Thursday, April 24, 2025

HRSA Mired in Uncertainty, Instability, and Confusion; Patient Advocates Increasingly Concerned

By: Ranier Simons, ADAP Blog Guest Contributor

The Trump Administration's developing policies regarding population health and well-being continue to propagate uncertainty, instability, and confusion amidst entities that affect optimal health outcomes for all citizens. Notably, there is a concerted effort to dismantle infrastructure instituted by previous administrations that made the Ryan White HIV/AIDS Program (RWHAP) and other federal health programs more inclusive of the needs of marginalized communities. A recent Special Bulletin sent out by the Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) does not immediately effect change. Yet, some stakeholders are concerned about its possible implications (Engels, 2025). But numerous things unfolding simultaneously have yielded chaos.

U.S. Department of Health & Human Services headquarters
Photo Source: CNS photo/Nancy Phelan Wiechec

The HRSA HAB special bulletin contained a 'Dear Colleague' letter from HRSA Administrator Thomas J. Engels addressed to RWHAP program awardees and stakeholders, which includes many national partners and federal colleagues. The letter began by extolling the virtues and successes of RWHAP and how it is a lifeline for people living with HIV/AIDS (PLWHA). It then proceeded to criticize RWHAP policies under the Biden administration. The letter states, “…under the previous administration, certain interpretations of RWHAP’s allowable uses, as outlined in prior communications, co-opted the program’s patient-centered mission in favor of radical ideological agendas and policies. Congress envisioned RWHAP as a lifeline for those battling HIV and AIDS, not as a vehicle for broader social or medical experimentation. More to the point, this politicized commandeering risks diverting resources away from HIV/AIDS patients, whose lives depend on RWHAP’s core medical services.” (Engels, 2025)

The letter contained a direct footnote in reference to what it described as ‘radical ideological agendas and policies’ (Engles, 202). The footnote was guidance from the U.S. Department of Health and Human Services (HHS) from December 2021, stating that RWHAP funds could be used to support gender-affirming care through RWHAP core medical and support service categories (Cheever, 2021). The 2021 guidance defined the appropriate services as those outlined in Policy Clarification Notice #16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses of Funds (PCN# 16-02).

Some State AIDS Drug Assistance Programs (ADAP) have gender-affirming hormone therapy as part of their formulary. Holistic treatment of transgender individuals living with HIV also includes services such as mental health counseling for gender dysphoria, substance use disorder treatment, and even housing and case management services. These services are necessary to support anti-retroviral treatment adherence and positive HIV-related healthcare outcomes in transgender individuals, hence why the Biden administration issued the policy guidance (Cheever, 2021).

After the direct reference to transgender HIV care as a radical policy, the Special Bulletin further adds, “…HAB reaffirms that RWHAP funds shall be marshaled exclusively toward evidence-based interventions proven to combat HIV, sustain viral suppression, and improve the quality of life for those living with the disease.” It defines those as outpatient care and support services, including but not limited to providing HIV medications and housing assistance. Interestingly, the letter emphasizes that RWHAP funds are not authorized for things outside of the scope of PCN# 16-02, the same notice utilized by the Biden administration’s 2021 policy guidance, including affirming gender-affirming care under RWHAP (Engels, 2025).

Trump walking on transgender flag
Photo Source: The New York Times

Specifically highlighting gender-affirming care with the implication that it is radical and not authorized, utilizing guidance that defined it as appropriate, essentially to say it is not appropriate, is contradictory and nebulous. The Dear Colleague letter is not a policy implementation, yet it leaves enough doubt for many RWHAP recipients to be concerned about the services they are providing. According to 2021 data, 11,600, or 2.1 percent of RWHAP patients, are transgender (Cheever, 2025). That is a large population of vulnerable individuals potentially losing certain needed services.

