field of “neglected tropical diseases”), the results often fall between grim and hopeless.

Human greed is a powerful force! Companies should see value in investing in the medicines we all rely on. But keeping that greed in check is just as important, and I think Argentina is failing in the latter to serve the former.

A ‘mysterious skin disease’ in Pakistan

We’ll finish on a small but worrying report out of Pakistan that’s worth flagging. At least nine children have died in the country’s southeast Sindh province from what officials have described as a “mysterious skin disease,” though the cause has not yet been identified, Pakistan Today reports.

On Monday, “samples from eight affected children had been sent to Karachi [the capital of the province] for testing,” but results have not yet been released.

It’s too early to know what this actually is, although the big worry is a novel outbreak. Local officials have suggested possibilities including chickenpox or mpox. (Although additional reporting suggests that while mpox has been detected in some of the cases, health officials say it was not the direct cause of the deaths.)

With no diagnosis yet and only local reporting so far, this may ultimately turn out to be a familiar disease rather than something new. Still, unexplained childhood deaths are always worth watching closely, and I’ll keep an eye out for further reporting.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

NYC health department submits budget plan while bracing for potential federal funding cuts

2026-03-20T19:24:50+00:00

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The New York City Department of Health and Mental Hygiene is bracing for a potentially significant loss in federal funding as the agency submits its preliminary 2027 budget.

Almost a quarter of the health department’s $2.51 billion budget comes from the federal government, making it vulnerable to cuts from the Trump administration. The department’s federal funding mostly supports disease control and emergency preparedness.

With a projected shortfall of $5.4 billion over the next two years, the full municipal budget proposal is to take effect July 1 after negotiations and revisions with the City Council.

In testimony before the City Council’s Health Committee, Health Commissioner Dr. Alister Martin said Thursday the department was preparing for potential cuts, noting that the Trump administration had tried to slash more than $11 billion nationwide in public health funding last year, with some $100 million earmarked for the city’s health department. After a coalition of attorneys general led by New York AG Letitia James sued, a federal judge issued a temporary halt on the efforts to block the funding.

“We must brace for possible future cuts,” Martin told the committee. “We are enduring coordinated and large-scale attacks on public health, and we do not foresee them letting up soon.”

When City Council Health Committee Chair Lynn Schulman asked Martin about the health department’s “contingency plan,” Martin said conversations were underway.

“We are closely monitoring the situation,” Martin said. “We are currently in active discussions with [the Office of Management and Budget], with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities. We will assess and make decisions around what will protect New Yorkers’ health and safety.”

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

It was the first budget hearing for Martin since he began the job Feb. 23, with him and chief financial officer and deputy commissioner Aaron Anderson facing questions about the preliminary financial plan for fiscal years 2026-2030. About $1 billion of that proposed fiscal 2027 budget of $2.51 billion comes from a city tax levy. The remaining support comes from a mix of federal, state, and other funding.

The health department’s projected fiscal 2027 budget represents 1.9% of the city’s proposed $128.9 billion fiscal 2027 budget. The department’s budget consists of public health, mental health, and the office of the chief medical examiner.

The proposal includes funding for child care site inspections that will be required as part of Mayor Zohran Mamdani’s campaign pledge to provide universal child care across the city. Funding is also earmarked for outreach and education for early intervention services for children with learning disabilities and a new public health laboratory.

Budget highlights include support for children

Here are four key areas presented in the preliminary budget documents.

Early intervention. The program helps children under age 3 who have learning disabilities and may require extra support. The preliminary plan includes an additional $78.5 million of city funding in fiscal 2026 for the program, growing to $93 million in fiscal 2027, $108.7 million in fiscal 2028, $125.6 million in fiscal 2029, and $143.9 million in fiscal 2030 for existing early Intervention services.

2-K inspections and early intervention connection. The preliminary plan includes an additional $1.6 million of city funding in fiscal 2027, $2.3 million in fiscal 2028, and $2.9 million in fiscal 2029 and 2030 to enhance the 2-K centers’ ability to screen for disabilities in children. The plan also includes 10 positions to support mandated inspections and 6 for early intervention services.

Child care regulation and monitoring. The preliminary plan includes an additional $5.4 million of city funding starting in fiscal 2026 to expand 3-K child care facility regulation and monitoring with 59 inspectors and 3 staff for after-school services.

New public health laboratory. The preliminary plan includes an additional $7.7 million of city and state funding in fiscal 2026, $16.8 million in fiscal 2027, $15.8 million in fiscal 2028, $16.3 million in fiscal 2029, and $16.8 million in fiscal 2030 for operating costs for a new, state-of-the-art public health laboratory in Harlem that will focus on environmental health issues, as well as funding five positions, including the facility director and IT technicians and managers. The lab is due to be completed this year.

The city is expected to see the restoration of $60 million in core public health services as part of a state funding package from an original $90 million that was cut in 2019 under former Gov. Andrew Cuomo. Schulman, a vocal advocate for the restoration of what’s referred to as Article 6 of the Public Health Law, asked what programs and services might be restored with the new funding.

Schulman suggested that the city do “something publicly” to show Gov. Kathy Hochul how the Article 6 funding was used.

Citing the upheaval at the Centers for Disease Control and Prevention, Schulman asked about the status of federally funded positions at the health department. Anderson said there are 14 such positions and that none of them had been eliminated or furloughed.

The proposed fiscal 2027 budget for disease prevention and treatment is $36.7 million less than the amount allocated in fiscal year 2026, according to documents submitted to the City Council. This includes $26.2 million less for fighting communicable diseases, $1.7 million less for sexually transmitted infection programs, and $1.1 million less for a tuberculosis control program.

The funding difference, the documents noted, are concerning given the recent rise in communicable disease cases like tuberculosis and HIV. The reduced funding could limit the department’s ability to conduct disease surveillance, testing and case management.

Mamdani appoints deputy mayor for community safety

The Thursday hearing coincided with Mamdani announcing at City Hall that he had appointed longtime advocate Renita Francois to serve as the city’s first deputy mayor for community safety. Mamdani said he had signed an executive order to set up an office overseeing that portfolio.

Most recently, Francois served as chief strategy officer and chief program officer at Beyond Impact, a nonprofit that supports social justice issues. She also had a leadership role in a neighborhood safety program under former Mayor Bill de Blasio.

The new community safety office was a central part of Mamdani’s campaign last year. Modeled after similar programs around the United States, the office of community safety aims to accommodate people who are experiencing mental health episodes by sending medical professionals in addition to law enforcement.

With cheers from the rotunda audible from the chambers, Council Member Tiffany Cabán asked if the health department was “involved in the planning for the office.”

Cabán also asked:

“As of now, have you identified any mental hygiene programs that are going to be transferred into that office?”

“We’re still in conversations with City Hall and OMB about what the future will look like, and I’m eager to talk to and build a relationship with the new deputy mayor,” Martin said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

With highest rate of new HIV cases, Georgia moves to allow pharmacists to prescribe prevention drugs

2026-02-20T16:33:09+00:00

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Lawmakers in Georgia, the state with the highest rate of new HIV infections in the country, are moving to allow pharmacists to prescribe and administer HIV prevention drugs.

The bill aims to make the drugs easier to get and lower the costs of care – two challenges that have hampered attempts to stem the number of new cases.

Pharmacists could provide both the pill and long-acting injectable forms of pre-exposure prophylaxis, known as PrEP, which that prevents HIV, as well as PEP, post-exposure prophylaxis, a course of drugs that can prevent HIV after exposure if taken soon enough.

The measure could be “a game changer for shifting the landscape of the epidemic,” said Natalie Crawford, a professor at Emory University’s Rollins School of Public Health.

At eight, Georgia has one of the lowest PrEP-to-need ratios in the country, indicating that people who need the drugs are not getting them. That overall ratio hides deep inequities in how many people are accessing PrEP. The ratio is 32 for white people but plummets to 4 for Black people, according to the latest data from AIDSVu, an online tracking tool based at Emory University.

At least 20 other states allow pharmacists to prescribe the drugs.

Pharmacists said they welcome the legislation – even though some details, especially around payment, still need to be worked out.

Pharmacies are much more accessible to many rural Georgians than doctors’ offices and clinics, said Jordan Khail, a professor at the University of Georgia College of Pharmacy. Pharmacies often also have longer hours than doctor’s offices.

Pharmacies could bring drugs closer to patients

Rural residents often have to travel long distances to a facility that prescribes the drugs, Crawford said.

Even some in urban areas have the same problem. While there are more new HIV cases on the south side of Atlanta, the clinics that provide the drugs are typically on the north side, Crawford said.

Georgia leads in U.S. HIV cases. Here’s why the lifesaving drug PrEP faces barriers in the state.

“As a PrEP user and Georgia resident, I am in full support of pharmacy-based PrEP, but to be truly effective we must continue to work to protect PrEP coverage for insured individuals and expanding access for uninsured populations through a national PrEP program,” said Michael Chancley, communications and mobilization manager for PrEP4All, a nonprofit that advocates for increasing access to PrEP.

The bill’s sponsors – Sen. Chuck Hufstelter, a Republican anesthetist from Rome, and Rep. Mark Newton, a Republican emergency physician from Augusta – said expanding access to the drugs could lower the number of new infections and save the state money in the long run by reducing the number of patients that need state-funded care.

Lifetime HIV-related costs can range from about $420,000 to over $1 million.

“It’s in the best fiscal interest of the state to prevent HIV transmission,” said Jeff Graham, executive director of Georgia Equality, an LGBTQ advocacy group.

The bill includes several requirements for a pharmacist to administer the drugs:

Pharmacists need a protocol agreement with a physician, advanced practice registered nurse, or physician assistant.
Pharmacists would need to complete a qualified training program about the drugs.
Any drugs for PEP or PrEP that are determined by the state Board of Pharmacy to be approved by the Centers for Disease Control and Prevention for preventing HIV infections will be eligible.
Pharmacists would have to notify the patient’s primary care provider. If the patient does not have one, the pharmacist would have to provide a list of physicians and clinics to contact for follow-up care.
The patient would need to provide proof of a negative HIV test within the past seven days, or take a test that proves negative on the spot.

Pharmacists would be able to issue at least 30-day and up to 90-day supplies of the drugs.

Payment models haven’t been determined

Khail and others said pharmacists excel at finding the lowest-cost options for patients. Most American insurers are required to cover the cost of PrEP and PEP, though uninsured people may need to jump through extra hoops to afford them.

While the injectable forms are typically more expensive, pharmaceutical companies’ patient assistance plans can lower the cost for the uninsured.

But the bill also asks pharmacists and pharmacy technicians to do work like counseling the patients and making sure they don’t have any reactions to the drugs.

“We definitely have to talk compensation for pharmacies, and I would even push it further to say pharmacy technicians,” said Dr. Kenric Ware, a professor of pharmacy at Mercer University.

A similar measure in Louisiana included payment provisions for pharmacists, Khail said.

That part still needs to be worked out for Georgia – perhaps through a companion bill or administrative regulations that don’t need legislative approval.

Ware and Khail pointed to the model used for immunizations, in which pharmacists are compensated for the extra work they do in counseling and supervising patients and providing the shots, as a good model for PrEP.

A lack of a plan to reimburse pharmacists could limit how many pharmacists decide to offer the service when it takes effect.

If it passes, the law would take effect July 1, with a Jan. 1, 2027 deadline for the state pharmacy board to designate training programs for pharmacists.

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

Pharmacists and the bill’s advocates said a range of options are needed to address the state’s high HIV rates. Georgia typically has at least 2,400 new cases each year, amounting to a rate of 26 per 100,000 people, second only to Washington, D.C.

Telemedicine works well for some, but it has downsides.

People who live with others may not want to receive their drugs via mail at home for privacy reasons. Others may lack the internet service or digital literacy needed to access the service, Ware said.

Black and brown communities, especially women, tend to use telemedicine services for PrEP and PEP at rates far below their white counterparts, Crawford said, in part because marketing efforts have left them out.

The bill gained the unanimous support of the Senate last year. The House Representatives overwhelmingly voted for it, with only seven “no” votes.

The measure must now return to the Senate for final approval before it can be sent to Gov. Brian Kemp for his signature.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

HIV work in Kenya showed me the powerful impact of treating a whole population

2026-01-12T15:03:39+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 3 at Manuel’s Tavern in Atlanta. Watch the full show here. Sign up to receive Healthbeat’s free Atlanta newsletter here.

I embodied the cliché that drives many people to become doctors: I wanted a career that was both deeply impactful and also really interesting. And I made it. I graduated from the medical school at Temple University and then completed my residency in, um, “war-torn” Portland, Oregon.

Although as a teenager, I’d been aware of the Centers for Disease Control and Prevention’s investigative work during the 1976 Legionnaires’ disease outbreak in Philadelphia, it was during residency that I truly began to understand public health. The general concept was familiar — impacting health — but instead of working with one patient at a time, public health offered the chance to impact entire populations simultaneously.

After residency, I joined the CDC’s Epidemic Intelligence Service. I found myself in Pakistan, evaluating the validity of survey questions on immunization rates, and later on rooftops in Los Angeles, sampling water from cooling towers for the now-infamous Legionella bacteria. After EIS, I returned to clinical medicine to complete my infectious diseases specialty training and was immersed in the rapidly evolving world of HIV treatment.

A decade later, I landed my best job ever — working for the CDC to help establish HIV treatment clinics in Kenya. In Kisumu, in western Kenya, where I lived with my family, 1 in 4 adults had HIV infection. Almost all hospitalized adults were HIV positive. When we arrived in 2001, coffin makers were thriving. Our research programs had to hire 125% of needed field staff because so many people were dying on the job.

The world had finally begun to realize that HIV treatment needed to be offered in the hardest hit parts of the world. With initial seed funding from the CDC, followed by a major grant from Columbia University’s School of Public Health, then the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief – PEPFAR – my job was to visit clinic after clinic with my Ministry of Health colleagues, asking whether they wanted to establish HIV treatment services. When they voiced concerns about lacking resources or expertise, I could say, “I can offer both.”

As PEPFAR started, we had to secure the drugs. The contracting office put us in a bind — they’d finalize the contract to secure essential drugs and supplies from the mission — but only if we could secure signatures from six board members scattered all over Kenya over a weekend. My colleague, John, took eastern Kenya, I took the west. With a CDC driver, off I went. I had the easier job. All of the board members were bishops, but two of mine were Anglican, meaning they had wives — who were easier to find, and who led us to their husband board members.

Cellphone coverage was limited, and the roads were rough, but by the end of the weekend, John and I had both secured our share of the needed signatures. To the people who’d been asking “when are the drugs coming,” I could soon say “they are here.”

Before HIV treatment was made available in western Kenya, many furniture manufacturers turned to making coffins.

I had lived through the transformation of HIV in the United States — from a death sentence to a manageable chronic illness. Now, I had the privilege of witnessing that transformation again, on a massive scale. By the time my family returned to the United States in 2005, 65,000 people in Kenya were on treatment. That’s a small fraction of the number who have since initiated care.

But that early period was transformative. Coffin makers returned to building furniture. Ambulances stopped serving as full-time hearses. Weekends, once dominated by funerals, reclaimed their hold on dance parties and weddings.

Taxi drivers in Kenya are a great source of wisdom. During my frequent trips to Nairobi, I often asked for their perspectives. Every one of them had been touched by HIV — through a sibling, a spouse, or their own diagnosis. Many had faced initial reluctance to get tested or seek treatment. But in overcoming stigma and barriers, they found a return to normalcy — and a deep gratitude to the World Health Organization and the United States.

The effects of establishing HIV programs began to ripple outward, strengthening the health system. That trust meant we were often the first called when new threats emerged — whether aflotoxicosis from poorly stored corn, or a hemorrhagic fever.

So maybe not so much an “aha” moment, but a quiet recognition: Focused programs can build immense goodwill. And I had the great privilege of being one small part of that.

Dr. Barbara Marston is an infectious diseases physician who retired from the CDC in 2022 after a 28-year federal career primarily focused on international health. She had leadership roles in emergency responses (Ebola in West Africa and the international component of the Covid response). Since retiring, she’s traveling and supporting protection of endangered amphibians and native plants. She is the co-founder and the coordinator of a CDC advocacy group, CDC Alumni and Friends.

There’s more to the measles comeback than misinformation

2025-12-18T12:00:00+00:00

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Hello from Sydney, Australia.

I arrived on Sunday to spend the holidays with my in-laws. It has been an odd and heavy start. We landed just hours after the attack at Bondi Beach, a short distance from where we are staying. At the same time, this is Australia at Christmas, with its familiar rituals. Shrimp, shorts, and sunburns.

This week, I am finally catching up on a disease I have largely avoided covering: measles. I have tended to see its resurgence in the West as a misinformation problem with American roots. But as we’ll see, that framing falls short.

My name is William Herkewitz, and I’m a journalist (usually) based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Blaming misinformation isn’t enough to explain measles’ return

Follow measles across the West and you find an uncomfortable trail of resurgence. For example: Europe is seeing record cases, and Canada just officially lost its measles elimination status. For developed countries, this rise is most often blamed on vaccine misinformation. Basically, that widespread distrust and conspiracy-minded thinking (supercharged by a Covid-era backlash) is increasingly hollowing out vulnerable, unvaccinated pockets of people for the virus to spread between.

Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

In the United States, it is especially easy to believe this explanation right now. As Healthbeat reports, America’s chief public health official and renowned anti-vaxxer Robert F. Kennedy Jr. is actively undermining “the ability of public health officials to prevent and contain outbreaks” of the virus. But is that the full story?

Australia is the strongest test of this explanation (and, conveniently, I’m here). That’s because it’s a country with one of the world’s most robust public health and vaccination systems, free childhood vaccines, and historically high coverage. And measles cases are rising here, as well, Medscape reports.

I reached out to Julie Leask, a professor of public health at the University of Sydney and one of Australia’s leading experts on what people think, feel, and do about vaccination. I asked if vaccine misinformation is simply eroding confidence in the same way here, too.

Leask surprised me. In Australia, she said, while “the clickbaity idea that [measles resurgence] is all about vaccine refusal” absolutely dominates local headlines, the data do not fully support that explanation. She pointed to Australia’s National Vaccination Insights Project, a vaccination surveillance system that tracks the real-world reasons children miss doses. “Vaccine refusal is absolutely a problem,” she told me, “but it’s not the only problem.”

Leask notes that two other forces are doing at least as much work to recirculate the disease in Australia. One is rising measles cases in developing countries like Vietnam, Thailand, and Indonesia, where people may travel and return with an infection. The other is a mix of everyday practical barriers that Leask calls “social determinants of vaccination.” These range from hard-to-reach clinics and staff shortages to families who missed routine shots during the pandemic and never fully caught up, which have left pockets of children without vaccines or only partially vaccinated. Together, she said, those factors can pose as much risk as anti-vaccine sentiment alone.

The larger lesson, she argued, is that across the developed world, measles control depends as much on keeping vaccination easy, accessible, and routine as it does on countering misinformation.

Is misinformation rising, and should we be wary of it? Without question. But focusing on it alone misses where other real gaps are opening.

Kenya court pauses ‘America First’ health deal

Over the weekend, Kenya’s High Court halted the new U.S.-Kenya health aid deal that we discussed last week, Kenya’s The Standard reports. The agreement was meant to lock in $1.6 billion in American funding, and was the first test case of Washington’s new “America First” health aid model.

The issue? Data.

Tucked into the agreement was a provision committing Kenya to share population-wide health data with the United States and U.S. companies for up to 25 years, a scope and timeline that critics say were never clearly explained to the public or debated in parliament.

Last week I wrote that I “initially didn’t read this as a nefarious data grab,” but rather as a clumsy fix for the surveillance gap the United States created by exiting the World Health Organization. (But, as The Standard notes, the agreement “requires Kenya to share extensive medical data, including HIV/AIDS, tuberculosis, malaria, maternal and child health,” in addition to data purely on “disease surveillance,” which frankly makes my more charitable interpretation harder to sustain.)

Certainly, this ruling is an early embarrassment for the Trump administration’s flagship health agreement, though its practical impact on the deal will remain unclear for quite a while. The case isn’t even due in court until Feb. 12.

What’s the takeaway?

Well, it’s worth revisiting my conversation with John Kuehnle, who ran America’s health programs for the U.S. Agency for International Development in Kenya from 2020 to 2024. We discussed the data clause last week, well before the court intervened, and Kuehnle walked through potential rationales for why U.S. negotiators wanted the data in the deal at all.

A generous interpretation is that the information could “be mutually beneficial if it’s used to develop medicines and medical devices that are tailored to the needs for Kenyans and other Africans,” he said. But Kuehnle noted that this business case is thin at best. “What’s the point of making a drug tailored to a population that can only afford it if a donor buys it, when the donor funding runs out in five years?”

Even if the courts allow the data sharing to go through, Kuehnle cautioned that political consent is unlikely to outlast the money. “If no material gains come from Kenyans giving their data to the U.S. in the first five years, I would not be surprised if this fizzles after five years and the funding runs out,” he said. “I don’t see Kenyans continuing to share data for 20 years after the funding runs out simply because a politician in 2025 agreed to do so.”

An HIV surge in Papua New Guinea

Papua New Guinea is facing one of the fastest-growing HIV epidemics in the world*, The Guardian reports. New infections have roughly doubled since 2010, with nearly half occurring among children and young people. This has prompted the government to declare HIV a national crisis, as overstretched health services buckle after the loss of international funding.

Over a third of people living with HIV in Papua New Guinea don’t know they are infected, and mother-to-child transmission of the virus remains “one of the highest globally.” At the same time, prevention and outreach have weakened as international funding has fallen away. The Guardian story notes that hundreds of clinics run by the government and churches have cut back services or shut down entirely.

Luckily, Australia has moved to plug part of the funding gap, increasing its annual HIV funding to about $6.6 million. UNAIDS says this will keep its Papua New Guinea office operating for another two years. But this intervention only buys time. One source in the article says what when U.S. funding stopped this year, there was “no second plan given to us, and we were told to close down the clinic,” said a social worker in the capital, Port Moresby.

The takeaway: Even senior Papua New Guinean officials concede that there is no clear plan for the HIV outbreak if foreign funding doesn’t return. Foreign minister Justin Tkatchenko warned the country needs a “fallback position,” adding: “The long-term strategy is doing it ourselves. We can’t continually rely on other donor partners to help us.”

(*Worth noting: Papua New Guinea’s doubling of HIV cases is still dwarfed by the wild surges currently seen in the Philippines, Fiji, or Madagascar.)

Your lungs on airplane mode

Air travel has a dirty little secret … what passengers are breathing.

