Discontent and Lack of Trust Swirls Around RFK Jr

By: Ranier Simons, ADAP Blog Guest Contributor

Public health affects all Americans, regardless of their political ideology, religious beliefs, or socioeconomic background. The vast majority of the public also lacks an extensive medical or scientific background. Thus, citizens look to established institutions and entities for guidance on best health practices as they go about their busy lives. Consequently, the instability caused by the current state of upheaval in the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control & Prevention (CDC) is a public health hazard. The trust gap the average American has with RFK Jr. should not be trivialized, as it is having ripple effects throughout public discourse and the medical establishment.

Photo Source: STAT News

RFK Jr. has a very high-profile stance that many describe as being anti-vaccine. Although he does not hold a medical degree and has no prior experience as an environmental attorney, he has characterized the historically internationally respected CDC as a corrupt institution that has failed the American public (Soucheray, 2025). This sentiment is especially notable in his characterizations of COVID-19 vaccines and childhood vaccinations. Scientific data show that COVID-19 vaccinations worldwide prevented approximately 2.5 million deaths between December 2020 and October 2024 (John et al., 2025). Statistics such as this significantly damage his credibility.

A recent poll, conducted by The Economist and YouGov and surveying 1,691 adults, indicated that only one in four Americans trusts RFK Jr. with medical advice (Crisp, 2025). Approximately 51% of respondents stated they still trust CDC guidance, and 79% stated they trust the medical recommendations of their personal physicians (Crisp, 2025). Notably, 45% expressed disapproval of Kennedy’s job as HHS secretary.

Experienced career staff at HHS have also raised questions about RFK Jr.’s trustworthiness. A recent shooting at the CDC resulted in six CDC buildings sustaining damage and one police officer being killed (Fields, 2025). 

In response, on August 20th, over 750 current and former HHS staff members issued a letter addressed to HHS Secretary Kennedy and Congress asking him to stop spreading inaccurate health information. The letter expressed that, “The attack came amid growing mistrust in public institutions, driven by politicized rhetoric that has turned public health professionals from trusted experts into targets of villainization—and now, violence…Health and Human Services Secretary Robert F. Kennedy, Jr., is complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information…”.

Photo Source: STAT News

On September 3rd, over 1000 current and former HHS staff released another letter asking him to resign. The public cannot foster trust in the head of HHS when internal members of HHS are calling for his resignation.

Even amidst the recent outbreak of measles, RFK Jr.'s stance on childhood vaccines is fostering conflicting messaging and confusion. Recently, Florida’s Surgeon General announced that the state would be the first to end all vaccine mandates, including those for schoolchildren (Kearney, 2025). For years, all 50 states and the District of Columbia have had laws requiring school children to be vaccinated against diseases such as polio and measles. Despite the Florida Surgeon General’s announcement, a recent survey conducted by The Washington Post and the Kaiser Family Foundation (KFF) indicates 82% of Florida parents support public schools requiring vaccines for measles and polio, with some health and religious exemptions. Comparatively, 81% of parents nationwide also support school vaccine requirements.

In June of this year, HHS Secretary Kennedy fired all 17 members of the Advisory Committee on Immunization Practices (ACIP) (Stone, 2025). This committee helps develop vaccine policy and recommendations for the CDC. Kennedy stated that he removed all the members because he felt they all had conflicts of interest, as indicated in a government report (Huang, 2025). However, it has been documented that Kennedy’s interpretation of the report is inadequate, given that it is almost twenty years old, dating back to 2009. Dr. Tom Frieden, CDC director from 2009 to 2017, publicly stated Kennedy was giving “a total misrepresentation of a 20-year-old report, about a process that was already being improved before that report was issued” (Huang, 2025). Secretary Kennedy subsequently replaced the old members with several individuals who had previously expressed anti-vaccine sentiments.

Out of grave concern for public health, the American Academy of Pediatrics (AAP) recently published its own 2025 recommended schedule for child and adolescent immunization, which differs from the current CDC's ACIP (Gerlach, 2025). The AAP is outwardly challenging the current CDC guidelines, stating its recommendations are evidence-based. Susan J. Kressly, MD, AAP president, said in a statement, “The AAP will continue to provide recommendations for immunizations that are rooted in science and are in the best interest of the health of infants, children, and adolescents” (Gerlach, 2025). She added, “Pediatricians know how important routine childhood immunizations are in keeping children, families, and their communities healthy and thriving” (Gerlach, 2025). Among the significant divergences from CDC ACIP guidance, the AAP recommends universal COVID-19 vaccination for children aged 6 to 23 months and risk-based immunization for children aged 2 to 18 years, such as those who are medically vulnerable or living with high-risk individuals (Gerlach, 2025).