The present HRSA RWHAP messaging emphasis on gender-affirming care is in alignment with the Trump Administration’s delegitimization of transgender lives and transgender health. Presently, the administration is appealing a block on its desired ban of openly transgender service members in the military (Pierson, 2025). The administration’s attorneys argue circularly that the ban is not based on transgender identity but on the medical condition of gender dysphoria. They purport that those who identify as transgender can still serve if they do not have gender dysphoria or openly live as a sex different than their sex at birth. 

The Centers for Medicare and Medicaid Services (CMS) issued a letter on April 11, 2025, addressed to state Medicaid Directors, urging states not to use Medicaid funds for gender-affirming care for minors, highlighting hormone treatments, puberty blockers, or surgeries (Snyder, 2025). The letter refutes the legitimacy of gender-affirming care for minors. It further adds that “State Medicaid programs have a responsibility to ensure that payments are consistent with 'efficiency, economy, and quality of care' under Section 1902(a)(30)(A) of the Social Security Act…CMS is committed to following the highest standards of care and adhering closely to the foundational principles of medicine, especially when it comes to doing no harm to America’s children.”

Additional alarm stems from the HHS FY2026 discretionary "budget passback" that was leaked last week. The budget passback is a draft document that gives an informed look at the priorities of the Trump Administration’s Office of Management and Budget (OMB) as it prepares a budget request for Congress. The Washington Post reported that while Congress typically ignores the President's budget request, given that the current political environment is not typical, it’s important to investigate its drastic transformative blueprint (Sun et al., 2025).

The Washington Post headline on internal HHS budget passback document
Source: The Washington Post

ADAP Advocacy contacted Tim Horn, Director of Medication Access for NASTAD, for insight on the 64-page documents' details associated with infectious disease programs. The leaked budget proposal includes provisions to formally eliminate the CDC’s Division of HIV Prevention, Ending the HIV Epidemic (EHE) funding across the government, all funding for Part F of the Ryan White/HIV AIDS Program, Minority AIDS Initiative Funding, and a significant amount of SAMHSA Substance Abuse Treatment Programs of National and Regional Significance (PRNS). The Washington Post also highlights that the proposal cuts the NIH budget by 40 percent, eliminating entities like the NIH National Institute on Minority Health and Health Disparities (Sun et. al, 2025).

Although the current flurry of activity is causing RWHAP great unease, Jen Laws, CEO of Community Access Action Network (CANN), offers insight for the immediate present. Concerning the HRSA Special Bulletin, he shared, “A ‘special bulletin’ is not formal guidance or policy of any kind. That would most assuredly constitute a final agency action and open the door to either adding this issue to existing suits regarding public health funding programs or a suit on its own. Here, RWHAP sub-recipients need to know that this is not binding guidance and that their service offerings should not be changed. Rather, it's a flag, a signal, if you will, on what the Administration intends to do.”

Ongoing RWHAP stakeholder stress is further exacerbated by the breakdown in infrastructural support offered to them. For example, HRSA abruptly cancelled the HAB National Partners meeting initially scheduled for April 14, 2025, without any explanation or details about rescheduling it. One provider stakeholder, speaking to ADAP Advocacy on the condition of anonymity, decried, "We're feeling very devalued and simply bracing ourselves for the other shoe to drop."

Vigilance is imperative in monitoring HRSA's navigation through the current administration's actions and possible changes to Medicaid. The lives of PLWHA and other marginalized communities and the health of the general population are at stake. Distinguishing enforceable actions from propagandized smoke screens will help maintain hope and enable sustained focus on targeted response.