A new study in the journal Environmental International finds that airline passengers can be exposed to extremely high levels of ultrafine air pollution while flying, Oman’s The Arabian Stories reports. This is especially true during boarding, taxiing, and landing.

The findings are new here, but so too was the research approach. The researchers basically brought air-quality monitors onto real flights and measured what was in the cabin air at each stage of the trip, instead of relying on estimates or airport data.

The key point is that jet engine pollution can seep into cabin air before the plane reaches cruising altitude, when filtration systems work best. The particles the researchers measured are small enough to reach deep into the lungs and even enter the bloodstream, raising concerns for flight crews and airport workers who face this exposure repeatedly.

So the takeaway … is never fly again?

No, not exactly. While the pollution spikes were striking, the researchers also found that when you average exposure across an entire flight, overall ultrafine particle levels inside planes are actually lower than what people experience in many everyday settings, like sitting in heavy road traffic. The researchers say the risk is less about any single flight than about repeated exposure, and the findings point to specific moments on the ground where pollution is entering the cabin and could, in theory, be reduced.

Yes, we’re ending on poop

Let’s end this week’s edition with some optimistic news somewhere unexpected: the sewer.

Public health officials in the UK are expanding wastewater testing to spot outbreaks by analyzing what people flush away, the Financial Times reports. When people are infected, they shed viruses and bacteria in their waste, often days before symptoms appear. Sewers gather this, uh, trove of data, turning treatment plants into incidental health monitors for entire cities.

What I found striking in the Financial Times reporting isn’t the UK’s plan itself, but how fast wastewater surveillance is proliferating and diversifying worldwide.

The EU launched a Global Consortium for Wastewater and Environmental Surveillance for Public Health last year, while local projects are popping up elsewhere. In Houston, researchers detected measles virus in sewage 10 days before any cases were officially reported, a result that Anthony Maresso of Baylor College said “underscores the high sensitivity of the method.” In Nevada, scientists are using artificial intelligence to scan wastewater for flu, RSV, mpox, measles, gonorrhea, and drug-resistant fungi.

Gross? Absolutely. But incredibly cool? Oh yeah.

It’s a reminder that even as traditional disease surveillance faces challenges, new tools are emerging in unlikely places. And sure, wastewater is messy and unglamorous … but after the flush, the data are hard to spin!

Healthbeat will be on a holiday break for the next two weeks. I’ll see you next year.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

HIV cases rising in New York City in wake of pandemic disruptions in testing and care

2025-12-12T16:55:44+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

New York City is seeing an unsettling trend: New HIV infections are rising. The city was one of the earliest and hardest-hit of the HIV crisis. By the 1980s, thousands of New Yorkers were dying of HIV-related illnesses. Deaths peaked in the early 1990s, with ~7,500 New Yorkers lost each year in 1993 and 1994.

In the early years, government funding for HIV research was slow, in part because of stigma against the populations most affected, particularly gay men and people who inject drugs. In response to devastating losses, New York communities mobilized. Activist groups like ACT UP and GMHC led protests and demonstrations demanding faster research, more funding, and equitable care. Their efforts reshaped public health policy and laid the groundwork for today’s HIV treatment and prevention. But looming federal cuts are now threatening to undo some of this progress.

New York has since been lauded for its continued efforts in the prevention and reduction of HIV. But even the best systems can’t withstand prolonged stress, and recent data show some cracks. Key questions include: Why now? And how do we protect years of progress?

What is HIV, and where do we stand with treatment and prevention?

HIV (human immunodeficiency virus) is a virus that attacks and destroys the infection-fighting CD4 cells of the immune system, making it harder for the body to fight off other infections and some cancers. Without treatment, HIV can gradually destroy the immune system and lead to AIDS (acquired immune deficiency syndrome), the most advanced stage of HIV infection.

While there’s no cure for HIV, we have effective treatments and medications that can prevent infection:

Antiretroviral therapy (ART) reduces the amount of HIV in the body to levels that are essentially undetectable. When the virus is undetectable, it cannot be transmitted through sex (undetectable = untransmittable). ART allows people to live long, healthy lives, but timing matters. Starting ART early, before immune cells decline, leads to stronger immune recovery and longer life expectancy.
Pre-exposure prophylaxis (PrEP) can be taken before sex, injection drug use, or other potential HIV exposures. It reduces the risk of infection from sex by about 99%, and infection from drug use by about 74%.
Post-exposure prophylaxis (PEP) can be taken within 72 hours of potential exposure to reduce the risk of infection, but it’s less effective than PrEP.

These treatments and medications are truly remarkable for HIV prevention and treatment, but early testing, diagnosis, and access to care are essential.

Where we stand today

Thanks to breakthroughs in ART, new cases in New York dropped significantly after their peak in 1993. And since then, the downward trend in both new cases and deaths due to HIV has mostly continued.

History of the HIV epidemic in New York.

But that has recently changed — in 2024, for the second year in a row, New York City HIV cases increased.

Why are infections rising again?

Even in a state with some of the strongest HIV prevention programs in the country, New York was not immune to the ripple effects of the Covid-19 pandemic. The recent rise in HIV cases appears to be strongly tied to disruptions in prevention, testing, and care during the pandemic.

During the early stages of the pandemic in 2020, HIV testing plummeted across New York, and it still hadn’t returned to pre-pandemic levels by 2022.

Total HIV testing among NYS Department of Health AIDS Institute-funded providers in New York State.

Two-thirds of HIV testing clinics in New York City shut down in the early months of the pandemic. Community outreach at bars, nightclubs, and other venues also stopped. At the city level, only one of the NYC Health Department’s eight sexual health clinics remained open throughout the pandemic. To try to fill the gaps, the city health department created a sexual health hotline and launched programs to mail STI and HIV test kits and prevention supplies to residents. These were important adaptations, but they weren’t enough to close the gaps.

New PrEP prescriptions and total PrEP prescriptions (including among those already taking it) also dropped substantially during the first 6 months of the pandemic. There were fewer clinic visits, prescription refills, and conversations between providers and patients about PrEP.

Behind these statistics are deeper, structural issues. Housing instability, stigma, lack of adequate health insurance or employment, and unmet needs also continue to limit access to HIV services. Among those newly diagnosed in 2024 and interviewed by the NYC Health Department, 48% reported a lack of health insurance, 37% reported housing insecurity, and 13% reported food and nutrition needs.

While the pandemic didn’t create these problems, it did make them worse. Those problems show up in the data about who is getting infected and where infection rates are increasing.

There were 1,791 people newly diagnosed with HIV in New York City in 2024, a 5.4% increase from 2023. This follows a similar 6.9% rise the year before. In the rest of New York state, there were 734 new cases in 2024, no change from the year before.

HIV continues to reflect deep social and racial disparities:

85% of new diagnoses were among Black and Latino New Yorkers, who make up only 50% of the city’s population.
42% lived in high- or very high-poverty ZIP codes at the time of diagnosis.
75% of new cases were among men, 20% among women, and 4% among transgender women. Less than 1% identified as transgender men or another gender identity.

New York City communities that have the highest poverty rates (dark yellow/brown) also saw the highest rates of HIV diagnoses (dark pink).

But there are some bright spots, too. Screening is working better in some groups. Transgender women and youth ages 13–29 were more likely to be diagnosed during the earliest stage of infection, suggesting early detection is improving for these populations.

Access to care is also improving: 87% of people diagnosed with HIV in New York City are receiving care, and among those, 90% are virally suppressed.

Unfortunately, proposed federal funding cuts to HIV programs threaten to widen disparity gaps.

What federal HIV budget cuts mean for New York

Proposed federal budget cuts for FY 2026 could damage key programs in New York, especially in communities facing the highest risk.

These programs are on the line:

CDC HIV Prevention Program: The House budget bill proposes eliminating all $755.6 million in federal funding, including over $41 million for New York City. These funds support HIV surveillance, testing, and outreach. Without it, our ability to track and contain HIV will be weakened.
Ending the HIV Epidemic initiative: Congress could eliminate the entire $220 million budget for EHE. New York City is a priority site, and these funds currently support PrEP access, mobile testing, and same-day care.
Ryan White HIV/AIDS Program: The bill proposes a $525 million cut, including the elimination of programs that fund HIV care in community health centers, provider training, and support services for women, infants, children, and youth. Thousands of New Yorkers rely on Ryan White for care, housing, and case management.
Medicaid: Proposed changes would cut nearly $1 trillion from Medicaid over 10 years. In New York, almost half of all people with HIV depend on Medicaid.

Taken together, these cuts don’t just reduce funding, they remove the infrastructure that supports our entire HIV response. Right now, these programs are temporarily funded at last year’s levels under a short-term continuing resolution (which ended the government shutdown), but Congress will have to vote on the full FY 2026 budget in the coming months, putting them back on the chopping block. If enacted, New York could backslide on decades of progress, increasing disparities and seeing a resurgence of preventable infections.

Bottom line

New York has made incredible progress in the fight against HIV, but that progress is not guaranteed. Rising infection rates, persistent disparities, and looming federal funding cuts put us at risk of sliding backward. Continued investment in testing, early access to ART, and prevention are essential to keep moving forward.

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health advocate. She specializes in infectious diseases, outbreak response, and emerging health threats. She has led multiple outbreak investigations at the California Department of Public Health and served as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Donnelly is also an epidemiologist at Biobot Analytics, where she works at the forefront of wastewater-based disease surveillance.

This HIV expert quit the CDC: ‘Erasing people from the story harms actual people’

2025-12-10T12:00:00+00:00

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John Weiser, a doctor and researcher, has treated people with HIV since the beginning of the AIDS epidemic in the 1980s. He joined the CDC’s HIV prevention team in 2011 to help lead its Medical Monitoring Project, the only in-depth survey of HIV across the United States. The project has shaped the country’s response to the epidemic over two decades, but the Trump administration censored last year’s findings and stopped funding it.

Weiser spoke with KFF Health News on the evening before World AIDS Day, which the U.S. government didn’t acknowledge for the first time since 1988. That was only the latest blow to efforts to combat HIV. The Trump administration has cut funds to provide lifesaving HIV care abroad, withheld money to prevent and treat HIV in the United States, and fired HIV experts at the Centers for Disease Control and Prevention.

Weiser was fired from the CDC during mass layoffs in April, rehired in June, and then resigned. He continues to treat patients at Grady Memorial Hospital in Atlanta. In November, he published an article that warns against complying with presidential orders to censor data about transgender people.

The following conversation has been condensed and edited for clarity.

In the first weeks of his presidency, Donald Trump issued several executive orders with implications for HIV programs. One directed federal employees to exclude gender identities that didn’t correspond to a person’s biological sex assigned at birth.

On how this played out at the CDC:

We were told to scrub any mention of gender or transgender people from dozens of research papers and surveillance reports that had already been published or were going to be published, and to stop collecting information from participants about their gender identity. For example, we had to recalculate our numbers on HIV among men who have sex with men, or MSM, a category that the CDC changed to “males who have sex with males.”

The CDC had no director at the time. The order came from on high. And there was no discussion about whether we wanted to comply with the directive.

On how this directive has affected his research:

Using data from the Medical Monitoring Project, we found that people with HIV who misused opioids were more likely to engage in behaviors that could pass on HIV to another person — through unprotected sex or shared injection. And we found that very few people who misused opioids were receiving treatments for substance misuse. This information could have been useful to change clinical practice and boost funding to treat people with HIV who misuse opioids.

We were getting ready to publish this study, but when I put the paper through CDC’s clearance process, I was told to remove data about the prevalence of opioid misuse among transgender people.

I thought carefully about that, and I decided not to do that because it’s bad science to suppress data for ideologic reasons, and because erasing people from the story harms actual people. I thought about my transgender patients and how I would face them, and what I would say to them while I’m sitting with them in the exam room, knowing that I had erased their existence from CDC.

I withdrew the paper. It remains unpublished.

On how removing data harms people:

Purging data about transgender people has the effect of erasing them from the real world, pretending that they don’t exist. This group of people is heavily affected by HIV, and this type of information informs improvements in treatment. My transgender patients struggle with poverty, with unstable housing, with food insecurity, with mental health disorders, with substance misuse, and face a huge amount of stigma and discrimination in their daily lives.

My transgender patients are trying to get by, day by day. They’re trying to survive. I think it’s important to realize that somebody who is transgender needs to feel comfortable in their own body to be healthy — and denying them recognition compounds their challenges.

After the executive order came down, one of my patients said she felt even more afraid of being in public and not passing, and so she was considering having additional surgical treatment to feel safer. Her concern was not about politics. It was about survival.

On why the CDC went along with orders to remove transgender data:

I think the hope was that by complying with the directive, other work at the CDC would be spared. And unfortunately, that hasn’t proved to be the case. Funding for the Medical Monitoring Project was terminated after 20 years, and the concern within CDC is that the president will eliminate all HIV prevention and surveillance funding.

One of my concerns while there was that if it’s OK to comply with a directive to remove information about gender, what if the next demand is that we don’t report about people who emigrated from other countries, or on people who are experiencing homelessness? What if there’s a directive to suppress data about a particular racial or ethnic group that’s unpopular? How far would we go?

Some HIV clinics and organizations have considered curtailing their work with transgender people and undocumented immigrants, or on equity initiatives, because they fear the loss of federal funds.

His advice on these decisions:

People making these decisions are in a really tough spot. They want to do what’s best for their programs. They want to do what’s best for their employees. They want to do what’s best for the people they’re charged with taking care of. Those are careful decisions that need to be made weighing all of the considerations. What I want these leaders to do is also consider how a decision to essentially throw one group of people under the bus undermines scientific integrity, and harms everyone.

And I think that it’s also necessary for the rise of autocracy to go along, to compromise, to acquiesce. While all of this was going on, I heard an interview with Masha Gessen, who is a Russian American journalist who writes about the rise of autocracy. Gessen explained that decisions to go along are not made because people are unethical or heartless. They’re rational choices. They’re made in order to protect something that’s important — institutions, families, jobs — even if it means sacrificing principles. Gessen’s point is that this gradual process of compromising ultimately is what solidifies an autocrat’s power.

On why he resigned from the CDC:

As a physician working at the CDC, numbers have always described individual people, people whose suffering I witness. When you know somebody, they’re no longer just a concept that you make a judgment about.

I realized that I could do more good by spending more time with my patients than I could working for the CDC under this administration.

Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.

Fulton epidemiologist calls measles containment a ‘public health win’ after weeks of tracing contacts

2025-10-14T20:58:52+00:00

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Public health workers spent about 200 extra work hours to track down 268 people who might’ve been exposed to measles in recent weeks in an outbreak that began with an unvaccinated Georgia State University student, Fulton County health officials said Tuesday.

The county health agency identified the first measles case Sept. 10 in the student, who had spent time on campus, at a Sweetgreen eatery at Ponce City Market, and local soccer practices and games, Director of Epidemiology Sasha Smith said during the Fulton Board of Health meeting.

“These measles investigations are lengthy, and they’re very resource intensive,” Smith said. “We have to do rigorous contact tracing.”

For the outbreak to be considered over, two incubation periods (42 days) must pass without additional cases. That would put the end of this outbreak over about Oct. 22. “We’re on the tail end of” it, Smith said.

Of 268 identified as “close contacts” of the first case, seven either had not been vaccinated or had an unknown vaccination status. Those seven entered home quarantine to avoid spreading the highly contagious respiratory virus, Smith said.

Of those seven, three contracted measles. Smith said some of those quarantined agreed to get the measles, mumps, rubella vaccine but would not specify how many.

Smith said the GSU student first infected had no history of international travel, and it’s uncertain where they contracted measles, which she called a “bit concerning.”

The Board of Health sent an environmental health team to Sweetgreen, where the student had spent hours over three days while contagious, and alerted the restaurant’s employees about the potential exposure.

Since many of the close contacts were exposed at GSU’s downtown Atlanta campus, it was easy to track down students’ vaccination records, Smith said. The university requires students to be vaccinated but allows exemptions for religious reasons. Students must sign an affidavit to obtain the exemption, a GSU spokesperson said.

Smith said containing the outbreak had been a “huge public health win” and credited the hard work of public health employees and the cooperation of other organizations, including other county health departments and the state Department of Public Health, and those who were asked to quarantine.

Georgia has reported a total of 10 measles cases this year. Nationally, 1,563 cases had been reported as of Oct. 8, according to the Centers for Disease Control and Prevention. Most of the cases are connected to a large outbreak in west Texas and New Mexico. Two Texas children and a New Mexico adult – all unvaccinated – have died.

Measles has been reported in Alabama, Florida, Tennessee, and South Carolina, where 16 cases have been reported and more than 150 unvaccinated children in Spartanburg County are quarantined due to the ongoing outbreak.

Meanwhile, Smith said Fulton is also hearing from parents and child care facilities about cases of hand, foot, and mouth disease.

It is highly contagious and causes a fever, mouth sores, and a skin rash, though it typically is not serious, according to the CDC.

Smith urged parents to keep their children at home until they have been free of fever for 24 hours without fever-reducing medicine and no longer have open blisters.

HIV update, West Nile season, tuberculosis cases

The agency is starting a do over of $2 million in grants awarded last month to 12 community organizations for work on HIV prevention and care, interim district health director Chris Rustin said.

The awards, funded by the CDC, had not been consistently evaluated, so the board canceled them on Thursday and will start the bidding process over.

Affected groups include AID Atlanta, SisterLove, the AIDS Healthcare Foundation, Empowerment Resource Center, and the Georgia Harm Reduction Council.

Meanwhile, Fulton is close to filling nine jobs in HIV prevention and sexual health after 17 of those workers were laid off in May. Fourteen of the jobs were restored. Nine employees are set to start on Thursday, as recruiting continues for the remaining vacancies.

A few other Fulton health updates:

West Nile virus: The season is almost over, said Brandon Leftwich, environmental health director. Fulton County had one case in a human this year, and there were a total of 15 human cases in Georgia this year as of Oct. 7, according to the CDC.
Tuberculosis: Fulton County health workers have identified an apartment complex where there are eight cases of tuberculosis. Many of the patients came from West Africa, and workers are screening 20 of their contacts for the disease, according to a board document.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

CDC reversal restores funding for Atlanta-based HIV home testing program

2025-10-10T15:17:02+00:00

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Funding for an Atlanta-based program that has provided nearly 1 million free HIV home testing kits nationwide has been restored, allowing it to continue for another year.

Together Take Me Home, based at Emory University, delivers the tests through an easy-to-use website and integration with dating apps. The program is funded by the Centers for Disease Control and Prevention and earlier this year received notice that its funding would not be renewed amid cuts to the CDC.

That decision has been reversed, said Dr. Travis Sanchez, the project’s executive director and a professor at Emory University’s Rollins School of Public Health. The project will get $10 million for its fourth year, which runs through October 2026 – $2 million more than the prior year. The grant was for around $55 million over five years, starting in 2022.

Together Take Me Home is funded through Ending the HIV Epidemic, an initiative launched by President Donald Trump during his first term, with a goal of cutting new infections 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, which has the highest rate of new cases among states.

Nationwide, there has been a 12% reduction in new infections from 2018 to 2022, according to the CDC, and the number of new diagnoses each year has also decreased in Georgia, from 2,491 in 2018 to 2,350 in 2023.

Deal to lower price for new HIV prevention shot is ‘huge moment of hope’ in global health

The April letter canceling the funding for the home testing program said the CDC would no longer have the staff to oversee it. About 150 staffers who work on HIV prevention were laid off that month as the Trump administration moved to restructure the nation’s federal health agencies.

Since then, many have been recalled to work.

Together Take Me Home is the biggest self-testing program ever, Sanchez said, resulting in about 7,000 people learning that they have HIV. He estimates the tests have saved about $200 million in health care costs by connecting people to care early and preventing additional infections.

The kits use a simple online interface (offered in English and Spanish) and can also be ordered directly from apps like Grindr. Oral swabs provide results within 20 minutes and provide guidance about next steps if the result is positive.

The free, discreetly packaged tests help surmount financial and transportation barriers, as well as stigma. Similar home test kits cost about $40 or more at commercial pharmacies.

The program has been effective in rural areas, and more than half of those who have ordered the tests are under age 35, Sanchez said.

Home testing “is more confidential than walking into a local health department or even a local organization where you may be stigmatized,” said Daniel Driffin, a project manager at the HIV Vaccine Trials Network.

That many of the people who used the home service were first-time testers “creates a new opportunity to start testing habits that one can maintain over longer periods,” he said.

The CDC recommends that all Americans be tested for HIV at least once in their lifetime, but only about 40% of adults have been tested, according to 2024 data from KFF, a nonprofit health policy organization.

Each Together Take Me Home kit comes with two tests, so people can test themselves more than once or share.

Other participating partners in the project include the National Alliance of State and Territorial AIDS Directors and Building Healthy Online Communities, which helped build relationships with dating apps.

Sanchez said the project’s leaders thought it would end this fall, when funding was due to run out. But renewal came in the nick of time, and services were never disrupted. He wasn’t sure why it was restored.

The program is tied to a pre-existing campaign from the CDC called “Let’s Stop HIV Together” – hence the Together Take Me Home moniker.

Sanchez said he’s glad the program’s funding has been restored, but he’s still worried about support beyond the next year, as well as funding for HIV prevention in general. President Donald Trump’s proposed budget includes deep cuts to the CDC and a plan to move HIV prevention work to a new agency, the Administration for a Healthy America.

“We’re paying very close attention to that,” Sanchez said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Deal to lower price for new HIV prevention shot is ‘huge moment of hope’ in global health

2025-10-02T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The short seasonal rains have returned, bringing a very welcome, cooling afternoon drizzle. Before we jump in, please enjoy this bizarre and wonderfully thematic painting my spouse just snagged at an U.S. Embassy warehouse auction. (It was sold with a pile of old medical devices, including defibrillators.) We understand it once hung in the embassy medical unit … though I don’t remember seeing it, and we’re puzzling over the Tanzanian flags.

My spouse snagged this painting at a U.S. Embassy warehouse auction.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A shot at ending HIV?

Earlier this year, a new injectable drug to prevent HIV infection called Lenacapavir was approved by both the World Health Organization and the U.S. Food and Drug Administration. It was hailed as a breakthrough in HIV prevention due to its near-perfect trial results and the fact that it offers protection for six months at a time. The catch? Its maker, Gilead Sciences, set the U.S. price at $28,000 per person per year. That’s 700 times more expensive than PrEP, the widely available, daily oral pill, which costs about $40 annually.

But a newly announced landmark deal all but eliminates the price barrier, the BBC reports. By 2027, Lenacapavir will be manufactured as a generic drug in India, and sold for about $40 per person per year across 120 low- and middle-income countries.

