HIV prevention advocates in the First State are alarmed about the possibility of federal funding cuts to the CDC.
Earlier this month, reports began to circulate that the Trump administration is considering cutting funding to or completely dismantling the CDC’s Division on HIV Prevention. Tyler Berl is executive director of the Delaware HIV Consortium, a non-profit focusing on HIV prevention and providing services to people with the virus.
“It could mean the removal of the entire budget for the Delaware Division of Public Health HIV prevention apparatus, which could be devastating here in Delaware," he said.
Federal money plays a major role in funding the state’s HIV prevention strategies.
Much of the state Division of Public Health’s $1.1 million budget for HIV prevention comes from the CDC. Berl says the state uses the funding for its activities, like distributing HIV tests and safe sex supplies and tracking new diagnoses for epidemiological purposes.
But about $450,000 of the federal money goes to local organizations for testing, education, and treatment at the community level.
Losing that funding stream would be catastrophic, Berl says.
“When money comes to the nonprofits who know the communities, they go out into the areas where populations are most impacted," he said. "They know their ZIP codes, they know the communities. And the community members trust the nonprofit.”
That $450,000 in funding is already stretched thin, Berl says.
"Community based providers have seen roughly a 60% cut in public support to begin with anyway," he said. "So that $450,000 is already making community based providers operate at a deficit, and so any further cuts would it mean that all of these community based providers would have to seriously consider stopping their HIV prevention programs."
Meanwhile, state contributions to HIV prevention have been nearly non-existent. While noting that statewide officials are supportive of HIV prevention, Berl says that state budgets have not included needed funding.
"The Delaware state budget has never included HIV risk reduction - or HIV care funding - in its general operating budget," he said.
But, he said, he's calling on state lawmakers to be prepared to step in if the CDC's HIV prevention funding is cut or eliminated.
"If CDC or federal funds go away for HIV prevention and care, then the state should strongly consider including additional funds in their state state budgets through their general operating budgets, to sustain these funds and increase these funds moving forward," he said.
That could put lawmakers in a tough situation, however, as state revenue forecasts predict a slight decline in revenues and other state departments pitch lawmakers on increases to their budgets.
He says advocates have been in touch with state and federal officials.
"We've seen a positive response that they are aware now that that cuts our potentially imminent and are supportive of the public health apparatus. Until a clear determination is made by the federal government that any threats are actually going to materialize they kind of are in a wait and see mode," he said. "But it's the community's sense that we need to be prepared for the time when cuts actually do occur."
Berl says the state has seen a 25% increase in HIV diagnoses since 2020, and funding cuts would likely result in higher numbers of HIV cases, especially in particularly vulnerable populations like men who have sex with men, minorities, and substance users who inject.
“We are dealing with populations who are traditionally marginalized across our health system, and so any additional cuts to the prevention sector here would have adverse impacts and would further widen those health disparities that we see across our state," Berl said.
Those potentially rising HIV cases would likely cause health care costs for everyone to go up. According to the Delaware HIV Coalition, lifetime treatment for a person with HIV costs about $500,000 across the nation, far more than prevention programs. And, in many cases, those treatment costs are paid for by Medicare, Medicaid, and similar programs.
The Delaware HIV Coalition also cites CDC analyses that say, "every dollar invested in HIV testing alone yields roughly two dollars in direct medical cost savings."