[1] Cheever, L. (2021, December 2021). Dear Colleague Letter. Retrieved from https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/hiv-care/gender-affirming-care-rwhap.pdf

[2] Engels, T. (2025, April 7). Dear Colleague Letter. Retrieved from https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/letter-grantees-rwhap-4-2025.pdf

[3] Pierson, B. (2025, April 22). Trump administration pushes appeals court to enforce military's transgender ban. Retrieved from https://www.reuters.com/legal/government/trump-administration-pushes-appeals-court-enforce-militarys-transgender-ban-2025-04-22/

[4] Snyder, D. (2025, April 11). CMS Letter to State Medicaid Directors. Retrieved from https://www.cms.gov/files/document/letter-stm.pdf

[5] Sun, L., Johnson, C., Roubein, R., Achenbach, J., Weber,L. (2025, April 16). Internal budget document reveals extent of Trump’s proposed health cuts. Retrieved from https://www.washingtonpost.com/health/2025/04/16/hhs-budget-cut-trump/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Thursday, April 17, 2025

Why Is the 340B Drug Pricing Program the Next ‘Too Big to Fail’

Read the full policy paper, “Is the 340B Drug Pricing Program the Next ‘Too Big to Fail’?

By: Brandon M. Macsata, CEO, ADAP Advocacy

The 340B Drug Pricing Program sounds wonky and complex, and most patients probably hear the program's name and think, “Oh, it doesn’t even apply to me or my care.” It is wonky; after all, it’s named after Section 340B of the Public Health Services Act of 1992. And even the most well-versed policy expert would admit the program is indeed complex. But rather than trying to explain it in words, click here to watch an amazingly straightforward patient education video produced by the Community Access National Network (CANN). The bottom line is this wonky, complex program has EVERYTHING to do with patient care, and it is highly likely it impacts the care of most of the folks who read this blog post. And here’s why the 340B Drug Pricing Program is the next ‘Too Big to Fail.’

Too Big To Fail: 340B
Photo Source: ADAP Advocacy

Today, patients living with HIV can successfully access highly effective therapies to manage the disease and achieve undetectable status, thus making a robust 340B Program essential. Unfortunately, that concept has warped into putting providers before patients. Originally designed to help poor patients access affordable healthcare, it has grown into a $66 billion program, largely benefiting healthcare providers. These healthcare providers' CEOs have benefitted abundantly, too, as ADAP Advocacy noted in its 2024 report and its 2025 supplemental report. Ironically, charity care – which is basically “free” healthcare hospitals extend to patients who otherwise cannot afford their care – has declined. So much for helping poor patients, right?

To make matters worse, a few extremely powerful special interest groups and their high-powered inside-the-beltway Washington lobbyists have successfully created a reform denialism narrative. That narrative is a fallacy. The chief antagonist of reforming the program to serve patients better is the American Hospital Association (AHA). Isn’t it ironic that the AHA fights any effort to reform the program that would result in its hospital members having actually pony up charity care for marginalized communities? Sadly, patient advocacy groups see through this smoke and mirrors by the big hospital systems. 

Pharmaceutical manufacturers—who fund the 340B Program via drug rebates—are pushing reforms to NOT “gut” the program but rather ensure their rebates are going to the intended recipients: patients! Industry-backed reforms are all driven by asking for more accountability and transparency on how their rebates are being spent. What could be more “pro-patient” than asking that rebates designed to help patients actually help patients? Novel idea, right?

Cartoon of a Lobbyist with this arm around Special Interests
Photo Source: Live | Viewpoint

The 340B Program’s reform denialists are scared, evidenced by their lobbyists contacting patient advocacy organizations and all but saying they're being duped by industry because they’re not intelligent enough to know what is best for them. Insulting, right?

The reality is that patients, patient advocacy organizations, and industry can and often do share values on public health and the delivery of healthcare services. The 340B Program is one such example. The program keeps exponentially growing, year after year, and yet medical debt is simultaneously exploding. The program is growing but failing to meet the law's legislative intent, which is helping patients. That is why it begs the question: Is the 340B Drug Pricing Program the Next ‘Too Big to Fail’?

Read the full policy paper, “Is the 340B Drug Pricing Program the Next ‘Too Big to Fail’?

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.