Is the news as good as it seems? I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition. We dove into what Lenacapavir means for the global fight against HIV, and where the gap still lies between having a better drug and actually injecting it into the abdomens of the people who need it.

For the most part, Warren says the celebration is warranted. Taking a pill every day still carries stigma in many communities and relies on daily adherence. A twice-yearly injection clears both barriers, making Lenacapavir a clear winner on the efficacy front. “I hope people come away understanding that this is a huge moment of hope and aspiration,” he says.

Still, the current architecture of the global HIV response depends heavily on the United States, which purchases more than 90% of preventative oral pills through its flagship HIV program, PEPFAR, the President’s Emergency Plan for AIDS Relief. Under the Trump administration, PEPFAR has signaled plans to reduce its footprint, narrowing its role to training health workers and procuring drugs and other medical commodities. While this still preserves a potential revenue stream to buy cheaper Lenacapavir, Warren cautions that “procurement is critical, health workers are critical — but they are not sufficient.”

“We have to be very clear that it’s not a miracle drug, and it doesn’t deliver itself,” Warren says. Key to the success of PrEP (which still only reaches 18% of at-risk people) is “demand amongst people who are potentially at risk of HIV, but are not thinking about HIV.”

There are big questions yet to be answered. “We’re talking about delivering an injectable product to people that are otherwise healthy in health systems that are already overburdened. These are not patients, they’re not sick. They don’t want to go to an HIV clinic, so what’s [the approach]? Will pharmacies be able to deliver this? Will community health workers be able to deliver this?” Warren asks.

Still, Warren returns to focus on optimism. “In the midst of lots of hand-wringing and disbelief about what’s happening in the dismantling of the global health architecture, this is an opportunity to lean in and actually do the right thing. It’s a huge opportunity, it’s a huge responsibility, and it’s something that we mustn’t squander.”

Free? Yes. Nutritious? Maybe

Indonesia’s nationwide school lunch program has been rocked by repeated outbreaks of food poisoning, Tempo, one of Indonesia’s leading independent news outlets, reports.

Part of what’s astonishing here is the sheer scale. The country’s “Free Nutritious Meal program” was launched just this year and is a $28 billion initiative that’s planned to feed more than 80 million schoolchildren daily. (That’s roughly equal to the entire population of Germany.)

In the mad rush to scale the program as quickly as possible, the free school lunches have sickened 6,400 children — including 1,000 just last week, the BBC reports. The suspected cause: negligent food preparation, with “cooks to packers to delivery workers” now under investigation.

The context: Yes, this is in many ways a story about Indonesia. But zooming out, malnutrition remains the leading cause of health problems worldwide, and the world is badly off-track on most 2025 United Nations nutrition targets. School meal programs are one of the few solutions with proven, daily impact that can be funded domestically (not just by donors) and reach millions of kids at once. That is … if they don’t get you sick.

More on Ebola’s return to Central Africa

Preface: Last week I shared an Al Jazeera story on how the Democratic Republic of the Congo is facing the first outbreak of Ebola in three years. Dr. Paul Spiegel, director of Johns Hopkins’ Center for Humanitarian Health, told me he isn’t only watching the case and death numbers to see if the containment efforts are a success. He’s also watching whether the response can secure the funding it needs, given the global retreat in emergency health dollars.

How’s the response progressing? Troublingly, according to the Associated Press. It’s still too early to judge how effective the containment effort has been. But the WHO says the outbreak has already “overwhelmed” health facilities in the province at the epicenter of the crisis, with the only treatment center “already at 119% capacity.”

This is partly due to underwhelming fundraising (exactly what Spiegel told us to watch.) Of the “WHO’s projected cost of around $20 million to respond to the outbreak over the next three months,” the international community has pledged less than a fourth — only $4.3 million. It’s worth repeating that previous Ebola outbreaks in Congo benefited from the one-two punch of well-funded responses from the U.S. Agency for International Development and the U.S. Centers for Disease Control and Prevention. This time, local officials say the U.S. presence has dwindled to “some small support,” leaving containment efforts at risk unless new donors step in.

And the clock is ticking. Ebola demands enormous resources right at the outset of the outbreak (protective gear, vaccines, basic ambulances, and the footwork of paying thousands to trace contacts in some of the least developed parts of the world). Every delay gives the virus room to spread further out of control.

We’ll keep following this story.

The most ‘least important’ sandfly parasite

The arid northwest corner of Kenya, called Turkana County, has just declared a public health emergency after a surge in the world’s third-most-deadly parasitic disease, The Kenya Times reports.

Disease breakdown: Kala-azar, also known as visceral leishmaniasis (or, as a bit of a misnomer, as “black fever,”) is a parasite that’s passed by sandfly bites. It causes skin ulcers, fever, and liver damage, and is usually fatal if not treated within two years. It falls into the sad bucket of “neglected tropical diseases,” with no vaccine and very little new medical research devoted to treatments or prevention.

Kala-azar is an illness you’ve probably never heard about. It infects only around 1 million people a year, and unlike malaria, it has no billion-dollar advocacy machine or donor lobby behind it.

Why is this a top-five global health story? (No, it wasn’t just a slow week.) It’s the very smallness that makes it so big. A neglected disease with little outside funding is now testing whether a country like Kenya, which has one of the stronger health systems and economies in sub-Saharan Africa, can mobilize on its own when emergency strikes.

Officials are rushing to respond by detecting cases early, spraying insecticides against sandflies, and outreach with communities. But the backdrop is stark: While working at USAID, I flew into Lomekwi, a small town in Turkana County a year ago (our frightening “runway” was nothing more than a crumbling strip of gravel.) By the end of 2024, USAID was spending more on development programs in Turkana county than the county government itself. Most of that’s gone, which leaves me asking whether a system built on such lopsided outside support was ever sustainable. Or if that largess of development money sowed more harm than good, even before the pullout.

The takeaway: This outbreak is admittedly small, but worth watching. A year ago, foreign donors would likely have stepped in to tamp down the surge in this disease. Now, it’s Kenya’s move, and whether the country can mobilize its own resources for a neglected disease may set an important precedent. I’ll be keeping tabs.

Another pandemic is inevitable

In an Op-Ed in Time magazine, Dr. Seth Berkley warns that the world faces about “a 50% chance [that] another Covid-like magnitude of a pandemic … [hits] in the next 20 to 25 years,” with no guarantee the next one will be any less deadly. (Berkley is a former medical epidemiologist and served for 12 years as CEO of Gavi, the Vaccine Alliance.)

This is an essay worth reading in its entirety, so let me pull only a few quotes. Berkley makes the simple economic argument for the United States continuing to invest in global pandemic preparedness.

“The billions of dollars the U.S. annually spends on preventing a pandemic is a bargain compared to the tens of trillions it will cost in economic losses and expenses to extinguish a full-blown crisis.”

While he lays out how the current slashing in U.S. global health spending threatens this bargain, he points to a new, dramatic potential cut that I have to admit I wasn’t tracking. “The White House, in its funding request to Congress for Fiscal Year 2026, has called for the elimination of the Global Health Center,” an office in the CDC, Berkley writes.

What does this office do?

“For years, the GHC has had a presence in more than 60 countries (many of them low- and middle-income countries), leading efforts to combat diseases like polio, measles, HIV, tuberculosis, and neglected tropical diseases. It has helped those countries build stronger health systems and train experts to monitor, identify, and respond to disease outbreaks. And it coordinates with many other countries to respond to potential crises before they sweep across the globe.”

Any reason to be hopeful?

“There’s a small bit of good news: Congress is currently showing reluctance to dismantle global health programs. The Senate has already rejected proposed budget cuts, in some cases even increasing funding. The House of Representatives’ stance is mixed, but they are hesitant to approve deep cuts to State Department initiatives like Gavi.”

Thank you for reading. I’ll see you next week.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Funding cuts sting, but Southern HIV prevention leaders say community joy and resilience will keep them going

2025-08-19T19:46:37+00:00

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Frontline HIV prevention advocates from across the South gathered in Atlanta over the weekend to collaborate and compare notes about how to respond to challenges created by funding cuts and new Trump administration policies.

At the Saving Ourselves Symposium, an annual conference for leaders of color working on HIV prevention in the South, attendees were particularly alarmed about federal attempts to block projects that focus on gender identity and the health needs of the communities they serve.

Participants raised concerns about their ability to continue work on testing, education, and disease prevention – and about their own mental health as they navigate the challenges.

Trump’s proposed budget for next fiscal year would dramatically reduce funding for HIV prevention, and funding clawbacks have impacted organizations working on vaccine equity with vulnerable groups and people of color.

Here are four takeaways from the conference, which was themed “Black to the Future.”

HIV advocates worried about impact of funding and policy changes

The threat of funding cuts and the changed political environment were at the top of the agenda for many at the conference. Even groups that have not yet lost funding are rethinking their strategies as they anticipate cuts.

‘We need to keep fighting’: HIV activists organize to save lives as Trump guts funding

“It’s much harder now, as an organization. We did not immediately lose any funding, but what we did do was immediately began to forecast, and we know that it’s happening now,” said Kevin Anderson, CEO of the Houston-based The T.R.U.T.H. Project. “It just doesn’t look the same.”

Many leaders from different states said cuts that impact their work could come from a variety of directions.

For example, FreeState Justice, a Maryland LGBTQ+ advocacy group, lost state funding for a project involving victim services for people impacted by crimes, including hate crimes, Executive Director Phillip Westry said.

The latest funding problems are compounded by the longstanding structure of how HIV services are funded in the United States. Community groups are typically asked, as a condition of funding, to test or link to care for a certain number of people. That can lead to competition among groups to provide services to the same small group of clients in a certain region.

In response to those concerns, Daniel Driffin urged leaders to find ways to work together and to focus on their broader impact rather than just the raw numbers. Driffin is a project manager at the HIV Vaccine Trials Network and longtime HIV prevention advocate in Atlanta.

The conference drew a smaller number of people this year, about 156, compared to last year, said Mardrequs Harris, deputy director of the Southern AIDS Coalition, which organized the event.

Transgender people – especially those of color – face particular challenges

An in-depth, community-led study of Black trans women in Houston found that many feel a loss of autonomy over their bodies and judgment due to longstanding discrimination and the Trump administration’s attempts to restrict trans people’s rights.

That can manifest in challenges in accessing health care, with Black trans women being asked unnecessary questions by medical providers and feeling judged by staff. They also face long wait times for medical appointments and prescriptions. The need to seek separate care for issues ranging from gender transitions to HIV to routine matters can compound the complications, the study found.

Fulton County Board of Health to restore HIV prevention jobs after May layoffs

Black trans women want doctors to “treat my cough and not my gender,” said Joelle Espeut, the advocacy director at The Normal Anomaly Initiative who helped lead the study.

Organization leaders said they are feeling pressure to remove references to trans and gender non-conforming people from their official materials as they seek to protect their funding, creating a feeling of erasure.

Black trans women want to be included in the leadership of a variety of organizations, not just those focused on trans people, and be seen as regular members of society beyond just their gender identity.

“We work, we pay bills …. we are still taxpayers, we are still a part of this community,” said Christen “Coco” Valentine. “We’re human. So cut the stigma out.”

HIV workers focus on resilience

Many conference attendees said the recent funding cuts have taken an emotional toll on them.

“We’re holding the insecurities, the disappointments, the frustrations, the erasure,” said Simone Phillips, director of training and technical assistance at the St. Louis HIV/STI Prevention Training Center. Her comments drew “amens” from the audience.

“All of these headlines are just flooding us with nos and nos. So it does make you pause. It does make you feel overwhelmed, but it’s also like almost powerless to the sense of, ‘where do I start when there are so many fires?’” said Brady Maiden, the community science program manager for the Southern AIDS Coalition.

The desire to tell a different kind of story, one focused on resilience, was the impetus for Anderson’s short documentary “And We Rest on Giants,” which focuses on the stories of long-term HIV survivors and attempts to highlight the “joy and resilience as individuals that were living and thriving with HIV.”

The goal of the film is to encourage people to have conversations about HIV with their families and communities, reduce the secrecy and silence, and show that people living with HIV have rich and fulfilling lives and are not defined by the disease.

Resilience includes envisioning new ways to connect and support others in their community – like a proposed “auntie circle” in Houston, where women can lean on each other and learn from older trans women, said Bec Sokha Keo, a researcher at the University of Houston who helped coordinate the study.

Community support can be a vital resource

Research on HIV in the South can overcome federal funding cuts, Maiden said, by turning to community support, which can also help build trust and improve outcomes.

Research doesn’t always have to be sponsored by a large institution, Maiden said: “We are the subject matter of experts, and we’re allowed to ask questions.”

It’s important to ensure that projects center local voices because different parts of the South have different histories and challenges, she said. And it’s important to disseminate results of research to the communities who participated or are affected by the findings. Even decisions as basic as choosing a location should be guided by community needs and equity, she said.

“Community science is working with community, activating with community, being intentional, and making sure that we’re also using community to be the experts, but giving them that information back so they can also use it for what they need to advance,” Maiden said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Inside a crisis at the CDC: Shooting adds to trauma as workers describe projects, careers in limbo

2025-08-11T05:00:00+00:00

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Centers for Disease Control and Prevention workers whose jobs have been reinstated after dizzying Trump administration disruptions say they remain stuck in a budgetary, political, and professional limbo.

Their work includes major agency priorities such as HIV testing and monitoring, as well as work at the nation’s leading sexually transmitted infections lab. And while employees are back, many projects have been canceled or stalled, as funding disappears or is delayed.

“For a while, work was staring at a blank screen,” an HIV scientist said. “I had a couple of projects before this. I’m trying to get them restarted.”

“We don’t know what’s happening or what to do,” said an HIV prevention researcher who was fired then rehired.

These employees voiced deep concern over the future of the agency and its work on HIV and other threats. The unprecedented downsizing could lead to loss of life and higher spending on medical care, they say. Their uncertain employment status has sunk morale. Many worry about the future of public health.

On Friday, a gunman identified by Georgia authorities as Patrick Joseph White fired shots at CDC buildings in Atlanta. A first responder on the scene, DeKalb County police officer David Rose, was killed. White, who was found dead, was possibly motivated by his views on vaccines, according to news reports.

The attack added another level of anxiety for agency workers.

Run. Hide. Fight. What the CDC shooting means for public health

“We feel threatened from inside, and, obviously, now from outside,” a lab scientist said Sunday. “The trauma runs so differently in all of us. And is this the last straw for some of us? The overall morale — would you go back in the building and you could be shot at?”

Healthbeat interviewed 11 CDC workers, who offered a rare glimpse into conditions at the agency. All but one had been fired then offered their jobs back. Most have worked on HIV-related projects for at least several years. All spoke on the condition of anonymity, citing a fear of retaliation.

They fear their employment, in the HIV scientist’s terms, “is on shaky ground.”

“I’m concerned there is chaos and that we lost ground on HIV prevention” from reductions in data collection and layoffs of local public health workers, an HIV epidemiologist said. “I feel like a pawn on a chessboard.”

HHS spokesperson Emily Hilliard responded to a query with this statement:

“Under Secretary Kennedy’s leadership, the nation’s critical public health functions remain intact and effective. The Trump administration is committed to protecting essential services — whether it’s supporting coal miners and firefighters through NIOSH, safeguarding public health through lead prevention, or researching and tracking the most prevalent communicable diseases. HHS is streamlining operations without compromising mission-critical work. Enhancing the health and well-being of all Americans remains our top priority.”

CDC’s programs on HIV face uncertainty

The workers received some positive news July 31, when a Senate committee voted to keep CDC funding at more than $9 billion, near its current level. “It is very encouraging, but that’s only one step in the appropriations process,” the HIV researcher said.

Still, under the Trump administration’s budget request, the CDC’s programs on HIV face uncertainty. Dr. John Brooks, who retired as chief medical officer of the CDC’s Division of HIV Prevention last year, expressed concern over the Ending the HIV Epidemic initiative. Launched in President Donald Trump’s first term, it “breathed new life into HIV prevention,” Brooks said.

The successes of the Ending the HIV Epidemic initiative are jeopardized by the administration plan to scale back HIV prevention efforts, Brooks said. That would include the potential elimination of the CDC Division of HIV Prevention, which provides funds to state health departments and other groups for testing and prevention, conducts HIV monitoring and surveillance, researches HIV prevention and care, and assists medical professionals with training and education.

Fulton County Board of Health to restore HIV prevention jobs after May layoffs

“There is no way to achieve the goals of EHE without maintaining the national prevention infrastructure it depends on,” Brooks said. “There is every reason to worry that in fact new HIV infections will rise again.”

Under Secretary Robert F. Kennedy Jr., the Department of Health and Human Services carried out widespread layoffs at the CDC and other health agencies beginning in early April. Lawsuits over those mass firings are playing out in federal courts.

The administration’s budget blueprint would move CDC HIV work — with many fewer employees, according to people Healthbeat interviewed — to the Administration for a Healthy America, a new HHS division Kennedy has championed.

The Medical Monitoring Project, which tracks outcomes, quality, and gaps in HIV treatment, is set to be a casualty under the Trump restructuring plan, an HIV prevention physician said.

HHS officials have not communicated with the rank and file about the restructuring, several CDC workers said.

“It’s been crickets,” the HIV scientist said.

‘We need to keep fighting’: HIV activists organize to save lives as Trump guts funding

The White House’s proposed CDC budget for the next fiscal year contains a cut of more than 50%, plummeting from $9.2 billion in fiscal year 2025 to about $4.2 billion, according to administration documents and public health advocacy groups, with some agency functions transferred to the proposed AHA. The Senate committee, by an overwhelming vote, injected billions back into the agency budget and declined to fund the AHA.

U.S. Sen. Jon Ossoff, a Georgia Democrat, thanked the committee for “rejecting the unacceptable effort to defund most of the CDC.”

“The budget request from the White House included a 56% cut to the world’s preeminent epidemiological agency,” Ossoff said. He also criticized a “systematic destruction of morale at the CDC, the disbandment of entire agencies focused on maternal health and neonatal health and disease prevention at the CDC.”

How the cuts would trickle down to states

If the White House prevails and the prevention program is eliminated, “we would see most states have no funding for HIV prevention,” said Emily Schreiber, senior director of policy and legislative affairs for the National Alliance of State and Territorial AIDS Directors. “That means most states would not be able to conduct any HIV testing, any referral to care, and/or referral to preventive services like PrEP,” or pre-exposure prophylaxis, a drug that can prevent HIV infections.

“It means that states would not be able to help people get access to medications,” she said, “and that means that we would see new cases and an increased spread of HIV across the United States.”

“We would definitely see layoffs at the CDC, and I think we’d probably see them at state health departments and community-based organizations as well,” she added.

The Los Angeles County Department of Public Health has recently laid off or reassigned dozens of HIV workers due to funding problems, according to a statement emailed to Healthbeat.

“I fear all HIV prevention work will go away permanently,” the HIV prevention researcher said. “I don’t think this administration wants HIV prevention work to be done by the federal government.”

‘A lot of the enthusiasm is gone’

Georgia leads U.S. states in the rate of new HIV infections, according to the latest data from AIDSVu. CDC workers also said they’re concerned that vulnerable communities of color and LGBTQ+ communities would be deeply harmed by funding cuts.

In Georgia and other states, information provided by the Medical Monitoring Project about access to care will disappear, the HIV physician said. Information on prevention and treatment will dwindle for people who are disadvantaged, he said, including those with substance abuse problems or mental illness, transgender people, and those living in poverty.

“There is a lot of anger and sadness among people over the termination of the project,” the physician said. “A lot of the enthusiasm is gone.”

An effective home testing program for HIV plans to shutter this fall, said Patrick Sullivan, the Together TakeMeHome project’s lead scientist and a professor at Emory University’s Rollins School of Public Health. In its notice canceling funding for the project, the CDC said it no longer had the staff to oversee it. Based at Emory, the project delivered more than 900,000 free home testing kits to people across the country through an easy-to-use website and integration with dating apps.

More than 100 HIV workers were among the more than 450 CDC staffers brought back, said employees interviewed by Healthbeat. Some cited media coverage, support in Congress, and advocacy by patient groups and pharmaceutical companies for their reinstatement. “Members of Congress are going to bat for HIV,” the epidemiologist said.

Several are closely watching a lawsuit brought by 20 Democratic attorneys general, seeking to halt an agency restructuring plan Kennedy announced in March. They are also paying attention to a lawsuit filed in California that challenges the firings.

A few people whose jobs were restored have retired or moved on to other work. “Some people aren’t trusting we will remain, so they’re leaving,” the HIV prevention researcher said.

At the CDC’s sexually transmitted infections lab in Atlanta, work has also slowed due to a shrinking staff and new spending constraints on supplies, the lab scientist said.

Restored lab workers are focusing on high-priority areas such as syphilis and gonorrhea while other diseases have been back-burnered, the scientist said, adding “a lot of what we were doing was staying ahead of the next pathogen, and we feel like our time and effort to do that now is limited.”

“We’re all public health because we know what the mission is,” the scientist said. “We just want to get our job done and protect the American public.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org. Andy Miller is a freelance writer for Healthbeat in Atlanta.

Fulton County Board of Health to restore HIV prevention jobs after May layoffs

2025-07-23T20:59:17+00:00

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The Fulton County Board of Health will restore at least 14 jobs in HIV prevention and sexual health after laying off workers in May citing a lack of federal funding, officials told Healthbeat on Wednesday.

The layoffs of 17 workers came amid delays in funding for HIV initiatives to state and local health departments from the Centers for Disease Control and Prevention. Those funds have since arrived, said Chris Rustin, interim district health director for Fulton County.

The Georgia Department of Public Health received $25.9 million for the second year of a CDC grant aimed at improving HIV surveillance and prevention. Of that, $5.9 million is allocated to Fulton, which covers the positions, DPH spokesperson Nancy Nydam Shirek said.

Fulton has also received other federal funds, including for the Ryan White program, which focuses on treating and supporting people living with HIV, and the CDC’s teen pregnancy prevention program, Rustin said.

The jobs will be reposted, and the former workers can reapply, though they will not automatically be rehired, he said.

Rustin said the county health agency is still working out the details of the budget with the state DPH, but that getting the job opportunities posted soon is “a priority,” and he hopes that will happen in the next couple of weeks.

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

Fulton health officials said in May that the layoffs would have no impact on services. At a town hall organized in response to the firings, Atlanta HIV advocates said they were concerned about how services would be affected.

“If there were any services eliminated that are critical for the community, we’re going to work to bring them back,” Rustin said.

The firings created an unnecessary disruption, said Leisha McKinley-Beach, a longtime HIV prevention advocate and CEO of the Black Public Health Academy, a training institute. She attended Wednesday’s meeting.