Photo Source: ABC30

Some Democrat-led states are also pushing back against the current CDC ACIP advisories. Massachusetts recently became the first state to issue its own vaccine rules. Governor Maura Healey announced that health insurers doing business in Massachusetts will be required to cover vaccines recommended by the state health department, regardless of whether the CDC recommends them or not. Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans support the policy (Goldman, 2025 Sept.4) California, Oregon and Washington have formed what is being called the West Coast Health Alliance to issue their own vaccine recommendations to battle the politicization of the CDC (Goldman, 2025 Sept.3). New Mexico recently through its health department issued and order that all its residents can obtain COVID-19 vaccinations even though Kennedy announced they should be restricted to high-risk patients (Goldman, 2025, September 5).

Just this week, PlusInc – an organization promoting health equity – issued a strongly worded rebuke of RFK Jr's assertion that there is a definitive link between Tylenol and autism. The statement, in part, reads: "Monday’s disorganized pronouncement was made with either complete unawareness or discounting of findings from a study published just last year in JAMA Network that found no link between the use of acetaminophen and children’s risk of autism, attention-deficit/hyperactivity disorder (ADHD), or any intellectual disabilities."

Distrust in RFK Jr’s leadership is adversely disruptive to public health and problematic for the evidence-based established infrastructure of medical science. Moreover, since states have the legal latitude to create their own health policies and guidance, the result could lead to a patchwork quilt of public health protections that vary from state to state. The public will ultimately be left with apprehension regarding health decisions, and states may face retaliatory funding responses from the federal government. The trust gap between RFK Jr. and the American public is not merely an issue of political theater, but a threat to the lives of citizens.

[1] Crisp, E. (2025, September 3). 1 in 4 Americans trust RFK Jr. with medical advice. Retrieved from https://thehill.com/policy/healthcare/5484579-kennedy-poll-medical-advice/

[2] Fields, A. (2025, August 12). 500 shots fired in CDC attack in Atlanta. Retrieved from https://thehill.com/homenews/state-watch/5447797-gunman-cdc-headquarters/

[3] Gerlach, A. (2025, August 21). American Academy of Pediatrics Releases 2025 Child, Adolescent Immunization Recommendations. Retrieved from https://www.pharmacytimes.com/view/american-academy-of-pediatrics-releases-2025-child-adolescent-immunization-recommendations

[4] Goldman, M. (2025, September 4). Massachusetts becomes first state to impose its own vaccine coverage rules. Retrieved from https://www.axios.com/2025/09/04/massachusetts-vaccine-coverage-rules

[5] Goldman, M. (2025, September 3). 3 western states form vaccine alliance to counter feds. Retrieved from https://www.axios.com/2025/09/03/cdc-vaccine-washington-california-oregon-guidelines-recommendations

[6] Goldman, M. (2025, September 5). Blue states eye rival health rules to defy RFK Jr.. Retrieved from https://www.axios.com/2025/09/05/rfk-vaccine-rule-states-democrats-vaccine-rules

[7] Huang, P. (2025, March 11). RFK says most vaccine advisers have conflicts of interest. A report shows they don't. Retrieved from https://www.npr.org/sections/shots-health-news/2025/03/11/nx-s1-5323771/rfk-jr-vaccine-advisers-conflicts-interest

[8] John, Pezzullo, A. M., Cristiano, A., & Boccia, S. (2025). Global Estimates of Lives and Life-Years Saved by COVID-19 Vaccination During 2020-2024. JAMA Health Forum, 6(7), e252223–e252223. https://doi.org/10.1001/jamahealthforum.2025.2223

[9] Kearney, A. (2025, September 4). Most Parents Nationally and in Florida Want Schools to Require Vaccines. Retrieved from https://www.kff.org/quick-take/most-parents-nationally-and-in-florida-want-schools-to-require-vaccines/

[10] Soucheray, S. (2025, September 4). In heated Senate committee meeting, RFK Jr says fired CDC chief lied about ouster. Retrieved from https://www.cidrap.umn.edu/anti-science/heated-senate-committee-meeting-rfk-jr-says-fired-cdc-chief-lied-about-ouster#:~:text=During%20the%203%2Dhour%20meeting,see%20today's%20CIDRAP%20News%20story).

[11] Stone, W. (2025, June 9). RFK Jr. boots all members of the CDC's vaccine advisory committee. Retrieved from https://www.npr.org/sections/shots-health-news/2025/06/09/nx-s1-5428533/rfk-jr-vaccine-advisory-committee-acip#:~:text=boots%20all%20members%20of%20the%20CDC's%20vaccine%20advisory%20committee,-Listen%C2%B7%203:25&text=Secretary%20of%20Health%20Robert%20F,issue%20statements%20denouncing%20the%20move

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.   

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.

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). 

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).

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.