Thursday, April 10, 2025

DOGE-related Funding Cuts Upending HIV Care in Local Communities, Causing Chaos

By: Ranier Simons, ADAP Blog Guest Contributor

Federal funding cuts driven by the so-called Department of Government Efficiency (DOGE) are ongoing, affecting many elements of healthcare infrastructure nationwide. Amidst all the uncertainty, chaotic communications, and inconsistencies currently experienced by federal departments, agencies, and institutions, it’s essential to illuminate the local impacts. Nationwide, community organizations and patient advocates are speaking out to amplify the impact of these potential HIV funding cuts on treatment and prevention services from a front-line perspective. What follows is local voices speaking to local impact.

Hands-Off protest sign
Photo Source: Let's Kick ASS Palm Springs

In Wisconsin, Vivent Health serves people living with HIV/AIDS (PLWHA) with an integrated model of care, including both clinical and social services. The clinical services include medical, dental, mental health, and pharmacy. Holistic HIV treatment and prevention entails testing and providing access to medication as well as social service support such as food and housing security. Via contractual relationships with the state, Vivent Health receives approximately $1.9 million from the Centers for Disease Control & Prevention (CDC), with most of the funds supporting care in the Milwaukee and southeastern Wisconsin areas (Peralta-Arellano, 2025). 

These funds are part of the approximately $1 billion in national funding for HIV testing, treatment, and prevention presently under scrutiny for significant cuts. Wisconsin does not have robust investment per capita in terms of public health; thus, the loss of funds would harm many of the communities Vivent Health serves. Bill Keeton, Vivent Health’s chief advocacy officer, explains, “At the end of the day, what it means is, if the $1.9 million in CDC-derived funding that Vivent Health receives goes away, we’re going to be unable to sustain the level of services and reach the number of people we need to reach to continue to successfully address the HIV epidemic in the state of Wisconsin. And that’s really unfortunate because we know that these programs are working” (Peralta-Arellano, 2025).

Marginalized communities are disproportionately affected by HIV and, thus, are disproportionately affected by funding freezes and cuts in funding. Columbus, Ohio-based Equitas Health system, which specializes in serving the LGBTQ community and PLWHA, is also alarmed at the potential for funding cuts (Johnson, 2025). The health system was already dealing with the effects of the Trump administration’s freeze on domestic and foreign aid in January. Announcements of HIV treatment and prevention cuts add urgency to the health system’s need to make plans to deal with the outcomes. According to David Munar, CEO of Equitas Health, “Ohio stands to lose not only the funding but also the ability to fight the epidemic in our state and curve the epidemic for our people.” He further explains, “Every case, every new infection means a lifetime cost of half a million dollars. So, it’s not even the human suffering, but economically, it’s also a big step back” (Johnson, 2025).

Patient holding sign, "No Cuts to HIV Funding"
Photo Source: San Francisco AIDS Foundation

Suffering setbacks in HIV prevention and treatment would result in an increase in preventable HIV infections as well as decreases in the rates of viral suppression. The negative ramifications of these adverse effects are multifocal, given that Ohio has several active HIV criminalization laws. Six laws have resulted in 214 HIV-related prosecutions from 2014-2020.

Palm Springs, California, is especially vulnerable to potential cuts in HIV funding due to its demographics. It has one of the largest populations of PLWHA in the country as well as many PLWHA who are aging. Palm Springs has the highest prevalence of gay men living with HIV who are 50 years of age or older (Murphy, 2025). Jax Kelly, President of Let’s Kick ASS Palm Springs (AIDS Survivor Syndrome), states, “As someone who has lived through the earliest years of the AIDS epidemic and now works closely with older adults aging with HIV, I can tell you plainly: these proposed cuts—and the chaos emanating from Washington—are retraumatizing long-term survivors and sparking real fear throughout our community.”

Kelly added, “Community health organizations are unsure how long they can continue offering stable care. Clients—many of whom rely on multiple safety net programs—are afraid their doctors will be taken away, their medications interrupted, and their lifelines severed.” Aging while living with HIV is uniquely stressful when faced with healthcare access challenges, in addition to potential cuts to Medicare, Medicaid, and Social Security. Moreover, funding cuts could adversely impact clinical trials that are uniquely beneficial to aging PLWHA.