“It is an action that should have never happened,” she said. “Many of the staff that were released are necessary for implementation of the HIV prevention program.”

HIV testing services are vital in metro Atlanta. Fulton, DeKalb, and Clayton were among the 15 counties in the United States with the highest rates of new HIV diagnoses in 2022, according to the latest available data from AidsVu.

Fulton health leaders return from administrative leave

Two Fulton health leaders – district health director Dr. Lynn Paxton and human resources director Carol Lawrence – were put on administrative leave after the layoffs, which “were done without the prior knowledge or approval of the Georgia Department of Public Health,” Nydam Shirek said. Both are state employees assigned to county work.

Paxton has since been reassigned to DeKalb County, where she is serving as the interim district health director, replacing Dr. Sandra Valenciano, who left to accept the position of health officer for public health in Seattle & King County, Washington.

Rustin, who formerly served as a deputy commissioner at the state DPH, has stepped away from those duties to serve as the interim district health director for Fulton.

On Wednesday, Lawrence was back at work in Fulton, attending the board meeting.

DPH determined she was not involved in the layoff decisions and was reinstated on May 24, Nydam Shirek said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

‘We need to keep fighting’: HIV activists organize to save lives as Trump guts funding

2025-06-24T14:22:43+00:00

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GREENVILLE, Miss. — Cedric Sturdevant woke up with “a bit of depression” but made it to church, as he does every Sunday. In a few days, he would drive from Mississippi to Washington, D.C., to join HIV advocates at an April rally against the Trump administration’s actions.

It had clawed back more than $11 billion in federal public health grants to states and abruptly terminated millions of dollars in funds for HIV work in the United States. Testing and outreach for HIV faltered in the South, a region that accounts for more than half of all HIV diagnoses.

Dangerous changes loomed: To compensate for tax cuts for the wealthy, Trump’s “big, beautiful” bill and budget proposal for fiscal year 2026 threaten to curtail Medicaid, which provides health coverage for people with low incomes and disabilities. About 40% of adults with HIV rely on it for their lifesaving treatments.

Further, the budget proposes to eliminate all HIV prevention programs at the Centers for Disease Control and Prevention. This alone could lead to an additional 14,600 HIV-related deaths within the next five years, according to one analysis.

CDC staffing upheaval disrupts HIV projects and wastes money, researchers say

Trump’s budget proposal also would cancel a major grant that provides housing assistance for people with HIV. And it would end a strategic initiative to expand HIV services in minority communities, and another to support the mental health of people of color with HIV or at risk of infection.

“President Trump is committed to eliminating radical gender and racial ideologies that poison the minds of Americans,” a White House addendum to the budget says. Letters terminating HIV grants used similar language, targeting “diversity,” “equity,” and “gender minorities,” words that focus resources where they are needed most. Black and Latino people account for about 70% of new HIV infections in the United States.

The cuts affect Sturdevant personally. He is a gay, Black man living with HIV and the co-founder of a grassroots group that combats health disparities in the Mississippi Delta, one of the poorest regions of the country.

“Walk boldly!” said pastor Jerry Shelton during a sermon at the Anointed Oasis of Love Ministry church in the Mississippi Delta.

That morning at church, a close friend, pastor Jerry Shelton of Anointed Oasis of Love Ministry, asked Sturdevant to help him deliver a sermon about resisting the urge to give up when life is hard. “The storm may come, but I shall not be moved!” Shelton preached, directing the congregation to approach adversity with confidence in themselves and in God. “Walk boldly!” he shouted.

After the service, Sturdevant resolved to bring the same energy to Washington. He’d tell his colleagues that they are survivors, he said. He’d tell them, “Let’s get together and make a plan.”

In the past few months, HIV advocates have begun to organize and strategize ways to limit the damage as federal funds are slashed and inflammatory rhetoric rises.

“It is a very scary time to be Black, queer, and living with HIV,” said Marnina Miller, co-executive director of the Positive Women’s Network, a nationwide group for women living with HIV. “But I am grateful that I am part of a community that will not bow down.”

“People are not giving up,” said June Gipson, the CEO of a health care nonprofit, My Brother’s Keeper, in Mississippi. Then she referenced the 1980s cartoon where heroes combine forces to create a super robot to defend the universe:

“We’ve got to form Voltron.”

HIV carries the weight of stigma

Sturdevant often reminds his colleagues of all the HIV movement has overcome. In the 1980s, the government refused to acknowledge HIV as gay men died young. Once powerful treatments were available in the 1990s and early 2000s, the public health establishment largely neglected Black people with HIV, especially in the South. In that period, the demographics of the epidemic shifted away from white, upper- and middle-class gay populations in liberal states. Half of new diagnoses today are in the South, and a third are among people with low incomes.

When Sturdevant first tested positive for HIV in 2005, he didn’t seek treatment. He kept his diagnosis hidden from friends and family because he knew how people talked about HIV. They considered it a death sentence, a punishment for irresponsible behavior, or a disease that could infect them through a touch or a shared toilet seat — which it cannot.

“I thought my family was going to disown me,” he said.

Communities in the Mississippi Delta come together on Sundays at the Anointed Oasis of Love Ministry church.

A year later, his weight plummeted because he couldn’t hold down food or water. Gaunt and feverish, he went to the hospital and learned he had AIDS. His mother slept at his hospital bedside for two weeks: “She said, ‘God got you.’”

Once he regained his health, Sturdevant resolved to care for others in his position. Scientists had developed powerful HIV drugs that, if taken daily, transform it from a death sentence into a manageable chronic disease in which a person’s virus levels are so suppressed that they cannot spread HIV to others. And policymakers ensured that almost everyone in the United States with HIV could get treated regardless of their ability to pay, largely because of Medicaid and the Ryan White HIV/AIDS Program.

But HIV experts had failed to overcome a key problem: Roughly a third of people living with HIV in the United States don’t get treated or don’t take the drugs regularly enough to be virally suppressed. Viral suppression rates are better in many African countries than in America.

To seek treatment and stick with it, Sturdevant understood, people had to have basic needs like food and housing met and, as importantly, a sense of belonging and empowerment. At his first job at an HIV organization in Jackson, Mississippi, Sturdevant regularly checked in with clients who didn’t have family members to support them. He hosted gatherings at his apartment and even offered it up as a place to stay. He has taken on the role of dad or uncle to many. “We called ourselves the family of love,” he said.

HIV testing and outreach falter as Trump funding cuts sweep the South

He saw how care bolstered lives, but the federal government needed data to drive its approach to HIV.

In 2012, the CDC expanded its in-depth surveys to learn more about the lives of people at risk of HIV and of those with HIV who weren’t virally suppressed. The surveys revealed what Sturdevant knew: A disproportionate number of them grappled with unstable housing, food insecurity, depression, and anxiety. Many participants agreed to prompts like, “Having HIV makes me feel that I’m a bad person,” or “Most people think that a person with HIV is disgusting,” or “Most people with HIV are rejected.”

The data showed policymakers that to curb the epidemic, they needed to address underlying problems that people with HIV faced. Federal funds began to flow to grassroots groups embedded in marginalized communities.

Public health researchers folded Black churches into the effort, recognizing them as hubs of volunteerism and as leaders of social movements. Although churches in the United States had historically fueled stigma against sexually transmitted diseases, Amy Nunn, a public health researcher at Brown University, said every pastor she talked with was eager to help. It paid off. In Kansas City, for example, researchers found that congregants who went to Black churches involved in HIV education and outreach were more than twice as likely to be tested.

The Mississippi Delta is one of the most underserved regions in the country, a situation rooted in sharecropping, Jim Crow laws, segregation, and gerrymandering. Crosses stand near one of hundreds of small churches in the region.

Community-based interventions worked: New HIV infections dropped by 12% from 2018 to 2022.

Now the grassroots groups that have been so effective are in jeopardy and the in-depth surveys have halted as the Trump administration cuts funds and lays off CDC staff. Some health departments have issued stop-work orders to community-based groups that test people for HIV and connect them to treatment because federal HIV grants are unusually delayed. And as the Department of Health and Human Services continues to cancel HIV grants, the directors of grassroots groups anticipate more cuts.

“A lot of them are new and don’t have the resources to survive a year without funding,” said Masen Davis, executive director of Funders Concerned About AIDS.

One such group is Sturdevant’s.

Republicans in Congress: ‘Trust the process’

In 2017, Sturdevant returned home to the Mississippi Delta to launch a nonprofit, Community Health PIER, in one of the poorest and most medically underserved parts of the country. The average life expectancy in the Delta is 68, a decade shorter than the national average. The disenfranchisement of its majority-Black population stems from the region’s history, in which policies concentrated wealth and power among the minority-white population during the era of cotton sharecropping, Jim Crow laws and segregation, and, recently, due to gerrymandering.

Sturdevant set up shop in Greenville, near a Black church that served as a headquarters for civil rights activists in the 1960s. In a small office, his team organizes health events, tests people for HIV, and connects those who test positive with treatment and housing assistance, funded through federal programs like Ryan White.

“Whites have been getting Ryan White and other programs for years and living healthy,” said Ashley Richardson, administrative assistant of Sturdevant’s group. “Around here, Black people are just now getting to the point where we know there are resources to help.”

Lately the team fields calls from people with HIV who are terrified they will lose their lifesaving drugs and housing if government programs no longer help with the cost.

Sturdevant worries about keeping his staff employed and his community safe. On the drive home from the April event in Washington, he drearily recounted conversations with Republicans in Congress: “They basically all said trust the process.”

The heads of national HIV organizations have stepped up their advocacy, asking Congress to oppose cuts in President Donald Trump’s budget request, said Gregorio Millett, director of public policy at the Foundation for AIDS Research, a nonprofit known as amfAR.

Emily Hilliard, spokesperson for the Department of Health and Human Services, responded to queries from KFF Health News by writing, “Critical HIV/AIDS programs will continue under the Administration for a Healthy America.” Yet the administration’s proposed budget for HIV prevention represents a 78% reduction compared with fiscal year 2025, according to a KFF analysis.

HHS Secretary Robert F. Kennedy Jr. has fostered skepticism about scientific facts concerning HIV, without citing evidence. “Any questioning of the orthodoxy that HIV is the sole cause of AIDS remains an unforgivable-even dangerous-heresy among our reigning medical cartel,” he wrote in a 2021 book.

Advocates are not bowing to barriers

Researchers and HIV advocates are hashing out strategies to fill in the vacuum in HIV care that the government is poised to leave. For decades, it has driven priorities, coordinated a constellation of HIV groups, and tracked the epidemic. Leisha McKinley-Beach, CEO of a training institute, Black Public Health Academy, in Atlanta, said people must remember that wasn’t always the case.

“This massive industry we have today was created by committed individuals at the grassroots level, who were going to help people live with HIV or die with dignity, by any means necessary,” she said.

One idea is to have larger, established HIV organizations partner with nascent groups in underserved regions. The bigger ones stand a better chance of garnering significant private donations. And by taking on the fiscal management of grants, large groups could enable small ones to devote time to service rather than fundraising, McKinley-Beach said.

Another strategy, said Kathy Garner, executive director of Mississippi’s AIDS Services Coalition, is to fill gaps by coordinating with churches and nonprofits dedicated to food assistance, housing, or mental health.

“One of the solutions is going to be civil society stepping up,” Garner said. “That’s an old term for people taking care of each other, outside of the government.”

“I have real concerns with what the Trump administration is doing, and how it will play out for the health of people in a poor state,” said Bishop Ronnie Crudup of New Horizon Church International in Jackson, Mississippi.

“We’re going to need to ramp up our services in all kinds of ways, and health and HIV will be a part of that,” said Bishop Ronnie Crudup of New Horizon Church International in Jackson, and a member of Mississippi Faith in Action, a coalition of African American churches involved in HIV.

“I have real concerns with what the Trump administration is doing, and how it will play out for the health of people in a poor state,” he said.

National groups, such as AIDS United, have been speaking with corporate funders and philanthropies about building a pooled fund to help sustain HIV organizations across the United States.

Philanthropy for HIV has never come close to matching federal dollars, however. Non-governmental funders put $284 million toward HIV in the United States in 2023, compared with about $16 billion in annual federal funds for HIV in recent years.

“The truth is there is no way for philanthropy to make up for the cuts from the federal government,” Davis said. “I suspect we will see new infections rise within 18 months, which is heartbreaking.”

Sturdevant focuses on survival, not forecasts. “This isn’t going to be easy,” he said, “but we need to keep fighting for those who don’t have the fight in them.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

CDC staffing upheaval disrupts HIV projects and wastes money, researchers say

2025-06-13T14:48:52+00:00

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Dozens of HIV experts at the Centers for Disease Control and Prevention received emails on Wednesday revoking notices they received 10 weeks ago that laid them off. Damage to their projects may be permanent, however, and ongoing restrictions on their research will harm lives, multiple HIV scientists at the CDC told KFF Health News on condition of anonymity because of fears of retaliation.

The researchers were laid off in early April, just before they put the finishing touches on in-depth, national surveys about HIV. Health officials across the country had interviewed tens of thousands of people at risk of acquiring HIV, or who are living with the virus, and compiled information from mountains of medical records.

States and cities were prepared to submit the information they collected to the CDC in April so the agency’s statisticians could prepare the volumes of data for analysis.

Health officials and policymakers use the data to design HIV programs that more efficiently curb the spread of infections and save lives. For example, a 2023 survey revealed that about half of adults under age 30 who were living with HIV weren’t on treatment steadily enough to keep them healthy and prevent them from spreading the virus to others. Treatment rates were far higher for those over 50. As a result, health officials doubled down on outreach to younger generations.

However, in April, state and local health officials found themselves cut off from their CDC counterparts after the layoffs. Emails from the Department of Health and Human Services told staff their roles were “either unnecessary or virtually identical to duties being performed elsewhere in the agency.”

Marti Merritt, a project coordinator at the Illinois state health department, was flabbergasted that she and other state employees had invested more than a year into the surveys only to have them go dark in the final phase. “It’s like the data has gone into a black hole,” she said. “How do you set priorities if you don’t have data?”

Merritt worries that if the surveys don’t resume, limited budgets will be misspent — and that cases will rise. Data allows health departments to tailor their efforts to the populations at greatest risk of infection or disease progression.

Evidence shows that preventing HIV is far cheaper than treating people once they’re infected. Preventing one HIV infection results in $466,000 in lifetime savings. Merritt was also dismayed to have wasted the time of thousands of people who opened up about intimate details of their lives in hopes of fighting the HIV epidemic.

A doctor and HIV expert reinstated at the CDC this week said the late termination of the surveys would waste millions of taxpayer dollars that have already been spent on data collection. Two large, long-standing efforts, the Medical Monitoring Project and the National HIV Behavioral Surveillance system, cost around $72 million, he said.

“Two years’ worth of data from 30,000 participants will be unusable, and therefore wasted,” if the projects can’t be finished, he said.

To resume the surveys, he and other CDC researchers would need a green light from higher up because the grants covering these surveys ended while they were on administrative leave in May.

State health officials said they haven’t received the CDC notices that typically renew the surveys every June. Merritt has conducted interviews for the Medical Monitoring Project for about 20 years, she said, but the Illinois health department has now assigned her to other tasks. Other health departments have laid off or reassigned employees dedicated to HIV surveillance, too.

If HHS allows the reinstated researchers to resume the projects, they could try to account for the 10-week gap in their analysis. But it would take time, further delaying the next round of surveys — if those begin at all.

“These surveys aren’t lights that you turn on and off,” said John Brooks, a researcher who retired from the CDC’s Division of HIV Prevention last year. If the surveys resume, he said, “we can get some value out of all of the money spent.”

However, the surveys would be further impaired by actions related to Trump’s executive orders targeting words such as “gender” that researchers use to learn who has HIV, who is at risk, and why.

Experts at the CDC said they’ve already had to revise earlier surveys and recalculate results to not reference gender. This has meant altering data on two populations disproportionately affected by HIV: transgender people and men who have sex with men.

“To erase people from our data harms them,” said the researcher and doctor now reinstated at the CDC. “I care about the transgender patients I see, and it’s so hurtful to see them treated this way by the government.”

The doctor said he has treated HIV patients since the beginning of the epidemic in the 1980s, and the sting he feels now is worse than under President Ronald Reagan, who never publicly mentioned HIV in his first term.

“There was a lack of funding,” he said, “but they didn’t censor science or try to control science like they’re doing now.”

Many HIV researchers have taken jobs outside the government or moved since the April layoffs. Some researchers returning to the agency called the reinstatements perplexing because the notices don’t say what they’ll be doing when they return and for how long.

A terse email to CDC employees from Tom Nagy, chief human capital officer at the Department of Health and Human Services, reviewed by KFF Health News, simply refers to the notice regarding the reduction in force and says, “That notice is hereby revoked.”

In an email response to queries, Andrew Nixon, HHS director of communications, wrote, “HHS is streamlining operations without compromising mission-critical work. Enhancing the health and well-being of all Americans remains our top priority.”

“We’ve been getting paid this whole time even though we’ve not been allowed to work, and that doesn’t feel good when you’re a dedicated civil servant,” said one reinstated employee.

Amy Maxmen is Healthbeat’s national reporter under a partnership with KFF Health News.

Medicaid cuts threaten health of Atlanta’s Black LGBTQ+ community

2025-06-09T15:24:15+00:00

This story originally appeared at Capital B Atlanta. Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

As lawmakers push for sweeping cuts to Medicaid, fear weighs heavily on Tori Cooper.

Cooper, a trans woman who serves as the director of strategic outreach and training for the Human Rights Campaign, told Capital B Atlanta that for her and other Black trans residents, these cuts will have a detrimental impact on their lives.

“The Black LGBTQ community will be greatly impacted, and Black trans folks even more so,” said Cooper. “For years, we’ve acknowledged how systematic racism impacts the lives of Black LGBTQ people. Inequity and racist ideology and policies have traditionally led to worse health outcomes for poor, less educated, underemployed people and those of us who live in the South.”

Last month, congressional House Republicans passed a bill that would cut billions over the next 10 years from Medicaid, the federal-state health care insurance program that helps pay for health care for low-income people. The bill also would prohibit gender transition care from being covered by the program.

“I worry that preventable health conditions like HIV will ravage my community,” Cooper said. “I worry that Black trans people will lose some of the social and political traction that our transestors fought for. I worry that my Black trans family will have to go back into the proverbial closet for safety. Closets are made for clothes, not people.”

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

Cooper worries that in a place like Georgia, where HIV rates are high and access to health care is already difficult due to the Georgia General Assembly’s refusal to expand Medicaid, the Black LGBTQ+ community will be one of the vulnerable and bear the brunt of these looming cuts.

In 2023, about 1 in every 4 Black Georgians was covered by Medicaid, compared to about 1 in every 10 white Georgians, according to the State Health Access Data Assistance Center.

Nationally, Black LGBTQ residents are twice as likely to be enrolled in Medicaid compared to the general population, Victoria Kirby York, director of public policy and programs for the National Black Justice Coalition, told Capital B Atlanta.

York said she’s fearful that critical areas of health care for Black LGBTQ+ residents such as gender-affirming care, mental health services, and substance abuse treatment will all be impacted by the Medicaid cuts.

“Thirty-two percent of [LGBTQ people] versus 15% of the general population use Medicaid in order to access health care, and that number is even higher for transgender members of our community, where 45% of the community are relying on Medicaid,” York said.

Georgia could lose billions in Medicaid funding

Although Georgia is one of the 10 states that did not expand Medicaid, leaving hundreds of thousands of residents uninsured, the proposed budget cuts will still be felt. The state could potentially lose billions in federal Medicaid funding, and hundreds of thousands of Georgians could lose Medicaid coverage over the next 10 years, according to reporting from the Kaiser Family Foundation.

Matthew Rose, senior public policy advocate with the Human Rights Campaign, told Capital B Atlanta these cuts will put a strain on the state’s budget, resulting in a push by state lawmakers to make “draconian” decisions on how to further cut costs.

This could mean cutting back on some of the optional health services and medicines provided underneath Medicaid in Georgia, such as HIV preventative medications or mental health services, or lawmakers could tighten eligibility requirements so fewer residents are covered by the insurance program.

When it comes to HIV, Maxx Boykin, the campaign manager for Save HIV Funding, told Capital B Atlanta he worries Medicaid cuts could exacerbate the already high HIV transmission rates in the state, as many people living with HIV rely on Medicaid for medication and wraparound services like home health care and therapy.

Fulton County health department leaders put on leave after HIV workers laid off

According to the Kaiser Family Foundation, Medicaid is the largest source of insurance coverage for people with HIV in the United States, covering an estimated 40% of the nonelderly adults with HIV, compared to just 15% of the nonelderly adult population overall.

According to the Centers for Disease Control and Prevention, Georgia had the second-highest HIV diagnosis rate and the second-highest rate of HIV related deaths in 2023 in the United States.

Additionally, Georgia had the highest rate of new HIV infections in 2022. In addition, despite constituting about 32% of Georgia’s population, Black people accounted for approximately 71% of new HIV diagnoses in 2021.

“When thinking about HIV, that means less people will have access to the medications that they need, and we will see an even larger spread of HIV in our communities, and a big part of that will be because the majority of people living with HIV actually need Medicaid,” said Boykin.

Seniors and those with disabilities make up half of Medicaid spending

Maisha Standifer, the director of population health at the Satcher Health Leadership Institute at the Morehouse School of Medicine, said the elderly and those with disabilities shouldn’t be forgotten when thinking about Medicaid and the LGBTQ community.

According to the Human Rights Campaign, in the United States, LGBTQ+ adults, and transgender adults in particular, were significantly more likely than non-LGBTQ+ adults to self-report having at least one disability.

Standifer said that for Georgia’s Medicaid program, people ages 65 and older and people with disabilities account for more than half of the state’s $16 billion Medicaid spending.

“We have community partners who are 30-plus years living with HIV and aging. So with aging naturally comes other chronic conditions. We’re talking about diabetes, cancer, heart disease,” said Standifer.

The cuts to Medicaid are part of the Trump administration’s efforts to curb federal spending to offset the cost of extending the president’s 2017 tax cuts for high-income earners.

Of further concern to Rose with the Human Rights Campaign is the impact on the LGBTQ community when the Medicaid cuts are layered on top of the proposed SNAP cuts in the bill, creating even more harm to LGBTQ people’s health.

“We’ve seen the result of what hunger can do, which is why we feed people, why we created these programs in the first place, and the SNAP cuts would be devastating. … Then you tack them on to the fact that you’re not eating as much, which weakens your immune system, and so it makes it easier for you to get sick, so it’s a compounding issue,” said Rose.