Proposed CDC HIV Prevention Funding Cuts Loom Large; Advocates Fear for Treatment Dollars

By: Ranier Simons, ADAP Blog Guest Contributor

The current administration’s interest in a multitude of funding cuts and reorganization of federal programs and entities has been at the forefront of daily news for weeks. Recently, a Wall Street Journal report highlighted information sourced indicating the Trump administration is considering cuts to the CDC’s domestic HIV program (Wyte, Mosbergan, & Rockoff, 2025). Specifically, there are talks of significant cuts in HIV prevention funding, including a reduction of CDC personnel and possible restructuring or elimination of the CDC’s HIV Prevention division. Public health professionals, clinicians, patient groups, and many other stakeholders are alarmed by the detrimental ramifications of the cuts being discussed.

Photo Source: WSJ

There are an estimated 1.2 million people in the U.S. living with HIV, of whom 13% are unaware of their status (Wyte et al., 2025). Those who are unaware they are living with HIV are in dire need of testing to learn of their status and get into treatment. Testing is the cornerstone of HIV prevention. Mitchell Warren, executive director of HIV prevention organization AVAC, when speaking to the Wall Street Journal, stated, “One of the greatest lessons in public health is you can’t end epidemics with treatment alone. Without prevention, we are going to be fighting the virus with one hand behind our back.”

An opposition letter written by Representative Maxine Waters addressed to Robert F Kennedy, Jr., Secretary of the U.S. Health and Human Services delineates a reported elimination of $700 million in CDC HIV prevention funding because of the 2025 Congressional Continuing Resolution (Waters, 2025). HIV prevention funding was only 3% of the federal government’s fiscal expenditure on HIV in FY2022, even though the CDC represents %91% of federal HIV prevention funds. The FY2024 appropriation for HIV prevention at the CDC was approximately $1 billion, and the CDC spent $1.3 billion on HIV, viral hepatitis, STIs, and tuberculosis in FY2023 (Dawson,2025; Wyte et al., 2025). Thus, a $700 million cut is devastating.

The pushback was bipartisan, as evidenced by Representative Mike Lawler's taking to X to express his concern over the reports. "Our country has been at the forefront of the global fight against HIV and AIDS, and now is not the time to cut programming," he tweeted.

Photo Source: X

Additionally, ADAP Advocacy directed a letter to select Members of the North Carolina Congressional Delegation on the same day the Community Access National Network (CANN) appealed to Members of the Louisiana Congressional Delegation. According to the ADAP Advocacy letter, "North Carolina's effort to address HIV is nearly exclusively funded by the federal government. For example, approximately $42.7M was appropriated for the State AIDS Drug Assistance Program (ADAP), as well as prevention programs funded by President Trump's own Ending the HIV Epidemic initiative (EHE, announced in 2019), including a focus on Mecklenburg County." CANN's letter likewise noted the impact on Louisiana, "Louisiana's effort to address HIV is nearly exclusively funded by the federal government. These dollars, as addressed specifically by prevention programs, including President Trump's own Ending the HIV Epidemic initiative (EHE, announced in 2019), include $5.94M for programs, $1.12M for surveillance activities, and an additional $3M associated with EHE activities. In total, this type of "cut" would amount to the state of Louisiana losing more than $10.06M shift in cost to the state for HIV prevention and surveillance activities for the state of Louisiana alone, even as the state faces a fiscal cliff, making it unlikely that state appropriator, despite their best efforts, to be able to fill the gap caused by program elimination."

The majority of CDC HIV prevention funding is not spent on internal administration. The CDC is a primary funding funnel, with funds distributed to state and local health departments, including community health organizations. The Frannie Peabody Center, Maine's largest provider of HIV and AIDS services, has publicly spoken out against the cuts, as there are an estimated 1,800 Maine residents living with HIV. Executive Director Katie Rutherford stated, “Eliminating this division of the CDC would decimate decades of progress that we have made in fighting an end of HIV and AIDS in the U.S.” (WGME, 2025). 

Photo Source: Courage Forward Strategies

HIV disproportionately affects marginalized communities. Thus, cuts in HIV prevention funding would have disproportionately adverse health outcomes for groups such as Black and Latino gay men. In 2022, among the subpopulation of men who have sex with men, 38% of those who were diagnosed with HIV were Black, and 32% were Latino (Reed, 2025). Texas Health Action, a non-profit that operates several branches of culturally affirming Kind Clinic, states, “HIV prevention is a proven, cost-effective public health strategy. Reducing funding doesn’t save money—it leads to more infections and higher long-term healthcare costs. Nearly 5,000 Texans were diagnosed with HIV in 2022 alone. Cutting these essential programs now would be catastrophic for communities that rely on them.” (Texas Health Action, 2025).