Photo of Jeff Graham with Georgia Equality at the state capitol
Photo Source: ACLU Georgia

Georgia, one of the most heavily impacted states in terms of HIV, faces significant losses because of potential funding cuts. Ninety-five percent of Georgia’s budget for HIV prevention comes from federal funding through the CDC (Scaturro, 2025). If all the cuts go through, Georgia would lose $21 million of its $24.4 million HIV prevention budget. 

ADAP Advocacy reached out to Jeff Graham, Executive Director of Georgia Equality (seen above in photo from 2004), for insight into the gravity of HIV funding cuts in the state. Graham stated, “The State of Georgia in general and the metro Atlanta area in specific have been especially hard hit with the number of new HIV diagnoses in recent years, especially among black communities. The Georgia Department of Public Health and most local health departments rely almost exclusively upon federal funds to conduct the surveillance and re-granting of funds that community-based organizations depend upon to do the front-line work that is so desperately needed.” He further explained, “Any cuts to federal funds will have a direct impact on those communities who are already facing challenges due to this administration's policies attacking people of color, transgender individuals, and LGBTQ serving organizations. We are not just looking at a probable increase in new HIV diagnoses. We are looking at the roll-back of decades of work addressing the root causes of HIV and AIDS in the South.”

In many aspects, it is sometimes difficult for people to understand how the actions of the federal government impact citizens’ daily lives. Elevating the plight of local communities navigating the ever-changing developments in HIV funding cuts colors the slashed numbers on a ledger with humanity.

[1] Johnson, C. (2025, April 2). HIV funding cuts will hinder Ohio treatment and prevention, LGBTQ+ health group says. Retrieved fromhttps://www.msn.com/en-us/politics/government/hiv-funding-cuts-will-hinder-ohio-treatment-and-prevention-lgbtq-health-group-says/ar-AA1C9iv9?ocid=socialshare

[2] Murphy, T. (2019, October 10). Living the Golden Years With HIV in Palm Springs, California. Retrieved fromhttps://www.thebody.com/article/living-the-golden-years-with-hiv-in-palm-springs-california

[3] Peralta-Arellano, M. (2025, April 2). Health organization in Milwaukee concerned over potential federal cuts to HIV prevention. Retrieved from https://www.wuwm.com/health-science/2025-04-02/health-organization-in-milwaukee-concerned-over-potential-federal-cuts-to-hiv-prevention

[4] Scaturro, M. (2025, March 21). Georgia could lose nearly all HIV prevention funds with proposed CDC cuts. Retrieved from  https://www.ajc.com/news/health-news/georgia-could-lose-nearly-all-hiv-prevention-funds-with-proposed-cdc-cuts/2KIVL4R6QVBM5D56YF3XMIY6GA/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Thursday, April 3, 2025

DOGE-related Funding Cuts Threaten the Fight to End the HIV Epidemic

By: Ranier Simons, ADAP Blog Guest Contributor

Actions driven by the so-called Department of Government Efficiency (DOGE) continue destabilizing the U.S. public health and scientific research infrastructure. Funding cuts, including eliminating grants and dismissing thousands of employees at the National Institutes of Health (NIH) and Center for Disease Control & Prevention (CDC), are being announced increasingly quickly. The onslaught of DOGE actions is aggressively wielding a hatchet from multiple angles without guidance to those affected, leaving confusion and a paucity of guidance in its wake. Diverse stakeholders are concerned about the potentially grave impending impacts of these cuts on the fight to end the HIV epidemic and public health overall.