While the Medicaid cuts are still under review in the Senate, advocates are encouraging anyone in opposition to the cuts to reach out to their representatives and share their concerns about the proposed legislation.

“We need to hold our elected officials accountable, both on the federal side, the state side, and our local side, to make sure they’re actually doing what’s right for folks,” said Boykin.

Alyssa Johnson is Capital B Atlanta’s enterprise reporter.

Trump administration is ending multiple HIV vaccine studies, scientists and officials say

2025-06-03T13:58:06+00:00

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The Trump administration has moved to end funding for a broad swath of HIV vaccine research, saying current approaches are enough to counter the virus, several scientists and federal health officials say.

Notifications that the funding would not be extended were relayed Friday to researchers, who were told by National Institutes of Health officials that the Department of Health and Human Services had elected “to go with currently available approaches to eliminate HIV” instead.

The cuts will shutter two major HIV vaccine research efforts first funded by the NIH in 2012 at the Duke Human Vaccine Institute and the Scripps Research Institute, scientists said. A Moderna spokesperson said the vaccine manufacturer’s clinical trials through the NIH’s HIV Vaccine Trials Network have also been put on pause.

One senior NIH official said the HHS had instructed the agency not to issue any more funding in the next fiscal year for HIV vaccine research, with only a handful of exceptions.

A budgetary rule change specifically targeted at HIV vaccine research is also expected to lead to another cut to the NIH’s awards for studies initiated by scientists, an official said.

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

The change, to be finalized shortly, inflates the accounting for the upfront cost of studies into HIV vaccines funded by the agency. Instead of the cost of a five-year grant being spread over five years, the NIH plans to make HIV vaccine dollars from multiyear grants all count toward a single year, the official said, making it harder for them to get funded.

A spokesperson for HHS told CBS News that “complex and duplicative health programs have resulted in serious duplication of efforts,” saying that “27 separate programs that address HIV/AIDS” had spent $7.5 billion.

“The administration believes the United States should have the best medical research in the world. To that end, we are advancing policies to maximize the impact of every federal taxpayer dollar and ensure proper oversight of this funding,” HHS spokesperson Emily Hilliard said.

Hilliard claimed “critical HIV/AIDS programs will continue” under the new agency that Health and Human Services Secretary Robert F. Kennedy Jr. has proposed creating, dubbed the Administration for a Healthy America.

“For HIV vaccine design and development, we’ve begun to see light at the end of the tunnel after many years of research. This is a terrible time to cut it off. We’re beginning to get close. We’re getting good results out of clinical trials,” said Dennis Burton, an immunology professor at Scripps Research.

Burton warned that his institution’s HIV vaccine research could not simply be turned back on, even if a future administration decided to change course on HIV funding. He said that ongoing experiments would be shuttered and that researchers assembled to study the issue would be forced to refocus their careers on other topics.

“This is a decision with consequences that will linger. This is a setback of probably a decade for HIV vaccine research,” Burton said.

The cancellation of the funds comes weeks ahead of the FDA’s June 19 deadline for deciding on approval of lenacapavir, a twice-yearly injectable drug to prevent HIV.

The drug, which is being brought to the commercial market by drugmaker Gilead Sciences, builds on NIH-backed research into earlier HIV medications. The drug’s availability could lead to a significant drop in HIV cases worldwide, since a study found it was 100% effective in preventing transmission.

An NIH official, who was not authorized to speak publicly, rebuked the claim that the effectiveness of current HIV prevention strategies meant a vaccine was no longer needed. “The only way of ending the HIV epidemic in the U.S. and AIDS pandemic worldwide” is with a vaccine, the official said.

CDC cancels grant that funded free home test kits for HIV

Developing an effective HIV vaccine has been an elusive target for researchers, though scientists have hailed recent breakthroughs in the field.

“HIV has established roadblocks to us fighting it off, which are unparalleled in vaccinology. We’ve had to learn what each of the roadblocks are and to devise ways to overcome it. This virus mutates so quickly,” said Duke professor of medicine Barton Ford Haynes, who is part of the Duke Human Vaccine Institute.

Haynes said his institute’s work was essentially combining different vaccines as part of a strategy to design an effective HIV vaccine.

He praised lenacapavir as a “wonderful development for the field” but said there was still a need for a vaccine. Lenacapavir requires injections every six months to remain effective, a challenging proposition even before steep cuts to the Centers for Disease Control and Prevention’s domestic HIV programs and U.S.-backed HIV/AIDS foreign aid programs.

“The hope was that adding an HIV vaccine to all the preventive measures that we have would finally allow us to end the pandemic,” Haynes said.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Atlanta HIV prevention advocates plan town hall on Fulton County public health firings

2025-05-27T19:41:57+00:00

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Atlanta HIV prevention advocates plan to hold a town hall Wednesday to discuss the layoff of 17 workers from the Fulton County Board of Health.

The town hall is scheduled for 11 a.m. to 1 p.m. at Mayfaire Medical, Suite 410, in the Summit South Building at 777 Cleveland Ave. in Atlanta. It is open to the public.

The event is being organized by Daniel Driffin, an independent public health consultant, and William Francis, pastor of The 166 Church. Both have spent years working on HIV prevention.

They are concerned about access to services like testing and access to drugs that can prevent infection in the wake of last week’s layoffs of Fulton health department staff who worked on HIV and sexual health.

“The safety net is literally being yanked out from under people,” Francis said.

Fulton, DeKalb, and Clayton counties were among the 15 counties in the nation with the highest rates of new HIV diagnoses in 2022, according to the latest available data from AidsVu.

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

“We as a community are going to have to figure out what can be done so people don’t fall through the cracks of public health,” Francis said.

After the surprise layoffs, the state Department of Public Health placed two senior Fulton health department leaders on unpaid administrative leave: District Health Director Dr. Lynn Paxton and Carol Lawrence, human resources director. The DPH said the Fulton layoffs were unauthorized.

Neither state nor Fulton health department officials would elaborate on the layoffs, or the source of the funding for the terminated staff.

“My greater concern is that this will ripple across the state,” said Jeff Graham, executive director of Georgia Equality, a nonprofit LGBTQ advocacy organization.

“There needs to be some transparency from the state health department and Fulton County immediately,” Graham said, adding that groups that provide services to people with HIV are worried about their own funding and also want to ensure that people have the services they need to prevent HIV.

Some of the affected Fulton workers and other advocates told Healthbeat that innovative services like a syringe exchange and initiatives with community groups to promote HIV testing could be disrupted.

Tyson Randolph, who was among those laid off last week, said the terminations will have “major implications for the community’s health going forward.”

“I was in the developmental process of building the bridge with the kids at this community center … but my efforts are all out the window.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

2025-05-27T11:00:00+00:00

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Georgia has the highest rate of new HIV infections among all states. Access to affordable testing is a key component of ending the epidemic.

The Centers for Disease Control and Prevention recommends that every adult get tested at least once in their lifetime as a part of routine health care, but only about a third of Americans do it, said Patrick Sullivan, a professor at Emory University’s Rollins School of Public Health.

There are many convenient, discreet, even free, ways to get tested in Atlanta. Most of these services focus on connecting people to prevention and treatment services. The AIDS Healthcare Foundation, for example, attempts to connect people who test positive with a medical appointment within three business days and remove any barriers to treatment.

Here are some of the options.

1. At home. Together Take Me Home is a national project that mails two free HIV testing kits to your home in discreet packaging. The rapid test is conducted with an oral swab, so no blood draw is necessary. The project has reached nearly 750,000 people. But hurry: The program will end in September after the CDC terminated it due to a lack of staff to oversee it.

2. At the club. AIDS Healthcare Foundation’s mobile testing units often visit night clubs and community fairs around the city.

3. At the “adult store.” Positive Impact Health Centers conduct tests at Starship Enterprises locations on Memorial Drive in Stone Mountain on the first Sunday of every month; at the Old National Highway location in Atlanta, and the Highpoint Road location in Snellville on the third Sunday of every month. Testing is offered from 4 to 7 p.m.

A bus for SisterLove, an Atlanta reproductive health nonprofit, is parked at the Georgia State University Clarkston Campus in January.

4. On the bus. You can’t miss the big purple Healthy Love bus sponsored by SisterLove, or its friendly and devoted driver, Will Settle. He’s been driving the bus since its start in 2022, a major shift from his past career at the Delta Air Lines Foundation. The bus has logged more than 10,000 miles and helped to provide more than 2,000 tests. “Without question, this service removes transportation barriers,” Settle said. The tests are free. The bus will be at SisterLove’s community health fair from 1 to 7 p.m. July 19 at 3699 Bakers Ferry. Rd.

5. At the drugstore. You can purchase an HIV test at many retail pharmacies. At CVS, it costs about $46 over the counter. You can also get the tests delivered with services like DoorDash and UberEats. No prescription needed.

6. At the thrift store. The Out of the Closet thrift store at Ansley Mall creates a “destigmatizing space” where people can shop, get tested for HIV for free, and access community pharmacy services, said Imara Canady of the AIDS Healthcare Foundation. Ninety-six cents of every dollar spent at the store goes directly back into HIV services in the local community, Canady said. People can also get tested for other STIs and access pre-exposure prophylaxis (PrEP) at the clinic.

Jeanne Cooper and Brandon Nguyen work at the Out of the Closet Thrift Store.

7. At church. Houses of worship have emerged as an important testing site, Canady said. Many local churches host testing events, he said, pointing to the work of the Rev. Dr. Monte Norwood, pastor of Bible Way Ministries, in Atlanta’s Thomasville Heights neighborhood.

8. Schedule online. Many local clinics let you book an appointment online. Empowerment Resource Center and SisterLove offer online signups for free testing at their clinics.

9. Or call. Other clinics also offer testing services you can book by phone, including AID Atlanta, Positive Impact Health Centers in Duluth and Decatur, and Someone Cares in Marietta.

10. At the local public health department. County health departments offer HIV testing at their clinics.

DeKalb Public Health provides free testing at its health center locations and free home testing kits for pickup.
Fulton County Board of Health provides free or low-cost HIV testing, depending on the individual’s income.
The Clayton County Health Department provides free testing at its clinic on Battle Creek Road, as well as free at-home tests.
Cobb and Douglas Public Health provides free rapid testing at four locations. Free home testing kits are also available at the Marietta location, as well as via an online portal.
GNR Public Health, which covers Gwinnett, Newton, and Rockdale counties, provides in-person and at-home rapid testing.

For more options, visit locator.hiv.gov and FreeHIVTest.Net. To invite a mobile testing team to come to an event, reach out to the AIDS Healthcare Foundation and SisterLove.

Got an option to add to the list? Email us: atlanta.tips@healthbeat.org. You can also add upcoming HIV testing events to Healthbeat’s free events calendar.

This story has been updated to correct the spelling of Imara Canady’s name.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Fulton County, Georgia health department leaders put on leave after HIV workers laid off

2025-05-21T19:18:28+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

The Fulton County Board of Health this week laid off 17 workers, including those focused on HIV and sexual health services, apparently without the approval of the state Department of Public Health.

The unexpected layoffs prompted the state to place “two executive leaders” of the county agency on unpaid administrative leave.

Jack Hardin, chairman of the Fulton health department’s board, confirmed Wednesday that District Health Director Dr. Lynn Paxton and Human Resources Director Carol Lawrence were placed on leave. Chief of Staff Brian Easom is leading the department.

The Monday layoffs “were done without the prior knowledge or approval of the Georgia Department of Public Health,” spokesperson Nancy Nydam said Wednesday in an email, and “DPH is reviewing the actions.”

Neither Paxton nor Lawrence could immediately be reached for comment.

Hardin said the layoffs were part of a restructuring and would not affect delivery of services.

“FCBOH emphasizes there is no disruption in HIV, STI, and TB clinical services because of these actions,” Nydam said.

County health departments like Fulton’s provide a range of HIV testing and other sexual health services.

Tyson Randolph, who told Healthbeat he was laid off on Monday, said his team was working on innovative ways to bring services to those who aren’t typically reached.

He worked on public health education with youth groups and college students in Atlanta’s West End, where he lives.

The layoffs will have “major implications for the community’s health going forward,” Randolph said. “I was in the developmental process of building the bridge with the kids at this community center … but my efforts are all out the window.”

HIV testing services are vital in metro Atlanta. Fulton, DeKalb, and Clayton counties were among the 15 counties with the highest rates of new HIV diagnoses in 2022, according to the latest available data from AidsVu.

The U.S. Centers for Disease Control also recently laid off much of its HIV prevention staff, including the team working on preventing mother-child transmission of the disease. A CDC-funded program headquartered at Emory University that delivered nearly 750,000 free home HIV testing kits also will be canceled.

Community groups across the South have cut back on HIV services due to funding delays and cuts.

The Fulton County workers laid off this week will be paid through the end of May, with additional severance payments in June, according to a letter to one employee viewed by Healthbeat.

The staffing cuts come after the state health department lost an estimated $334.2 million in funds due to “clawbacks” of Covid-era funding from the CDC announced in March. Those cuts resulted in layoffs of temporary contact tracers and other workers at the state agency.

Georgia community groups including those focused on vaccine outreach and equity also lost grants due to the cuts.

This story has been updated to correct a quote from state health department spokesperson Nancy Nydam to include that the Fulton County Board of Health emphasized that HIV, STI, and TB clinical services would not be disrupted.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

CDC cancels grant that funded free home test kits for HIV

2025-05-06T20:42:12+00:00

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Federal funding for a program that used dating apps to connect people with free HIV home tests - identifying nearly 7,000 new cases since its start in 2022 - has been canceled.

The Together Take Me Home project, based at Emory University in Atlanta, has delivered almost 750,000 free home testing kits to people across the country through an easy-to-use website and integration with dating apps. The Centers for Disease Control and Prevention funded the project with about $55 million to be granted over five years, starting in 2022.

The cancellation notice said the CDC no longer has the staff to oversee the project, said Patrick Sullivan, the project’s lead scientist and professor at Emory’s Rollins School of Public Health.

About 150 employees of the CDC’s HIV prevention division were fired in April, gutting five of its 10 branches. The CDC fired around 2,400 employees as part of a restructuring under President Donald Trump’s executive order to eliminate waste in the federal government.

The CDC notified Emory in late April that funding for Together Take Me Home will end in September, two years earlier than planned.

The program has been effective in identifying and preventing HIV infection, Sullivan said.

HIV testing and outreach falter as Trump funding cuts sweep the South

CDC staffing cuts have also resulted in a reduction in data published about HIV in the United States. The latest data, released in late April, does not include information on HIV incidence or use of the HIV prevention drug PrEP due to a “reduction in force,” according to a message posted on the CDC website. Researchers use the data to track new cases and whether prevention efforts are working.

These are among the latest disruptions in HIV work under the new Trump administration. People working on ending mother-child transmission of HIV were also fired from the CDC, jeopardizing decades of progress. Millions in federal grants have been cut to state and local health departments, universities, and nonprofit organizations, leading community groups across the South to cut back on their testing efforts.

At-home HIV test program ‘exceeded’ expectations

The Together Take Me Home project set a goal of mailing out at least 875,000 home testing kits over the five-year period and had come close to meeting that with more than two years left on the grant.

“The initial project … really exceeded everyone’s expectations,” Sullivan said.

The project also integrated with dating apps to reach people, said Jen Hecht of Building Healthy Online Communities, a nonprofit partner in the project that has been working with dating apps on public health initiatives for 15 years.

About half of the site’s users came from dating apps, Hecht said. About a quarter of people who ordered testing kits reported testing themselves for the first time.

People liked the program because it was easy, free, and discreet, Hecht said.

“We identified that there were opportunities through the apps to reach people who’ve never tested before. And then in creating this program … we have been able to reach a huge number of people to test for the first time,” Hecht said.

The program had a particularly high reach in the South, including in Georgia, which has the second-highest rate of new HIV diagnoses in the United States, after Washington, D.C.

Testing initiative provided privacy and information

The tests, which use an oral swab of the gums, are delivered in discreet packaging.

“People in the South who, because of stigma, choose not to go into some of our AIDS service organizations or clinics could now take control and still learn their HIV status in the comfort of their home,” said Leisha McKinley-Beach, founder and CEO of the Black Public Health Academy who has worked on HIV for more than 30 years.

“They don’t have to worry about someone seeing them going into a clinic … Eliminating this program takes an option away from them,” she said. Being able to test at home means people don’t have to take time off work, she said.

The test kits also provide important information.

CDC cuts hit HIV prevention program, jeopardizing decades of progress on reducing infant transmission rates

“If someone happens to be positive, what are your next steps, and even if someone is negative, resources for those who are on a journey to remain negative,” McKinley-Beach said.

At-home testing is valuable to people in rural areas and for those who may not want their partner to know they are testing, as in an abusive relationship, said Maximillian Boykin, an HIV advocate who works for PrEP4All.

“Taking this away makes it even harder for us to help in the HIV epidemic, and makes it even further away from the president’s promise of ending the epidemic in 2030,” Boykin said.

During his first term, Trump 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.

Together Take Me Home drew together partners like NASTAD, a nonprofit membership organization representing public health officials who work on HIV and hepatitis, and Building Healthy Online Communities to create a website in English and Spanish where it takes just a few minutes to order a kit.

The testing kits provide guidance to people about next steps if they test positive. That website will have to be taken down when the funding ends in September, Sullivan said.

The CDC recommends that all Americans be tested for HIV at least once in their lifetime, but only about a third are tested, Sullivan said.

Sullivan and Hecht said they hope other funders might step in.

“Especially for the South, where we see the majority of new HIV diagnoses, we want to provide absolutely every option available for people to be able to learn their HIV status,” McKinley-Beach said. “It’s very disheartening.”

To find out where to get an HIV test near you, visit https://locator.hiv.gov.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

HIV testing and outreach falter as Trump funding cuts sweep the South

2025-05-06T09:00:00+00:00

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JACKSON, Miss. - Storm clouds hung low above a community center in Jackson, where pastor Andre Devine invited people inside for lunch. Hoagies with smoked turkey and ham drew the crowd, but several people lingered for free preventive health care: tests for HIV and other diseases, flu shots, and blood pressure and glucose monitoring.

Between greetings, Devine, executive director of the nonprofit group Hearts for the Homeless, commiserated with his colleagues about the hundreds of thousands of dollars their groups had lost within a couple of weeks, swept up in the Trump administration’s termination of research dollars and clawback of more than $11 billion from health departments across the country.

Devine would have to scale back food distribution for people in need. And his colleagues at the nonprofit health care group My Brother’s Keeper were worried they’d have to shutter the group’s mobile clinic — an RV offering HIV tests, parked beside the community center that morning. Several employees had already been furloughed and the cuts kept coming, said June Gipson, CEO of My Brother’s Keeper.

“People can’t work without being paid,” she said.

The directors of other community-based groups in Mississippi, Alabama, Louisiana, and Tennessee told KFF Health News they too had reduced their spending on HIV testing and outreach because of delayed or slashed federal funds — or they were making plans to do so, anticipating cuts to come.

Scaling back these efforts could prove tragic, Gipson said. Without an extra boost of support to get tested or stay on treatment, many people living with HIV will grow sicker and stand a greater chance of infecting others.

President Donald Trump, in his first term, promised to end America‘s HIV epidemic — and he put the resources of the federal government behind the effort. This time, he has deployed the powers of his office to gut funding, abandoning those communities at highest risk of HIV.

Trump’s earlier efforts targeted seven Southern states, including Mississippi, where funds went to community groups and health departments that tailor interventions to historically underserved communities that face discrimination and have less access to quality education, health care, stable income, and generational wealth. Such factors help explain why Black people accounted for 38% of HIV diagnoses in the United States in 2023, despite representing only 14% of the population, and also why half of the country’s new HIV infections occur in the South.

The U.S. was on track to end the HIV epidemic. Budget cuts threaten that progress.

Now, Trump is undermining HIV efforts by barring funds from programs built around diversity, equity, and inclusion. A Day One executive order said they represent “immense public waste and shameful discrimination.”

Since then, his administration has cut millions of dollars in federal grants to health departments, universities, and nonprofit organizations that do HIV work. And in April, it eliminated half of the Centers for Disease Control and Prevention’s 10 HIV branch offices, according to an email to grant recipients, reviewed by KFF Health News, from the director of the CDC’s Division of HIV Prevention. The layoffs included staff who had overseen the rollout of HIV grants to health departments and community-based groups, like My Brother’s Keeper.

The CDC provides more than 90% of all federal funding for HIV prevention — about $1 billion annually. The Trump administration’s May 2 budget proposal for fiscal 2026 takes aim at DEI initiatives, including in its explanation for cutting $3.59 billion from the CDC. Although the proposal doesn’t mention HIV prevention specifically, the administration’s drafted plan for HHS, released mid-April, eliminates all prevention funding at the CDC, as well as funding for Trump’s initiative to end the epidemic.

Eliminating federal funds for HIV prevention would lead to more than 143,000 additional people in the United States becoming infected with HIV within five years, and about 127,000 additional people who die of AIDS-related causes, according to estimates from the Foundation for AIDS Research, a nonprofit known as amfAR. Excess medical costs would exceed $60 billion, it said.

Eldridge Dwayne Ellis, the coordinator of the mobile testing clinic at My Brother’s Keeper, said curbing the group’s services goes beyond HIV.

“People see us as their only outlet, not just for testing but for confidential conversations, for a shoulder to cry on,” he said. “I don’t understand how someone, with the stroke of a pen, could just haphazardly write off the health of millions.”

My Brother’s Keeper helps people help themselves

Ellis came into his role in the mobile clinic haphazardly, when he worked as a construction worker. Suddenly dizzy and unwell on a job, a co-worker suggested he visit the organization’s brick-and-mortar clinic nearby. He later applied for a position with My Brother’s Keeper, inspired by its efforts to give people support to help themselves.

For example, Ellis described a young man who visited the mobile clinic recently who had been kicked out of his home and was sleeping on couches or on the street. Ellis thought of friends he’d known in similar situations that put them at risk of HIV by increasing the likelihood of transactional sex or substance use disorders.

When a rapid test revealed HIV, the young man fell silent. “The quiet tears hurt worse — it’s the dread of mortality,” Ellis said. “I tried to be as strong as possible to let him know his life is not over, that this wasn’t a death sentence.”

Ellis and his team enrolled the man into HIV care that day and stayed in touch. Otherwise, Ellis said, he might not have had the means or fortitude to seek treatment on his own and adhere to daily HIV pills. Not only is that deadly for people with HIV, it’s bad for public health. HIV experts use the phrase “treatment as prevention” because most new infections derive from people who aren’t adhering to treatment well enough to be considered virally suppressed — which keeps the disease from spreading.

Only a third of people living with HIV in Mississippi were virally suppressed in 2022. Nationally, that number is about 65%. That’s worse than in eastern and southern Africa, where 78% of people with HIV aren’t spreading the virus because they’re on steady treatment.

My Brother’s Keeper is one of many groups improving such numbers by helping people get tested and stay on medication. But the funding cuts in Washington have curtailed their work. The first loss was a $12 million grant from the National Institutes of Health, not even two years into a 10-year project. “Programs based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry,” the NIH said in a letter reviewed by KFF Health News.

My Brother’s Keeper then lost a CDC award to reduce health disparities — a grant channeled through the Mississippi state health department — that began with the group’s work during the Covid pandemic but had broadened to screening and care for HIV, heart disease, and diabetes. These are some of the maladies that account for why low-income Black people in the Deep South die sooner, on average, than those who are white. According to a recent study, the former’s life expectancy was just 68 years in 2021, on par with the average in impoverished nations like Rwanda and Myanmar.

Volunteers at Hearts for the Homeless offer free lunch to unhoused people in Jackson, Mississippi. But the group is scaling back its services because of the Trump administration’s cuts to federal funding.

The group then lost CDC funding that covered the cost of laboratory work to detect HIV, chlamydia, gonorrhea, and syphilis in patients’ blood samples. Mississippi has the highest rate of sexually transmitted diseases among states, in part because people spread infections when they aren’t tested and treated.

“The labs are $200 to $600 per person,” Gipson said, “so now we can’t do that without passing the cost to the patient, and some can’t pay.”

Two other CDC grants on HIV prevention, together worth $841,000, were unusually delayed.

Public health specialists close to the CDC, who spoke on condition of anonymity because they fear retaliation, said they were aware of delays in HIV prevention funding, despite court orders to unfreeze payments for federal grants in January and February. “The faucet was being turned off at a higher level than at the CDC,” one specialist said. The delays have now been compounded, they said, by the gutting of that agency’s HIV workforce in April.

“I know of many organizations reliant on subcontracted federal funds who have not been paid for the work they’ve done, or whose funding has been terminated,” said Dafina Ward, executive director of the Southern AIDS Coalition.

To reach the underserved, these groups offer food, housing assistance, bus passes, disease screening, and a sense of community. A network of the groups was fostered, in part, by Trump’s initiative to end the epidemic. And it showed promise: From 2017 to 2022, new HIV infections decreased by 21% in the cities and the Southern states it targeted.

Disparities in infections were still massive, with the rate of HIV diagnoses about eight times as high for Black people as white people, and the South remained hardest hit. Ward was hopeful at the start of this year, however, as testing became more widespread and HIV prevention drugs — called preexposure prophylaxis, or PrEP — slowly gained popularity. But her outlook has shifted and she fears that grassroots organizations might not weather the funding turmoil.

“We’re seeing an about-face of what it means to truly work toward ending HIV in this country,” she said.

Clinic closed amid funding delays

Southeast of Jackson, in Hattiesburg, Sean Fortenberry tears up as he walks into a small room used until recently for HIV testing. He has kept his job at Mississippi’s AIDS Services Coalition by shifting his role but agonizes about the outcome. When Fortenberry tested positive for HIV in 2007, he said, his family and doctor saved his life.

“I never felt that I was alone, and that was really, really important,” he said. “Other people don’t have that, so when I came across this position, I was gung-ho. I wanted to help.”

But the coalition froze its HIV testing clinic and paused mobile testing at homeless shelters, colleges, and churches late last year. Kathy Garner, the group’s executive director, said the Mississippi health department — which funds the coalition with CDC’s HIV prevention dollars — told her to pause outreach in October before the state renewed the group’s annual HIV contract.

CDC cuts hit HIV prevention program, jeopardizing decades of progress on reducing infant transmission rates

Kendra Johnson, communicable diseases director at Mississippi’s health department, said that delays in HIV prevention funds were initially on the department’s end because it was short on administrative staff. Then Trump took office. “We were working with our federal partners to ensure that our new objectives were in line with new HIV prevention activities,” Johnson said. “And we ran into additional delays due to paused communications at the federal level.”

The AIDS coalition remains afloat largely because of money from the Ryan White HIV/AIDS Program for treatment and from the Department of Housing and Urban Development. “If most of these federal dollars are cut, we would have to close,” Garner said.

The group provides housing or housing assistance to roughly 400 people each year. Research shows that people in stable housing adhere much better to HIV treatment and are far less likely to die than unhoused people with HIV.

Funding cuts have shaken every state, but the South is acutely vulnerable when it comes to HIV, said Gregorio Millett, director of public policy at amfAR. Southern states have the highest level of poverty and a severe shortage of rural clinics, and several haven’t expanded Medicaid so that more low-income adults have health insurance.

Further, Southern states aren’t poised to make up the difference. Alabama, Louisiana, Kentucky, Mississippi, and Missouri put zero state funds into HIV prevention last year, according to NASTAD, an association of public health officials who administer HIV and hepatitis programs. In contrast, about 40% of Michigan’s HIV prevention budget is provided by the state, 50% of Colorado’s HIV prevention budget, and 88% of New York’s.

“When you are in the South, you need the federal government,” said Gipson, from My Brother’s Keeper. “When we had slavery, we needed the federal government. When we had the push for civil rights, we needed the federal government. And we still need the federal government for health care,” she said. “The red states are going to suffer, and we’re going to start suffering sooner than anyone else.”

Sean Fortenberry and Kathy Garner, of the AIDS Services Coalition, work inside the group’s HIV testing clinic, whose operation has been suspended because of delayed federal funds for HIV prevention.

Southern health officials reeling from cuts

When asked about cuts and delays to HIV prevention funding, the CDC directed queries to HHS. The department’s director of communications, Andrew Nixon, replied in an email: “Critical HIV/AIDS programs will continue under the Administration for a Healthy America (AHA) as a part of Secretary [Robert F.] Kennedy’s vision to streamline HHS to better serve the American people.”

Nixon did not reply to a follow-up question on whether the Trump administration considers HIV prevention critical.

On April 4, Gipson received a fraction of her delayed HIV prevention funds from the CDC. But Gipson said she was afraid to hire back staff amid the turmoil.

Like the directors of many other community organizations, Gipson is going after grants from foundations and companies. Pharmaceutical firms such as Gilead and GSK that produce HIV drugs are among the largest contributors of non-governmental funds for HIV testing, prevention, and care, but private funding for HIV has never come close to the roughly $40 billion that the federal government allocated to HIV annually.

“If the federal government withdraws some or all of its support, the whole thing will collapse,” said Alice Riener, CEO of the community-based organization CrescentCare in Louisiana. “What you see in Mississippi is the beginning of that, and what’s so concerning is the infrastructure we’ve built will collapse quickly but take decades to rebuild.”

Southern health officials are reeling from cuts because state budgets are already tight. Mississippi’s state health officer, Daniel Edney, spoke with KFF Health News on the day the Trump administration terminated $11 billion in Covid-era funds intended to help states improve their public health operations. “There’s not a lot of fat, and we’re cutting it to the bone right now,” Edney said.

Mississippi needed this boost, Edney said, because the state ranks among the lowest in health metrics including premature death, access to clinical care, and teen births. But Edney noted hopeful trends: The state had recently moved from 50th to 49th worst in health rankings, and its rate of new HIV cases was dropping.

“The science tells us what we need to do to identify and care for patients, and we’re improving,” he said. “But trends can change very quickly on us, so we can’t take our foot off the gas pedal.”

If that happens, researchers say, the comeback of HIV will go unnoticed at first, as people at the margins of society are infected silently before they’re hospitalized. As untreated infections spread, the rise will eventually grow large enough to make a dent in national statistics, a resurgence that will cost lives and take years, if not decades, to reverse.

Outside the community center on that stormy March morning, pastor Devine lamented not just the loss of his grant from the health department, but a $1 billion cut to food distribution programs at the U.S. Department of Agriculture. He rattled off consequences he feared: People relying on food assistance would be forced to decide between buying groceries, paying bills, or seeing a doctor, driving them further into poverty, into emergency rooms, into crime.

Deja Abdul-Haqq, a program director at My Brother’s Keeper, nodded along as he spoke. “So goes Mississippi, so goes the rest of the United States,” Abdul-Haqq said. “Struggles may start here, but they spread.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

Beyond Ivy League, RFK Jr.’s NIH slashed science funding across states that backed Trump

2025-04-17T13:54:38+00:00

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The National Institutes of Health’s sweeping cuts of grants that fund scientific research are inflicting pain almost universally across the United States, including in most states that backed President Donald Trump in the 2024 election.

A KFF Health News analysis underscores that the terminations are sparing no part of the country, politically or geographically. About 40% of organizations whose grants the NIH cut in its first month of slashing, which started Feb. 28, are in states Trump won in November.

The Trump administration has singled out Ivy League universities including Columbia and Harvard for broad federal funding cuts. But the spending reductions at the NIH, the nation’s foremost source of funding for biomedical research, go much further: Of about 220 organizations that had grants terminated, at least 94 were public universities, including flagship state schools in places such as Florida, Georgia, Ohio, Nebraska, and Texas.

The Trump administration has canceled hundreds of grants supporting research on topics such as vaccination; diversity, equity, and inclusion; and the health of LGBTQ+ populations. Some of the terminations are a result of Trump’s executive orders to abandon federal work on diversity and equity issues. Others followed the Senate confirmation of anti-vaccine activist Robert F. Kennedy Jr. to lead the Department of Health and Human Services, which oversees the NIH. Many mirror the ambitions laid out in Project 2025’s “Mandate for Leadership,” the conservative playbook for Trump’s second term.

Affected researchers say Trump administration officials are taking a cudgel to efforts to improve the lives of people who often experience worse health outcomes — ignoring a scientific reality that diseases and other conditions do not affect all Americans equally.

KFF Health News found that the NIH terminated about 780 grants or parts of grants between Feb. 28 and March 28, based on documents published by the Department of Health and Human Services and a list maintained by academic researchers. Some grants were canceled in full, while in other cases, only supplements — extra funding related to the main grant, usually for a shorter-term, related project — were terminated.

Among U.S. recipients, 96 of the institutions that lost grants in the first month are in politically conservative states including Florida, Ohio, and Indiana, where Republicans control the state government or voters reliably support the GOP in presidential campaigns, or in purple states such as North Carolina, Michigan, and Pennsylvania that were presidential battleground states. An additional 124 institutions are in blue states.

Sybil Hosek, a research professor at the University of Illinois-Chicago, helps run a network that focuses on improving care for people 13 to 24 years old who are living with or at risk for HIV. The NIH awarded Florida State University $73 million to lead the HIV project.

“We never thought they would destroy an entire network dedicated to young Americans,” said Hosek, one of the principal investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions. The termination “doesn’t make sense to us.”

NIH official Michelle Bulls is director of the Office of Policy for Extramural Research Administration, which oversees grants policy and compliance across NIH institutes. In terminating the grant March 21, Bulls wrote that research “based primarily on artificial and nonscientific 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.”

The U.S. was on track to end the HIV epidemic. Budget cuts threaten that progress.

Adolescents and young adults ages 13 to 24 accounted for 1 in 5 new HIV infections in the United States in 2022, according to the Centers for Disease Control and Prevention.

“It’s science in its highest form,” said Lisa Hightow-Weidman, a professor at Florida State University who co-leads the network. “I don’t think we can make America healthy again if we leave youth behind.”

HHS spokesperson Emily Hilliard said in an emailed statement that “NIH is taking action to terminate research funding that is not aligned with NIH and HHS priorities.” The NIH and the White House didn’t respond to requests for comment.

“As we begin to Make America Healthy Again, it’s important to prioritize research that directly affects the health of Americans. We will leave no stone unturned in identifying the root causes of the chronic disease epidemic as part of our mission to Make America Healthy Again,” Hilliard said.

Cuts bring harm to HIV, vaccine studies

The NIH, with its nearly $48 billion annual budget, is the largest public funder of biomedical research in the world, awarding nearly 59,000 grants in the 2023 fiscal year. The Trump administration has upended funding for projects that were underway, stymied money for new applications, and sought to reduce how much recipients can spend on overhead expenses.

Those changes — plus the firing of 1,200 agency employees as part of mass layoffs across the government — are alarming scientists and NIH workers, who warn that they will undermine progress in combating diseases and other threats to the nation’s public health. On April 2, the American Public Health Association, Ibis Reproductive Health, and affected researchers, among others, filed a lawsuit in federal court against the NIH and HHS to halt the grant cancellations.

Two National Cancer Institute employees, who were granted anonymity because they were not authorized to speak to the press and feared retaliation, said its staff receives batches of grants to terminate almost daily. On Feb. 27, the cancer institute had more than 10,800 active projects, the highest share of the NIH’s roughly two dozen institutes and centers, according to the NIH’s website. At least 47 grants that NCI awarded were terminated in the first month.

Local health projects across New York in limbo after abrupt HHS cuts

Kennedy has said the NIH should take a years-long pause from funding infectious disease research. In November 2023, he told an anti-vaccine group, “I’m gonna say to NIH scientists, ‘God bless you all. Thank you for public service. We’re going to give infectious disease a break for about eight years,’” according to NBC News.

For years, Kennedy has peddled falsehoods about vaccines — including that “no vaccine” is “safe and effective,” and that “there are other studies out there” showing a connection between vaccines and autism, a link that has repeatedly been debunked — and claimed falsely that HIV is not the only cause of AIDS.

KFF Health News found that grants in blue states were disproportionately affected, making up roughly two-thirds of terminated grants, many of them at Columbia University. The university had more grants terminated than all organizations in politically red states combined. On April 4, Democratic attorneys general in 16 states sued HHS and the NIH to block the agency from canceling funds.

Researchers whose funding was stripped said they stopped clinical trials and other work on improving care for people with HIV, reducing vaping and smoking rates among LGBTQ+ teens and young adults, and increasing vaccination rates for young children. NIH grants routinely span several years.

For example, Hosek said that when the youth HIV/AIDS network’s funding was terminated, she and her colleagues were preparing to launch a clinical trial examining whether a particular antibiotic that is effective for men to prevent sexually transmitted infections would also work for women.

“This is a critically important health initiative focused on young women in the United States,” she said. “Without that study, women don’t have access to something that men have.”

Other scientists said they were testing how to improve health outcomes among newborns in rural areas with genetic abnormalities, or researching how to improve flu vaccination rates among Black children, who are more likely to be hospitalized and die from the virus than non-Hispanic white children.

“It’s important for people to know that — if, you know, they are wondering if this is just a waste of time and money. No, no. It was a beautiful and rare thing that we did,” said Joshua Williams, a pediatric primary care doctor at Denver Health in Colorado who was researching whether sharing stories about harm experienced due to vaccine-preventable diseases — from missed birthdays to hospitalizations and job loss — might inspire caregivers to get their children vaccinated against the flu.

He and his colleagues had recruited 200 families, assembled a community advisory board to understand which vaccinations were top priorities, created short videos with people who had experienced vaccine-preventable illness, and texted those videos to half of the caregivers participating in the study.

They were just about to crack open the medical records and see if it had worked: Were the group who received the videos more likely to follow through on vaccinations for their children? That’s when he got the notice from the NIH.

“It is the policy of NIH not to prioritize research activities that focuses gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment,” the notice read.

Williams said the work was already having an impact as other institutions were using the idea to start projects related to cancer and dialysis.

Grant terminations hit work to improve rural health care

Congress previously tried to ensure that NIH grants also went to states that historically have had less success obtaining biomedical research funding from the government. Now those places aren’t immune to the NIH’s terminations.

Sophia Newcomer, an associate professor of public health at the University of Montana, said she had 18 months of work left on a study examining undervaccination among infants, which means they were late in receiving recommended childhood vaccines or didn’t receive the vaccines at all. Newcomer had been analyzing 10 years of CDC data about children’s vaccinations and had already found that most U.S. infants from 0 to 19 months old were not adequately vaccinated.

Her grant was terminated March 10, with the NIH letter stating the project “no longer effectuates agency priorities,” a phrase replicated in other termination letters KFF Health News has reviewed.

CDC cuts hit HIV prevention program, jeopardizing decades of progress on reducing infant transmission rates

“States like Montana don’t get a lot of funding for health research, and health researchers in rural areas of the country are working on solutions to improve rural health care,” Newcomer said. “And so cuts like this really have an impact on the work we’re able to do.”

Montana is one of 23 states, along with Puerto Rico, that are eligible for the NIH’s Institutional Development Award program, meant to bolster NIH funding in states that historically have received less investment. Congress established the program in 1993.

The NIH’s grant terminations hit institutions in 15 of those states, more than half that qualify, plus Puerto Rico.

Researchers can’t ‘just do it again later’

The NIH’s research funds are deeply entrenched in the U.S. health care system and academia. Rarely does an awarded grant stay within the four walls of a university that received it. One grant’s money is divvied up among other universities, hospitals, community nonprofits, and other government agencies, researchers said.

Erin Kahle, an infectious disease epidemiologist at the University of Michigan, said she was working with Emory University in Georgia and the CDC as part of her study. She was researching the impact of intimate partner violence on HIV treatment among men living with the virus. “They are relying on our funds, too,” she said.

Kahle said her top priority was to ethically and safely wind down her nationwide study, which included 418 people, half of whom were still participating when her grant was terminated in late March. Kahle said that includes providing resources to participants for whom sharing experiences of intimate partner violence may cause trauma or mental health distress.

Rachel Hess, the co-director of the Clinical & Translational Science Institute at the University of Utah, said the University of Nevada-Reno and Intermountain Health, one of the largest hospital systems in the West, had received funds from a $38 million grant that was awarded to the University of Utah and was terminated March 12.

The institute, which aims to make scientific research more efficient to speed up the availability of treatments for patients, supported over 5,000 projects last year, including 550 clinical trials with 7,000 participants. Hess said that, for example, the institute was helping design a multisite study involving people who have had heart attacks to figure out the ideal mix of medications “to keep them alive” before they get to the hospital, a challenge that’s more acute in rural communities.

After pushback from the university — the institute’s projects included work to reduce health care disparities between rural and urban areas — the NIH restored its grant March 29.

Among the people the Utah center thanked in its announcement about the reversal were the state’s congressional delegation, which consists entirely of Republican lawmakers. “We are grateful to University of Utah leadership, the University of Utah Board of Trustees, our legislative delegation, and the Utah community for their support,” it said.

Hilliard, of HHS, said that “some grants have been reinstated following the appeals process, and the agency will continue to carry out the remaining appeals as planned to determine their alignment.” She declined to say how many had been reinstated, or why the University of Utah grant was among them.

Other researchers haven’t had the same luck. Kahle, in Michigan, said projects like hers can take a dozen years from start to finish — applying for and receiving NIH funds, conducting the research, and completing follow-up work.

“Even if there are changes in the next administration, we’re looking at at least a decade of setting back the research,” Kahle said. “It’s not as easy as like, ‘OK, we’ll just do it again later.’ It doesn’t really work that way.”

KFF Health News is Healthbeat’s national reporting partner.

The U.S. was on track to end the HIV epidemic. Budget cuts threaten that progress.

2025-04-15T13:49:05+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The U.S. government has long been a leader in research and public health practice for preventing HIV infections. Since the start of the Trump administration in 2025, however, extensive cuts have been made or proposed to every federal agency that works on HIV.

These cuts threaten the United States’ goal of ending the HIV epidemic — an initiative launched during the first Trump administration — and will likely lead to substantial increases in HIV infections, HIV-related illness, and health care costs.

HIV prevention has long relied on three primary pillars: behavior, barriers, and biomedicine.

During the first three decades of the epidemic, public health programs focused primarily on the first two pillars. The most important behavioral interventions included delaying the onset of sexual activity, reducing the number of concurrent sexual partners, and avoiding needle sharing. Barrier interventions focused on increasing access to and acceptance of male condoms in health care and social settings.

This CDC program dramatically reduced infant HIV cases. HHS job cuts put it in jeopardy.

In 2010, the publication of two landmark clinical trials began shifting the focus of prevention to a biomedical approach. The biomedical approach involves using a combination of HIV antiretroviral therapy medications to either prevent or treat HIV infection.

The iPrEx trial, published in 2010, found that daily use of two ART medications markedly reduced the risk of acquiring HIV among men who have sex with men and transgender women. One year later, the HPTN 052 trial found that early initiation of ART (usually as a combination of three medications) in a person with HIV infection almost completely eliminated the risk of them transmitting HIV to an uninfected partner.

Subsequent studies across diverse populations — including injection drug users, heterosexual couples, and men who have sex with men — confirmed that ART can protect a person without HIV from getting infected and can render a person with HIV non-infectious (“undetectable” viral load means “untransmissible”).

How did biomedical HIV prevention become part of national policy?

HIV experts began advocating for a paradigm shift in clinics and community services toward “status neutral care.” This is the model used in the clinics where I currently treat patients with or at risk of HIV: prevention and care is managed together by the same providers, just as happens with other chronic medical conditions such as diabetes or high blood pressure. All adult and adolescent patients are offered HIV testing, people who test negative are offered PrEP, and people who test positive are treated with ART.

In 2019, the U.S. Preventive Services Task Force gave PrEP a grade “A” recommendation for HIV prevention, requiring health insurers to cover it at no cost as part of the Affordable Care Act. That same year, then-President Donald Trump announced the U.S. national plan to End the HIV Epidemic, which included PrEP for HIV uninfected and ART for HIV infected patients as core parts of its strategy.

What is the current state of the HIV epidemic?

The U.S. government website (HIV.gov) summarizes the latest data on the domestic HIV epidemic. About 1.2 million people in the United States have HIV infection. About 13% of the 1.2 million HIV infected don’t know they are infected. An estimated 31,800 people acquired HIV infection in 2022, which was a 12% decrease from 2018.

Until recently, the U.S. government strategy to reduce HIV infections has focused on expanding access to HIV prevention and care services, particularly in communities disproportionately impacted by HIV: Black and brown people; gay, bisexual, and other men who have sex with men; transgender people; and people living in the South.

The U.S. government has also invested heavily in new biomedical innovation, supporting research into long-acting formulations that can make prevention and treatment even easier. The most promising innovation is lenacapavir, the first of a new class of HIV drugs (capsid inhibitors).

Clinical trials have demonstrated that one injection of lenacapavir every 6 months prevents HIV infection, and a recent small, early stage clinical trial generated substantial excitement for the possibility that it could be used once every 12 months – essentially mimicking an annual vaccine

What cuts have been made to HIV programs at the federal level?