Science under siege: Trump cuts threaten to undermine decades of research Sweeping layoffs, funding freezes and executive orders have provoked outcry among federal researchers and their university partners, who fear that science itself is under siege.
Photo Source: NBC News

One notable loss was incurred by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Recently, NIH announced the halt of two of its principal funding grants, pulling $18 million annually from its operations (Oza, 2025). The ATN was established over 20 years ago when evidence-based research identified the very specific needs of adolescents and young adults living with HIV as compared to children born with HIV or adults living with HIV. The ATN’s work includes several multidisciplinary clinical trials aimed at improving HIV prevention, as well as treatment improvements across the entire HIV care continuum for youth, which are all being eliminated. One of the many successes of ATN is the development of a PrEP protocol for adolescents, which was approved in 2018. The termination of funding effectively terminates current trials, such as examining doxycycline prophylaxis in women and an investigational study for a multipurpose injectable to prevent HIV and pregnancy (Oza, 2025).

NIH grant cuts are also targeting health equity research. Health equity research seeks to identify and address avoidable adverse health outcomes experienced by specific populations due to social determinants of health, including socioeconomic status and race (Braveman et al., 2017). The current administration does not appear to recognize health disparities as a credible public health threat and views the work as baseless DEI conjecture. 

One such canceled grant involved research on maternal health. Jaime Slaughter-Acey, an associate professor at the University of North Carolina at Chapel Hill, was studying the poor maternal health and birth outcomes of black women (Hellman, 2025). The health crisis of poor maternal and infant mortality among black women is backed by sound scientific data and is a recognized consensus in the medical community. The risk of maternal mortality is the most significant disparity among all conventional population perinatal health measures, regardless of geographic location (Krishnamoorthi et al., 2023). 

Donald Trump Administration’s $12B Healthcare Cuts to Impact Millions—Here’s What the Impact on Health Sector
Photo Source: Inquisitr

Multiple health disparity grants specifically focused on LGBTQ issues have also been canceled. For example, several researchers at George Washington University lost grants for studies exploring HIV outcomes in minority populations (Lee, 2025). NIH grant funding was canceled for Jonathon Rendina, an associate research professor of public health, who was studying the inequities of HIV experienced by women and transgender people of color. The research was already underway and will lose $1.4 million that had not yet been spent. Derek Dangerfield II, an associate professor of prevention and community health, lost two grants. His grants funded studies investigating healthcare outcomes and systemic stigma in the healthcare system for Black men living with HIV. Together, both grants took almost $1.5 million away (Lee, 2025).

Explicitly, NIH has targeted and canceled funding for transgender health studies. It has issued internal guidance stating it no longer supports any research on transgender health issues or gender identity (Kozlov, 2025). Sari Reisner, associate professor of epidemiology at the University of Michigan, lost his grant entitled “Strategies to Prevent HIV Acquisition Among Transgender MSM in the US” (Spring, 2025). At least five of seven recently canceled grants at the University of Michigan involved gender identity research. Studies show that HIV disproportionately impacts transgender individuals. Transgender women are 49 times more likely to have HIV compared to the general population, and transgender men have higher rates of HIV acquisition as well (Baral et al., 2012).

Transgender health, in general, has been under consistent attack. Shanna Kattari, an associate professor of social work and women’s studies at the University of Michigan, explains, “The current political climate and anti-trans attacks have already harmed healthcare access for transgender and gender-diverse (TGD) people, from directly clinics shutting down puberty blocks or HRT for young people … to more indirectly, (where) many TGD people (are) choosing to avoid needed care, whether preventative care or gender-affirming care, due to fear of being denied, mistreated or being put on a ‘list’ for accessing such care” (Spring, 2025).

The White House Is Reportedly Considering Massive Cuts to HIV Prevention in the U.S.
Photo Source: THEM

The majority of those receiving notification of their grant funding by NIH received letters with verbiage expressing that NIH no longer holds their research as a priority. The letters state, “Research programs based primarily on artificial and non-scientific 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…”(Spring, 2025). They further legitimize their choice to defund, adding, “…so-called diversity, equity, and inclusion (“DEI”) studies are often used to support unlawful discrimination on the basis of race and other protected characteristics, which harms the health of Americans. Therefore, it is the policy of NIH not to prioritize such research programs”(Spring, 2025).