All of this progress, however, is now at risk. A sweeping combination of budget cuts, policy changes, and proposed reorganization of agencies suggests that the federal government is retreating from HIV prevention.

The U.S. Department of Health and Human Services is closing the Office of Infectious Disease and HIV/AIDS Policy (OIDP), which coordinates national strategy and publishes the HIV epidemic dashboard.

At the National Institute for Allergy and Infectious Diseases, key researchers have been removed from their positions, and HIV research grants have been cancelled.

Multiple programs within the Centers for Disease Control and Prevention’s Division of HIV/AIDS Prevention have been cut, along with services for infectious diseases that impact people with HIV, such as sexually transmitted infections and viral hepatitis. The CDC/HRSA Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment has also been disbanded, cutting off a key channel for expert input and public accountability.

HHS officials have discussed removing HIV entirely from CDC and placing it within the HHS program that provides HIV-related health care to people not covered by other insurance programs.

On top of these announced cuts are proposed reductions in Medicaid included in the congressional budget framework. Medicaid is the largest source of coverage for people with HIV and for low-income Americans at risk of HIV infection. If eligibility is narrowed, benefits are reduced, or states are given more leeway to drop enrollees, many individuals could lose access to PrEP and ART.

Globally, the defunding of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) will increase the burden of HIV globally, eventually leading to more HIV infections spilling back into the United States through travel or migration.

What will be the impact of legal and cultural changes on HIV prevention?

Beyond direct funding cuts, legal and cultural shifts present threats to HIV prevention.

A federal lawsuit before the Supreme Court questions whether the Affordable Care Act can mandate insurance coverage for PrEP at no cost to patients. If the court rules that this mandate violates religious freedom or exceeds government authority, it could lead to many insurance companies reducing coverage for PrEP.

The increase in anti-LGBTQ+ rhetoric and legislation across the country, especially targeting transgender people, may deter people from visiting health care facilities and disclosing information about their sexual practices.

Will HIV infections rise, and how much would this cost?

To understand the impact of these changes, consider, for example, the continuum that leads from discovery to delivery of a new HIV medication.

A new medication must be researched and developed in laboratories. It is then tested in humans through large clinical trials across multiple different states over multiple years. If successful, the medication is integrated into expert guidance, promoted through professional and public education, incorporated into insurance coverage, and adopted in real-world care settings. Every stage requires funding, planning, coordination, and education. Eventually, public health agencies need to monitor uptake and address disparities in coverage. Government experts at the National Institutes of Health and CDC have historically been involved at every step in this process.

Georgia leads in U.S. HIV cases. Here’s why the lifesaving drug PrEP faces barriers in the state.

When every step of this link is weakened, the result is predictable: rising HIV infections. Even small decreases in PrEP use or adherence to ART can have ripple effects, undermining decades of progress and sparking new chains of transmission.

The cost is not just in human welfare. It’s financial as well. A person with HIV infection costs the U.S. health care system up to seven times more in lifetime medical costs than a person without HIV infection: lifetime medical costs of $983,897 compared with $133,340 for uninfected people, an incremental difference of $850,557.

If HIV infections return to the 2018 level — before PrEP became part of national policy — that would mean an additional 4,500 infections or an additional $3.8 billion in lifetime costs for the U.S. health care system.

What can be done to reduce HIV funding cuts?

It is possible that local and state governments can fill some of these gaps with their own funding and programs. Private donors could help defray the loss of federal funding to community-based organizations, which are often the frontline of HIV prevention. And health care systems can continue adopting and refining a status-neutral approach that incorporates HIV into routine medical care without additional funding.

Nevertheless, these efforts are unlikely to sustain and accelerate progress in HIV prevention without a coordinated, well-funded national strategy. We have more effective tools for prevention than ever before. But without the sustained investment and infrastructure to support them, we risk squandering an historic opportunity to end the HIV epidemic.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

CDC cuts hit HIV prevention program, jeopardizing decades of progress on reducing infant transmission rates

2025-04-11T15:09:43+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

The sharp job cuts at the Centers for Disease Control and Prevention include a successful program reducing HIV transmission to babies. Over the past 30 years, the number of infant HIV cases has fallen dramatically.

Research published by Margaret Lampe, a CDC epidemiologist, found that from 1994 to 2020, the number of HIV transmissions to babies was cut by 97%, largely through pregnant women with the disease taking antiretroviral drugs.

That prevention work, experts say, may be jeopardized in the wake of job cuts at the division of the CDC that works on HIV prevention. Five of 10 HIV branches have been eliminated by last week’s massive cuts at the U.S. Department of Health and Human Services. It resulted in about 150 people losing their jobs.

HIV transmissions to babies still occur: Last year, an Atlanta HIV clinic saw three new children born with the disease.

“We see them every year,” said Dr. Brian Zanoni, medical director of the Ponce Family and Youth Clinic at Grady’s Ponce de Leon Center. “Every single child in the United States born with HIV is a tragedy and a failure of the medical system.”

“And already in 2025 we’ve had one new infection,” said Zanoni, who is also an associate professor of pediatrics at Emory School of Medicine.

Given the funding cuts, “We’re likely to see HIV rates increase,” Zanoni said. “When HIV rates increase, then children born with HIV are going to increase.”

Overall, the 2,400 CDC personnel whose jobs were terminated last week represent a heavy blow to the country’s public health efforts, experts said. The CDC cuts are part of the restructuring at the HHS that involves eliminating about 10,000 employees. Besides HIV, other CDC areas absorbing big cuts included divisions involving workplace health and safety, injury prevention, reproductive health, smoking, and violence prevention, CNN reported.

If the overall HIV funding is not restored, “new infections will at least remain where they are or go up again; we will see more infections, more illness, and more costs,” said Dr. John Brooks, former chief medical officer of the Division of HIV Prevention who retired about six months ago.

“There are several estimates of how much lifetime HIV care costs in 2024, between a low of $540,000 up to over $1 million per patient,” Brooks said. “That could result in up to $30 billion in annual expense just to treat people if infection rates continue as they are.”

Zanoni has worked on HIV in South Africa, where transmission rates to babies are higher.

“Prevention makes sense, and it’s cost-effective,” Zanoni said. “If you can prevent a few of these infections, you’re saving millions of dollars” in treatment and medical costs.

The prevention work for perinatal HIV transmissions has included engagement and communication with health care providers and public health departments, funding for early diagnosis and treatment, and data analysis.

CDC officials have also been working on preventing syphilis transmission to babies, which has more than tripled in recent years, with more than 3,800 cases reported in 2023 alone.

Antoinette Jones, 30, of Atlanta, wearing pink, was born with HIV, but with the help of antiretroviral drugs, her daughter was not.

Antoinette Jones of Atlanta, 30, was born with HIV. But with the help of antiretroviral drugs, her daughter was born without the disease.

She welcomed an HHS panel’s updating of guidelines on breastfeeding for parents with HIV last year.

“A lot of the work on mother-to-child transmission came from actual advocates on the ground who are living with HIV,” said Jones, who is co-founder of Dandelions Inc., an advocacy group for people who identify as lifetime survivors of HIV.

She said CDC officials “were listening, and went back to restructure and rework the way that they were trying to do things.”

The agency’s job reductions could even impact the first Trump administration’s program to target HIV in areas hard hit by the disease, Brooks said. “Trump wisely invested and committed the federal government to Ending the HIV Epidemic, and Kennedy’s cuts could sabotage everything,” he said.

In the wake of the massive health agency shakeup, Health and Human Services Secretary Robert F. Kennedy Jr. said about a fifth of the cuts likely were “mistakes,” saying last week: “We’re reinstating them. And that was always the plan,” he said.

Andy Miller is a freelance consultant and reporter for Healthbeat. Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Mass layoffs at CDC hit public health, economy in Atlanta

2025-04-01T22:16:26+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Thousands were laid off Tuesday from the Atlanta-based CDC, dealing a blow to the city’s public health workforce, local, national and global research on illness prevention, and likely the city’s economy.

The CDC’s parent agency, the U.S. Department of Health and Human Services, last week announced a sweeping reorganization that would result in about 2,400 “reductions in force” at the CDC.

Kevin Caron, a health scientist in the CDC’s Office of Smoking and Health, received notice via email early Tuesday that he had been terminated. He spoke to Healthbeat as he drove to the agency’s Chamblee campus to retrieve his belongings, including awards for his work.

Caron was instructed not to come in, but then received notice about 10:30 a.m. that his access to the office could be cut off by noon. He is on administrative leave until June 2 and was told to hold onto his work laptop for now.

Caron said the majority of the staff at the Office of Smoking and Health – over 90 people – was laid off. He was worried about the work they will leave undone. The office is “essentially not functional anymore,” Caron said.

The team’s research saved lives, he said, recalling their discovery in 2019 that a chemical was causing serious lung injuries and deaths in teenagers who vaped.

“Smoking is the number one, the leading cause, of preventable death in the U.S.”, and Caron’s entire office was working on it.

“Children will be vulnerable because they’re the ones who are most frequently targeted by the industry and most susceptible to becoming addicted to the use of tobacco products,” Caron said.

Kevin Caron, a health scientist in the Centers for Disease Control and Prevention's Office of Smoking and Health, was laid off from the agency on Tuesday. He and his wife, Priyanka Bhatt, a human rights attorney, are expecting a baby this month.

On the home front, Caron and his wife are expecting their first child on April 12, and his wife’s maternity leave has started.

“I’m very worried about what kind of world she’s going to come into, and worried about my own … financial security,” Caron said of the impending birth. “But I’m also worried about the bigger picture.”

Specimens put into deep freeze as cuts disrupt labs

Kevin Pettus also lost his job Tuesday after more than three decades at the CDC. Pettus worked as a clinical microbiologist and in syphilis serology as a unit lead at the Laboratory Reference and Research Branch of the Division of Sexually Transmitted Disease Prevention.

He was able to retrieve his belongings from the agency’s campus on Clifton Road but said he’s worried about the future of the lab — and the work that it did.

“We were just told to place whatever specimens that we are working on into our long-term freezer …. with the hopes that somehow this will all be recanted, and they will ask us to come back and continue our research,” Pettus said.

Lab instruments would become unusable without daily maintenance, he said.

Kevin Pettus, a clinical microbiologist who worked in syphilis serology at the Laboratory Reference and Research Branch of the Division of Sexually Transmitted Disease Prevention at the Centers for Disease Control and Prevention, poses for a photo with his wife and four daughters.

“I don’t see how this is saving the taxpayers money. [It] is going to cost them so much more in either repairing or even discarding some of these materials and supplies,” Pettus said.

The CDC lab provided important testing services to state and local health departments, Pettus said.

The changes will “dramatically impact healthcare and the testing process in the very near future,” Pettus said. “I’m not sure what these institutions and public health labs … are going to do moving forward.”

CDC job losses could impact Atlanta economy

HHS Secretary Robert F. Kennedy Jr. has said the CDC layoffs were in line with President Donald Trump’s executive order calling for “large-scale” terminations.

The reorganization will involve moving two CDC centers – the Agency for Toxic Substance and Disease Research and the National Institute for Occupational Safety and Health – to a newly created branch of HHS, the Administration for a Healthy America. Meanwhile, 1,000 employees at the Administration for Strategic Preparedness and Response will move to the CDC.

Supporters of workers at the Centers for Disease Control and Prevention rally outside the agency's Atlanta headquarters on Friday.

Lists circulating among CDC employees and retirees on Monday suggested that many parts of the agency had been impacted by the layoffs, including the divisions of violence and injury prevention, the Office of Health Equity, the asthma and air quality branch, the global division of HIV and tuberculosis, the division of reproductive health in the National Center for Chronic Disease Prevention and Health Promotion.

“There’s a growing sense of uncertainty and not feeling whole in this nation,” said Atlanta Mayor Andre Dickens on Friday of the impending reductions. “Cuts at the CDC impact health, national security, community wellness, jobs in Atlanta, and faith in our day to day.”

The CDC employed about 13,000 people, with 10,000 in Georgia, spokesperson Jason McDonald said in November.

“It has a specifically devastating impact on jobs in this area, and these are thousands of jobs,” said Barb Marston, who leads an informal group of CDC retirees who have been organizing and rallying each week to support the agency’s workers.

“Ordinarily, if somebody had something that was going to create thousands of jobs, they’d celebrate that as good for Georgia’s economy. Here we have a situation where we’re losing thousands of jobs. That’s obviously going to be bad for the economy,” Marston said.

The impact of the job losses will include the loss of employees’ spending on items like health care, housing, going out to eat and entertainment, said Peter Bluestone, of the Center for State and Local Finance at Georgia State University.

“Firms will be reluctant to make investments with an unpredictable future going forward, and job seekers may be reluctant to apply to the CDC again, with its future potentially uncertain,” Bluestone said.

Councilmember Jason Dozier last month sponsored an Atlanta City Council resolution calling on local and state governments to hire employees laid off by the CDC and other federal agencies. The resolution was adopted unanimously.

He said Tuesday he’s especially worried about the HIV epidemic in Atlanta.

“Atlanta is especially vulnerable to these cuts as our city has been and will continue to be on the frontline of combating the spread of HIV. But we need the CDC’s help in that fight. Black and LGBTQ+ communities in Atlanta are disproportionately affected by HIV and the CDC funds programs specifically designed to address these disparities,” Dozier said.

Georgia health dept. to lose $334.4M in federal funds

HHS last week cancelled billions in grants to state and local health departments, including funding initially provided for Covid relief and funds for mental health services.

The Georgia Department of Public Health said late Tuesday the cuts would result in a loss of at least $334.4 million in federal funds.

“There will be minimal impacts to essential core public health services,” DPH spokesperson Nancy Nydam said. The canceled grants were set to expire between May 2025 and July 2027.

Covid services will be reduced or continued, including testing kiosks, mobile vaccine deployments, community-based vaccine services, and vaccine and testing registration systems, Nydam said.

DPH also laid off about 170 Covid contract tracers on Thursday, Nydam said, as well as 10 other staffers.

“The impact on district-level staff is still being analyzed, with each district conducting its own review to determine local effects,” Nydam said.

The cuts could result in a $467,000 cut to the Cobb and Douglas county public health budget, leaders said last week.

This story has been updated to include a second interview with a CDC staffer and figures from the Georgia Department of Public Health on federal funding reductions released late Tuesday.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Here’s the Georgia HIV prevention work at risk from looming CDC funding cuts

2025-03-25T18:14:36+00:00

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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.

Georgia leads in U.S. HIV cases. Here’s why the lifesaving drug PrEP faces barriers in the state.

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.”

Atlanta startup founders on edge as changes to NIH disrupt funding

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.

Why cuts to global AIDS relief threaten U.S. health, economic growth, and physical security

2025-02-28T12:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Journalists and foreign policy experts have written extensively about the suffering caused by the Trump administration’s decision to halt food, health care, and other forms of assistance to some of the poorest people in the world. Given income inequality and the fragility of the social safety net in the United States, I am not surprised that some Americans approve, thinking, “Why are we spending money on people in other countries when it could be spent here, like to pay my health care bills?”

Defenders of foreign assistance rightly point out that it accounts for only a tiny fraction of the U.S. budget (about 1%) and that there has long been a bipartisan consensus that the wealthiest nation in the world has an ethical obligation to help people in other countries. One reason that popular support for foreign assistance has eroded is that many Americans are unaware that it directly benefits our own health, economic growth, and physical security. The most obvious example is U.S. foreign health assistance, such as through the President’s Emergency Plan for AIDS Relief.

What is PEPFAR, and how does it work?

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) under President George W. Bush started as a $15 billion commitment spread over five years to support 15 countries around the world, then eventually expanded to support more than 50 countries.

PEPFAR operates by directly funding health programs in recipient countries, working with governments, non-governmental organizations, and local health providers. The program provides antiretroviral therapy (ART), supports prevention (including stopping HIV transmission from mothers to their newborn babies), and strengthens overall health care infrastructure, including clinics, labs, and supply chains.

Through PEPFAR, U.S. government agencies, such as USAID and the Centers for Disease Control and Prevention, assign physicians, epidemiologists, lab scientists, and experts in related fields to live and work in these countries. The job was to work with the foreign government agencies and NGOs funded by PEPFAR and ensure that U.S. taxpayer money was spent wisely on saving lives and preventing infections.

Since its inception, PEPFAR has, in fact, saved over 25 million lives through ART, prevented HIV infections in 5.5 million babies, and increased life expectancy in PEPFAR-supported countries, an accomplishment that has been celebrated by people from different political backgrounds.

My experience with infectious disease control abroad

In 2003, I moved with my family from the CDC’s headquarters in Atlanta to Bangkok, Thailand to serve as the first CDC regional adviser to Southeast Asia for tuberculosis control. My job was to support the Ministries of Health in Thailand, Cambodia, and Vietnam with improving diagnosis, treatment, and prevention of TB.

At that time, HIV was spreading rapidly throughout Southeast Asia, because treatment was still not widely available. When HIV infection suppresses the immune system, it makes people exquisitely susceptible to developing severe illness and death from TB. Despite highly effective drugs against both TB and HIV, TB remains one of the world’s leading killers of people and the number one killer in people with HIV infection.

The U.S. government has a direct interest in supporting global TB control, because most TB cases in the United States arise in people who acquired their infection overseas (76% in 2023). As we have learned from Covid-19, Ebola, and mpox in the past 10 years, any disease around the world can readily spill over into the United States. (While I was based in Thailand, for example, I helped lead the response to an outbreak of multidrug-resistant TB among refugees being resettled to the United States.)

My assignment in Thailand was initially funded by money that had been appropriated by Congress in 1999 for the “Leadership in Fighting an Epidemic” initiative. Through that funding, the CDC assigned experts like me to countries with a severe HIV burden to help them prevent, care, and treat people with HIV and control associated diseases, like TB. Soon after I moved to Bangkok in 2003, Bush made the decision to super-charge the LIFE initiative and turn it into PEPFAR.

U.S. President George W. Bush takes part in a roundtable discussion on the PEPFAR AIDS program in 2008 at the Amana district hospital in Dar es Salaam.

Cutting PEPFAR threatens U.S. health

Twenty-two years later, cutting PEPFAR funding has immediate harmful consequences. Some of the world’s leading mathematical modelers in infectious disease previously collaborated to estimate what would happen to HIV infections and deaths if services were interrupted due to COVID-19 control measures. Adapting that model to the current situation, they estimate that thousands of adults and babies may have died already from the decision to halt PEPFAR services.

Why should Americans worry about this?

When millions of people reliant on ART have their treatment interrupted or receive drugs only intermittently, we create the ideal environment for the emergence of drug-resistant HIV strains — infections that will eventually spread to the United States and directly imperil the health of Americans. There is a similar risk of drug resistance emerging and spreading for TB, because the U.S. government is the largest donor of TB drugs and care through PEPFAR and other U.S. assistance programs. Without treatment, other infectious diseases may emerge too; patients with HIV develop severely impaired immune systems and then become a population in which new pathogens evolve or cause outbreaks, such as new variants of Covid-19 and mpox.

One important way that the U.S. government learns about outbreaks of emerging diseases is because we have CDC and USAID personnel in these countries working with ministries of health, the World Health Organization, and other health groups. Every time a new disease threat has emerged, these personnel have been instrumental in verifying what is happening, continuously monitoring the threat so that the United States can prepare adequately for it, and helping to slow or stop it from spreading to the United States.

The most dramatic example is how CDC personnel assigned to Thailand were critical in identifying the cause of the SARS outbreak in 2003. When I served overseas, I frequently reported back to Atlanta about what we were seeing about the emergence of new diseases. While at the African Union during the initial emergence of Covid-19, I participated in multiple calls, for example, with the National Security Council to help them understand the security implications for the United States.

One of the main reasons the United States stations intelligence and military personnel around the world is so that the government has eyes, ears, and boots on the ground to protect Americans from threats overseas before they come to the United States. For more than 20 years, Congress has funded overseas CDC personnel because it believes this type of work is as important for health security as it is for physical security.

A huge bolus of additional funding for CDC and USAID global health work came after the 2014-16 West Africa Ebola outbreak in which personnel from these agencies who were already assigned in Africa for PEPFAR-related work played a critical role in detecting, monitoring, containing, and treating Ebola. I was in Sierra Leone for two months in 2015 helping lead the CDC response, and many of my colleagues there with me were people whose salaries were paid by PEPFAR. Eliminating these programs makes us more vulnerable to disease threats.

Cutting PEPFAR threatens U.S. economic growth

By enhancing public health, PEPFAR has contributed to increased workforce productivity and economic growth in countries and regions, particularly in Africa. PEPFAR funding has been linked to a 2.1 percentage point increase in GDP per capita growth rates in recipient countries, partially through a significant increase in male employment rates.

Stopping PEPFAR funding could reverse these economic gains, leading to decreased productivity, higher health care costs, and economic instability in affected regions. This, in turn, could diminish markets for U.S. exports and disrupt global supply chains, adversely impacting the U.S. economy.

Many people do not realize that a large percentage of “foreign” assistance is actually “domestic” assistance. USAID, the CDC, and other agencies spend foreign assistance funding on contracts with U.S. companies; those companies create jobs for Americans and buy American-made medications, medical supplies, and technology that are sent overseas.

Cutting PEPFAR threatens U.S. physical security

PEPFAR is a critical tool of health diplomacy, strengthening U.S. alliances and fostering goodwill in regions of strategic importance. When the United States provides life-saving assistance, it builds partnerships that are crucial for intelligence-sharing, counterterrorism efforts, and military cooperation.

When I served the U.S. government overseas, I worked across the Asian and African regions with U.S. diplomats and military advisers. At the weekly “country team” meetings with U.S. ambassadors, I and my colleagues highlighted the assistance we were providing to the country we were in and our collaborations with the United Kingdom, Canada, the European Union, and other important U.S. allies — information that U.S. diplomats and military advisers would then use in their conversations with the local government and other ambassadors to highlight how our interests there were not simply about ourselves.

In a recent speech, the president of Ghana used polite diplomatic language to remind the United States what it was losing by its actions — and that U.S. competitors would now be gaining.

“One thing the U.S. will lose is that soft power it has wielded in the world — I mean, these are people that are grateful for the assistance they get,” President John Dramani Mahama said. “There are many other partners. The U.S. are not our only partner. We will continue to cooperate with other countries and that’s why we have a multipolar world.”

(When diplomats in Africa use the term “multi-polar” to U.S. and EU diplomats, they mean China.)

Beyond diplomacy, the United States needs to worry about the impact that the funding cuts will have on stability of different regions. A nation suffering from a collapsing health system is far more likely to experience political instability, mass migration, and conflict—all of which can have direct security consequences for the United States. By withdrawing health support, the United States risks losing influence in key regions, making it harder to negotiate treaties, access strategic information, or deploy military resources effectively when needed.

What it all means

While American generosity is important, building broad-based support in the United States to restart foreign assistance requires us to talk more openly about benevolent self-interest. Yes, we are doing good for the world, but even more importantly, we are doing good for ourselves. The consequences of cutting PEPFAR are clear: increased global instability, economic losses, and heightened threats to U.S. health and security.

Georgia leads in U.S. HIV cases. Here’s why the lifesaving drug PrEP faces barriers in the state.

2025-02-06T10:00:00+00:00

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Latonia Wilkins knows she needs to be on PrEP due to her non-monogamous lifestyle. But the 52-year-old Atlanta mother has faced repeated challenges getting the lifesaving drug that can prevent new HIV infections.

Years ago, Wilkins was dating a man newly diagnosed with HIV and went to get tested, she said, but was not offered PrEP.

Since then, Wilkins said, doctors either have told her she doesn’t need the drug or were reluctant to prescribe it. Her insurance through work would not cover a long-acting injectable form that tends to have better results than the original pill form. Getting to appointments across Atlanta for the pills was a challenge. She is now enrolled in a drug trial for a promising PrEP injection but worries about future access and cost.

Preexposure prophylaxis, known as PrEP, reduces the risk of new HIV infections through sex by 99% and among injectable drug users by at least 74%, according to the Centers for Disease Control and Prevention.

Among states, Georgia has the highest rate of new HIV infections, but residents — especially women and Black patients like Wilkins — are often not getting PrEP, data show.

A rule enacted by the Biden administration that took effect for many Affordable Care Act plans on Jan. 1 should make it easier for people like Wilkins to get long-acting PrEP injectable drugs.

A new Trump administration adds an X factor to this and other federal health programs. On Jan. 27, the White House announced a federal funding freeze, which sent shudders through health agencies and nonprofits. By Jan. 29, it had reversed the order.

Federal initiatives like the Ryan White HIV/AIDS Program and HIV prevention funding seemed to be affected — and “blocking access to PrEP would have deadly consequences,” said Wayne Turner, a senior attorney at the National Health Law Program.

Georgia has big racial and gender discrepancies in PrEP uptake, said Patrick Sullivan, who is an epidemiology professor at Emory University and leads AIDSVu and PrEPVu, which track HIV data and access to the drug — work that is backed by Gilead Sciences, a PrEP drug manufacturer.

Latonia Wilkins, a 52-year-old Atlanta mother, has faced several challenges accessing PrEP, an HIV prevention drug.

Public health experts use what’s called a “PrEP-to-need ratio” to measure how many people at risk of HIV are getting the drug. A higher number is better. In Georgia for 2023, the statewide ratio was 6, while it was nearly 167 in Vermont, according to PrEPVu.

While the ratio for white people in Georgia was roughly 22, it was about 3 for Black people and just over 3 for Hispanic people. And while it was 7 for men, it was just over 2 for women.

“Black people generally are underserved by PrEP, and women are underserved by PrEP relative to men,” Sullivan said.

Increasing PrEP uptake would help the state cut its new HIV diagnoses, said Dylan Baker, associate medical director at Grady Health’s HIV Prevention Program.

Georgia’s rate of new HIV diagnoses was 27 per 100,000 in 2022, according to the most recent available data. That’s second only to Washington, D.C., and more than double the national rate of 13 per 100,000. That amounts to about 2,500 new cases diagnosed in Georgia in a year.

Globally about 3.5 million people used PrEP in 2023, up from 200,000 in 2017 but short of the United Nations’ 2025 target of 21.2 million people, according to a 2024 report by the United Nations Program on HIV/AIDS.

PrEP users in Atlanta report many challenges in getting the drug, including cost, medical providers who don’t prescribe it, stigma, a lack of inclusive marketing, and transportation. Wilkins said she has run up against all of those.

“Here I am telling you that I’m here to get tested because I have come into contact with someone who was living with HIV, and we had a sexual relationship, and you’re not even mentioning PrEP to me,” Wilkins said. “That was a disservice.”

Insurers now required to cover PrEP

Cost has long been a barrier. The Biden administration last fall issued guidance requiring most insurers to cover the full cost of all forms of PrEP, without prior authorization, along with certain lab work and other services. This includes pills as well as Apretude, an injection given every two months.

That means insured PrEP users should not face out-of-pocket costs, said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, which lobbied for the rule.

It applies to those on the federal marketplace plans and most large private health plans. A similar rule exists for Medicare and Medicare Advantage plans.

Schmid said he does not think the Trump administration will repeal the rule, but he is concerned the U.S. Supreme Court could end coverage for preventive services, including PrEP, when it issues a decision in Braidwood Management v. Becerra, anticipated this summer.

Georgians on Medicaid have coverage for PrEP and related costs, if deemed medically necessary, Department of Community Health spokesperson Fiona Roberts said.

Medicaid patients may face copays that can still be a barrier to getting and staying on PrEP, Turner said.

The rule will not help the uninsured. In Georgia, which did not expand Medicaid under the ACA, about 1 million adults under age 65 are uninsured.

“The cost is also a struggle, especially given different people are part of the gig economy, a lot of folks don’t always have access to health insurance,” said Maximillian Boykin, an Atlanta PrEP user.

Seventeen of Georgia’s 18 public health districts provide PrEP medication at low or no cost to un- or underinsured patients, Department of Public Health spokesperson Nancy Nydam said.

Typically they don’t cover ancillary costs like lab work. But four Georgia health districts have implemented a program to cover those additional costs: North (headquartered in Gainesville), Clayton (Jonesboro), Southeast (headquartered in Waycross), and Northeast (headquartered in Athens), Nydam said.

Expanding Medicaid would help. States that have done so, Sullivan said, “have higher levels of PrEP uptake.”

New injectable lenacapavir looks promising

Since getting on PrEP in 2019, Wilkins has encountered two doctors who did not want to prescribe it.

One female OB-GYN told her “‘Girl, at our age, we should know better.’” Wilkins said she “fired” that doctor, telling her that such comments are stigmatizing.

When Wilkins moved, she looked for a nearby primary care provider so she would not have to pay for transportation to get PrEP.

But the doctor she found, Wilkins said, told her to find an infectious disease specialist for PrEP.

“‘You’re not treating an infectious disease,’ I say. ‘This is preventive care,’” Wilkins recalled.

Wilkins’ fortunes turned when she was selected to join a study for a twice-yearly injectable form of PrEP.

Lenacapavir, already approved for HIV treatment, showed promising results for HIV prevention in two earlier Gilead trials. Wilkins is part of a trial in Atlanta including about 250 cisgender women nationally who have sex with men.

It’s much better than a daily pill or even a shot once every two months, Wilkins said.

She hopes to stay on the drug, but the U.S. list price for lenacapavir as an HIV treatment averages about $40,000 a year.

Gilead last year announced it signed royalty-free licensing agreements with six manufacturers to make generic lenacapavir for 120 primarily low- and lower-middle-income countries.

It’s not clear where it falls with the Biden rule. “We believe it should be covered,” Schmid said, “but want the federal government to state that clearly.”

For many patients, challenges remain. Most people are willing to travel about 30 minutes for routine health care, Sullivan said, but in cities like Atlanta, those relying on public transportation may face longer commutes to PrEP providers. Some who need PrEP have unstable housing without firm mailing addresses.

Privacy is another concern. “Everybody should be able to find a place that’s comfortable,” Sullivan said. “More of that can go on in primary health care.”

Others agree that public health messaging around PrEP services should target more diverse audiences. Dázon Dixon Diallo is the founder of SisterLove, an HIV, sexual, and reproductive health organization focused on Black women in the Southeast.

“You’re not going to get to us by giving us a 3-second cameo in a commercial about PrEP,” she said. “There’s no story in there for me, right?”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Atlanta public health workers consider how Trump’s threatened cuts could affect their communities

2025-01-30T22:20:54+00:00

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At a health expo in Clarkston, workers offering services expressed pride in their efforts to contribute to metro Atlanta’s well-being. But many worried whether moves by newly elected President Donald Trump could hamper their mission.

Organizations filled a Georgia State University Perimeter College atrium Wednesday with booths offering health services to students and the broader community.

At one booth, Will Settle stood behind a table draped in a cloth with the logo for SisterLove, an Atlanta nonprofit focused on improving women’s reproductive health access.

Settle, a consultant for the agency, offered passersby information about sexually transmitted diseases and directed those interested to the organization’s mobile testing bus parked nearby. He’s proud of SisterLove’s efforts to share information about sexual health and finding ways to connect low-cost HIV preventive medication to people who need it.

“If you have HIV, it is no longer a death sentence,” he said. “A lot of people don’t know that this is something that is available.”

A bus for SisterLove, an Atlanta reproductive health nonprofit, is parked at the Georgia State University Clarkston Campus on Wednesday for a health expo.

Cuts could impact local HIV, reproductive health initiatives

This week has been filled with uncertainty for people like Settle and organizations like SisterLove. On Monday, a memorandum from the Office of Management and Budget directed federal agencies to stop distributing most of their funds. The letter cited Trump’s desire “to increase the impact of every federal taxpayer dollar” as a reason to halt the spending.

The directive was stalled and withdrawn before it could take effect, but Trump has vowed to still make drastic cuts that could affect how organizations like SisterLove operate. To connect people to low-cost HIV prevention medications, the nonprofit relies on a federal program that makes life-saving drugs more affordable — a program that may have been affected by the Budget Office’s order.

“We’re trying to get as much information, just like everyone else, as we can,” Settle said. “So it’s a wait and see.”

Settle said a funding stoppage, in addition to a flurry of executive actions Trump has been signing over the past two weeks, could have profound effects on Atlantans’ health. While he said SisterLove receives more of its operating budget from private partners than from the federal government, cuts that affect those partners could jeopardize the organization.

The threat comes at a critical time for Atlanta, Settle said, as nonprofits have been helping to address the city’s health care gaps left by recent hospital closures.

“If we’re impacted, that’s going to impact the folks in our community,” he said. “They’re not going to be able to get the access to health care that they desperately need.”

Future public health efforts were also on the minds of Makayla Jackson and Kayla Osmon, two second-year master of public health students who were working at the expo. They are interns with GSU’s Prevention Research Center, a program funded by the U.S. Centers for Disease Control and Prevention.

Makayla Jackson, a master of public health student at Georgia State University, poses behind a table at the college’s Health and Wellness Expo at its Clarkston Campus on Wednesday.

Jackson, who helped check in attendees, was excited for the opportunity to connect fellow students with free health services like SisterLove’s testing. She wants to continue advocating for health equity after she graduates later this year, although she knows that could be hard if some of Trump’s initial priorities are carried through in policy.

If there’s little money available to do that work, she said she would consider doing volunteer health equity work instead. But she hopes it doesn’t come to that.

“It is frustrating,” Jackson said. “I could always find employment, but my life is not threatened. So I’m more concerned about other vulnerable populations.”

Concern for underserved communities in metro Atlanta

Osmon also expressed concern about the health of underserved communities in the metro Atlanta area. Much of the Prevention Research Center’s work focuses on the mental health of Clarkston’s refugee, immigrant, and migrant residents, who often experience unique challenges accessing this type of care.

Over the past month, Osmon said she’s seen the stress of Trump’s immigrant-targeted executive orders take a mental toll on the groups she’s working with.

“We’re kind of in this stage of not really knowing how things are going to go, and how people are going to be treated, and how people’s lives are going to be affected,” she said.

Kayla Osmon, a master of public health student at Georgia State University, helps out at the college’s Health and Wellness Expo at its Clarkston Campus on Wednesday.

Osmon said she took inspiration from the other health professionals around the expo — like the group set up across the atrium that was working a booth for ICNA Relief, a national health care and social services nonprofit with offices in the Atlanta area.

One man at the table, Dr. Dawood Rateb, quickly offered blood pressure tests and glucose level screenings to anyone who walked by. Until a few years ago, Rateb and his wife practiced as doctors in Afghanistan. But he said his work as a medical interpreter for the U.S. military opened his family up to Taliban retaliation, making it dangerous for them to remain in the country.

Two years ago, Rateb and his family found refuge in the Atlanta area through the Department of State’s Refugee Admission Program, which Trump has ordered to stop taking new arrivals until “the further entry into the United States of refugees aligns with the interests of the United States.” Now, he and his wife both work as health coordinators for ICNA.

While the future may be uncertain, Rateb said that for the time being, he and his wife were happy they could offer their time and skills to help the Clarkston community be healthy.

“Today we are here, and we are so excited.”

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Fears over syringe exchanges hinder efforts to combat West Virginia’s HIV outbreak

2025-01-03T15:37:45+00:00

More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.

Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who’ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use.

Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He’s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.

“You see a city and a county willing to get to work at a scale that’s bigger than ever before,” Solomon said, “but we still have one hand tied behind our back.”

The hand he references is easier access to clean syringes.

In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers — to investigate dozens of newly detected HIV infections. The CDC’s HIV intervention chief called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”

Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.

Syringe programs help reduce HIV, hepatitis C

Research indicates that syringe service programs are associated with an estimated 50% reduction in HIV and hepatitis C, and the CDC issued recommendations to steer a response to the outbreak that emphasized the need for improved access to those services.

That advice has gone unheeded by local officials.

In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it in 2018 under pressure, with then-Mayor Danny Jones calling it a “mini-mall for junkies and drug dealers.”

SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.

But in April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.

As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right now operates an exchange program in the city under the restrictions.

Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. “Anyone I’ve talked to who’s used that program only used it once,” she said. “And the numbers they report to the state bear that out.”

A syringe exchange run by the health department in nearby Cabell County — home to Huntington, the state’s largest city after Charleston — isn’t so constrained. As Solomon notes, that program exchanges more than 200 syringes for every one exchanged in Kanawha.

A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington’s Mayor’s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it’s necessary to exchange a used syringe for a new one.

In August 2023, the Charleston City Council voted down a proposal from the Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, with opponents expressing fears of an increase in drug use and crime.

Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.

“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.”

In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC’s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped, Pollini said, but it’s difficult to know if that’s the result of getting the problem under control or the result of limited testing in high-risk groups.

“My inclination is the latter,” she said, “because never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.”

“If you go out and look for infections,” Pollini said, “you will find them.”

Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.

“It’s miracle-level work,” Solomon said.

But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.

“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”

Many rural counties don’t have syringe program

Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.

Teague is further concerned for West Virginia’s rural counties, most of which don’t have a syringe service program.

Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it’s difficult to know.

In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using “patient-trusted” individuals, to improve the delivery of essential services to people who use drugs.

Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That’s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation could pay for it.

Pollini said she hopes state and local officials allow the experts to do their jobs.

“I would like to see them allow us to follow the science and operate these programs the way they’re supposed to be run, and in a broader geography,” she said. “Which means that it shouldn’t be a political decision; it should be a public health decision.”

This story originally appeared at KFF Health News, Healthbeat’s national reporting partner. Sign up to receive Healthbeat’s free national newsletter here.

New HIV diagnoses rose slightly in New York City in 2023, but testing efforts ‘may be working’

2024-12-04T23:52:59+00:00

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New HIV diagnoses ticked upward in New York City in 2023, but the estimated number of new infections fell, suggesting possible progress in HIV testing efforts, city health officials said Wednesday.

The number of new HIV diagnoses in New York City has declined significantly over the past two decades, down from more than 5,000 per year in the early 2000s to fewer than 2,000 in recent years. New diagnoses dipped especially low in 2020, likely as a result of pandemic disruptions to healthcare delivery systems.

But new HIV diagnoses have risen in recent years, particularly among Latino New Yorkers. In 2023, 1,686 people in the city were newly diagnosed with HIV, an increase of 7.6% since 2022, according to the HIV surveillance annual report released by the New York City Department of Health and Mental Hygiene on Wednesday. At the same time, the city’s estimated number of new HIV infections — which may or not be diagnosed — fell by 17% between 2022 and 2023.

“We have much better infrastructure in place for managing the disease, but we still have work to do,” Dr. Michelle Morse, the Health Department’s acting commissioner, said Wednesday at the main branch of the Brooklyn Public Library during an event commemorating World AIDS Day. “Our health outcomes in New York City remain inequitable across race and wealth, and HIV is no exception, unfortunately.”

Sarah Braunstein, assistant commissioner for the Health Department’s Bureau of Hepatitis, HIV and Sexually Transmitted Infections, noted during a presentation that the discrepancy between rising HIV diagnoses and falling estimates of new infections suggests that more existing HIV infections have been diagnosed.

“Our efforts to promote HIV testing, particularly among people who have not accessed HIV services or sexual health care in some time, may be working,” she said.

The Health Department’s report also indicates that racial inequities persist in the city’s HIV epidemic. Black and Latino New Yorkers accounted for 84% of all new HIV diagnoses in 2023. Over the past five years, the difference in the numbers of new HIV diagnoses among Latino and Black New Yorkers has narrowed, and in 2023, Latino New Yorkers surpassed all other racial and ethnic groups for the first time.

From 2019 to 2023, according to city data, people in their 20s and 30s saw the highest numbers of new HIV diagnoses, in comparison to other age groups. Meanwhile, among the five boroughs, Staten Island, Queens, and Brooklyn saw increases in new HIV diagnoses. Additionally, during that five-year period, new HIV diagnoses rose significantly among New Yorkers born outside the United States.

During a panel discussion, public health leaders and community organizers highlighted the hard-won victories in New York City’s fight to end the HIV/AIDS epidemic, and voiced concerns about how the incoming Donald Trump administration could impact their work.

“We don’t know what the new administration will bring and how that will impact federal resources,” said Ofelia Barrios, senior director of community health initiatives at Iris House, an organization in Harlem that provides support and services for those affected by HIV/AIDS.

The current array of options for the treatment and prevention of HIV/AIDS is unprecedented — and while ending the epidemic is within reach, that victory is far from assured, said Dr. Marcus Sandling, the clinical director of sexual health at Callen-Lorde.

“We are at a cusp of history that could end the HIV epidemic, not only in the United States, but globally,” Sandling said. “And it is literally just a matter of will and political interest in doing that.”

Guillermo Chacón, president of the Latino Commission on AIDS, urged the audience to “fight like hell” to protect global HIV/AIDS health work, including preserving funding for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

During her remarks, Morse reflected on the value of programs like PEPFAR, which she said she saw firsthand while working in Botswana from 2006 to 2007. During that year, Morse made home visits to HIV-positive residents in an area with a 36-year life expectancy, seeing both the “human cost” of HIV and the sense of possibility afforded by expanded funding for health work.

As public health systems face what could be a “very difficult time” under the Trump administration, Morse emphasized the Health Department’s commitment to working with community-based organizations focused on HIV prevention and treatment.

“We remain committed to protecting and promoting the health and well-being of every New Yorker, no matter what comes next,” she said. “And we are readying ourselves for what’s coming.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

New HIV diagnoses rising in New York, particularly among Latino residents

2024-08-15T20:09:23+00:00

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Following years of steady declines, new HIV diagnoses have ticked upward in New York in recent years, particularly among Latino New Yorkers, mirroring national trends.

The total number of new HIV diagnoses across the state declined in 2020 to 1,933, likely a result of pandemic disruptions to routine health care, and rose the next two years, to 2,318 diagnoses by 2022, according to data from the Ending the Epidemic Dashboard, a project funded by the New York State Department of Health. In New York City, new diagnoses rose in 2021 and remained fairly flat in 2022.

That uptick could reflect a catch-up in diagnoses that were delayed due to Covid-19, according to experts and advocates. But preliminary 2023 data from the Centers for Disease Control and Prevention suggest that those upward trends continued last year, and that Latino New Yorkers outpaced other racial and ethnic groups in HIV diagnoses for the first time in a decade.

Nationwide, HIV diagnoses among Latino Americans increased 17% between 2018 and 2022, according to the CDC.

Daniel Castellanos, vice president of research and innovation at the nonprofit Latino Commission on AIDS, said he had expected the rise in new HIV diagnoses in New York would start to level off in recent years. But that’s not what the data show.

“By 2022, when the data was released, you could see that it was going up,” he said. “For 2023, the data, though it’s preliminary, shows that it’s still increasing, particularly for Hispanics.”

The New York City Department of Health’s 2022 HIV Surveillance Annual Report, released last fall, acknowledged that progress toward its goals of ending the HIV epidemic had “slowed compared with previous years.” The report cited the impact of Covid-19 on the health care system and “persistent inequities” in access to HIV prevention, testing, care and treatment, particularly for communities of color.

During the depths of the Covid-19 pandemic, disruptions to people’s access to health care set the conditions for an increase in new HIV infections, said Denis Nash, a professor of epidemiology and executive director of CUNY’s Institute for Implementation Science in Population Health, which developed the ETE Dashboard.

Not only did people with HIV have more difficulty maintaining access to medications that suppress their viral load, he said, but also those who were HIV negative and at high risk for the virus faced disruptions in access to pre-exposure prophylaxis (PrEP), an HIV prevention medication.

“Those two things combined are a recipe for an increase in transmission,” Nash said. “Those two things were going in the opposite direction before Covid, and that’s what was helping us reduce the number of new infections year over year.”

Tailoring access to HIV care to individual circumstances is key, said Ramona Cummings, chief program officer at Alliance for Positive Change, a nonprofit organization that serves New Yorkers living with HIV and other chronic health conditions. And some of the technological shifts that came with Covid-19 have helped expand access.

“Maybe you don’t have a MetroCard — we can offer the services to you via telehealth. We can call you and engage. We can offer you a Zoom so that you can call in and talk to us and participate in an intervention that keeps you socially connected,” Cummings said.

There’s another bright spot when it comes to local efforts to fight the HIV epidemic, said Guy Williams, director of prevention at Alliance: increased use of PrEP.

Statewide data show that PrEP utilization has climbed steadily in the last decade, from about 3,000 individuals filing at least one prescription for the medication in New York in 2014 to more than 50,000 people doing so in 2022. PrEP is typically taken as a daily pill, but a new long-acting injectable form of the medicine, approved by the Food and Drug Administration in 2021, is administered every two months.

“There’s a lot more men of color who are interested in PrEP,” Williams said.

Castellanos said that expanding the usage of PrEP hinges on building trust with at-risk people, particularly those in immigrant communities, who might hesitate to access services or engage with the medical establishment.

“We have made some progress and it’s great — new medications, more openness in people’s relationships to talk about sex,” he said. “But that’s not enough. It’s not enough because an HIV diagnosis — even when there is great medication out there and it’s not like it was 40 years ago — it still impacts people’s lives. It’s a traumatic moment in people’s lives.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.