There is a human toll to the Trump Administration's slash and burn. Michigan resident Jeremy Toney summarized, "Being directly affected by these recent funding cuts to public health, specifically HIV prevention and research, has left me feeling very uncertain about the future. My team and I experienced a massive direct cut to our NIH R01 research grant that was set to change how we look at HIV Prevention in Primary Care from a health system perspective. We were on the heels of implementation as we put time and effort into building a project from scratch. The devastation of our grant being terminated without warning and true reason is quite egregious and speaks to how this current administration views science and the work that so many credible individuals have put into saving lives. We're all feeling unsafe and uncertain about the future of our jobs, the loss of impactful research, and the distrust of the government, but we must fight back against it."

Population health is not an amorphous equity objective. HIV prevention and treatment studies do indeed enhance health, lengthen life, and reduce illness. The average estimated lifetime HIV-related medical expenditure per individual in the U.S. is around $420K (Bingham, 2021). Saving over $420K per person by preventing HIV infection is a significant return on investment. Medical knowledge gained from the study of population subsets can be expanded to application to the general population. That is the epitome of expanding our knowledge of living systems. As we continue to monitor ongoing DOGE-related funding cuts and “reductions in force,” it is imperative to find ways to mitigate the present dangers as well as offensively protect the future.

[1] Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2012). Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet Infectious Diseases, 13(3), 214–222. https://doi.org/10.1016/s1473-3099(12)70315-8. Retrieved from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(12)70315-8/fulltext

[2] Bingham, A., Shrestha, R. K., Khurana, N., Jacobson, E. U., & Farnham, P. G. (2021). Estimated Lifetime HIV-Related Medical Costs in the United States. Sexually transmitted diseases, 48(4), 299–304. https://doi.org/10.1097/OLQ.0000000000001366. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33492100/#:~:text=Results:%20We%20estimated%20an%20average%20lifetime%20HIV%2Drelated,and%20$326%2C411%20in%20our%20least%20favorable%20scenario.

[3] Braveman, P., Arkin, E., Orleans, T., Proctor, D., Plough, A. (2017, May 1). What is health equity? Retrieved from https://www.rwjf.org/en/insights/our-research/2017/05/what-is-health-equity-.html#:~:text=In%20a%20report%20designed%20to,in%20discussions%20around%20the%20concept.

[4] Hellman, J. (2025, March 24). Trump cancels NIH grants on equity research. Retrieved from https://www.msn.com/en-us/health/other/trump-cancels-nih-grants-on-equity-research/ar-AA1BzOLx?ocid=socialshare

[5] Kozlov, M. (2025, March 26). Exclusive: NIH to cut grants for COVID research, documents reveal. Retrieved from https://www.nature.com/articles/d41586-025-00954-y

[6] Krishnamoorthi, M., Balbierz, A., Laraque-Arena, D., & Howell, E. A. (2023). Addressing the National Crisis Facing Black and Latina Women, Birthing People, and Infants: The Maternal and Child Health Equity Summit. Obstetrics and Gynecology, 141(3), 467–472. https://doi.org/10.1097/AOG.0000000000005067. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9974748/

[7] Lee, J. (2025, March 31). GW researchers lose five NIH grants amid federal funding cuts. Retrieved from https://gwhatchet.com/2025/03/31/gw-researchers-lose-five-nih-grants-amid-federal-funding-cuts/

[8] Oza, A. (2025, March 25). NIH cuts halt 24-year program to prevent HIV/AIDS in adolescents and young adults. Retrieved from https://www.statnews.com/2025/03/25/nih-cuts-include-hiv-aids-prevention-program-for-adolescents/

[9] Spring, E. (2025, March 26). NIH pulls funding from UMich transgender health research. Retrieved from https://www.michigandaily.com/news/research/nih-pulls-funding-from-umich-transgender-health-research/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.