Drastic cuts to HIV prevention funding would also harm the youth. In 2022, 1 in 5 new HIV diagnoses were in the 13 to 24-year-old cohort, and 56% of all new cases were among those 34 and younger (Reed, 2025). Raynard Washington, a county health director in Mecklenburg, North Carolina, when speaking to AXIOS news, stated, “There is nothing more heartbreaking than having to tell a 14-year-old that they have an illness that they won't be able to cure, and they'll have to take medication in various forms for the rest of their life” (Reed, 2025). Sexually active 13-24-year-olds have the highest probability of living with undiagnosed HIV and have lower rates of viral suppression (Hsu & Rakhmanina, 2024). It is imperative to strengthen HIV prevention and education efforts for the youth, not defund them.

In addition to the funding cuts, the administration is considering dismantling the CDC HIV Prevention Department and placing HIV prevention funding under HHS, such as with HRSA. This is also faulty reasoning. The CDC and HRSA are functionally separate entities. HRSA is tasked with HIV healthcare service delivery through the Ryan White HIV/AIDS Program. By statute, except for PrEP delivery at community centers, it is prohibited from providing most HIV prevention services for which the CDC is experienced and structured (Dawson, 2025). Moreover, the Substance Abuse and Mental Health Services Administration (SAMHSA) is considering cuts to its HIV programs (Waters, 2025). SAMHSA funding is crucial because it directs intervention to those who benefit from HIV prevention and substance addiction treatment. Reducing CDC HIV prevention funding, in addition to markedly reducing SAMHSA HIV-related funding, further leaves vulnerable populations subject to increases in HIV transmission and poor health outcomes from poor linkages to care.

Photo Source: HIVMA

During President Trump’s 2019 State of the Union address, he announced a heightened focus on eliminating HIV in the U.S. within ten years (Dawson, 2025). The administration’s Ending the HIV Epidemic in the U.S. Initiative (EHE) aimed to reduce new HIV infections by 90% by 2030. The current discussion of massive cuts to CDC HIV prevention funds starkly contrasts the 2019 EHE goals. Slashing HIV prevention funding means the destruction of programs for outreach, HIV surveillance, PrEP access, and seamless linkages to care.

In a joint statement put out by ADAP Advocacy and Community Access National Network (CANN), Jen Laws, CANN President & CEO, gave a fitting summation of the damage cutting HIV prevention programs will cause. He said, “Prevention programs further support treatment programs with testing, screening activities, and linkage to care upon reactive tests. The economic impact of these programs can be measured in more jobs, more clinics, healthier families, and more productive employees. Conversely, cutting these programs and their associated funding will be measured in terms beyond economic loss. It would be measured in the human toll, the harm to our communities, untreated illness, late diagnoses, families torn apart, and lives lost." (Macsata & Laws, 2025).

[1] Dawson, L. (2025, March 19). Cutting HIV Prevention Funding at CDC: What Would it Mean? Retrieved from https://www.kff.org/quick-take/cutting-hiv-prevention-funding-at-cdc-what-would-it-mean/

[2] Hsu, K., Rakhmannina, N. (2024, May 17). HIV in Children and Teens. Retrieved fromhttps://www.healthychildren.org/English/health-issues/conditions/sexually-transmitted/Pages/HIV-Human-Immunodeficiency-Virus.aspx

[3] Macsata, B., Laws, J. (2025, March 19). Joint Statement On Reported HIV Prevention Funding Cuts. Retrieved from  https://www.adapadvocacy.org/pdf-docs/202_ADAP_Press_Proposed_Cuts_HIV_Prevention_03-19-25-CANN-Joint-Statement.pdf

[4] Reed, T. (2025, March 20). Young people could be most at risk with HIV prevention cuts. Retrieved from https://www.axios.com/2025/03/20/cdc-hiv-prevention-cuts-trump-young-people

[5] Texas Health Action. (2025, March 18). Texas Health Action responds to proposed cuts in HIV prevention funding. Retrieved from  https://dallasvoice.com/texas-health-action-responds-to-proposed-cuts-in-hiv-prevention-funding/

[6] Waters, M. (2025, March 18). Letter to Robert F. Kennedy, Jr. regarding CDC HIV Prevention funding cuts. 

[7] WGME. (2025, March 19). Maine provider for HIV, AIDS services criticizes Trump administration cuts. Retrieved from https://www.msn.com/en-us/health/other/maine-provider-for-hiv-aids-services-criticizes-trump-administration-cuts/ar-AA1BgFhD?ocid=socialshare

[8] Wyte, L., Mosbergan, D., Rockoff, J. (2025, March 18). Trump Administration Weighing Major Cuts to Funding for Domestic HIV Prevention. Retrieved from https://www.wsj.com/health/healthcare/trump-administration-weighing-major-cuts-to-funding-for-domestic-hiv-prevention-8dcad39b

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.

Putting Politics Ahead of Public Health is Spelling Trouble for Tennessee

By: Ranier Simons, ADAP Blog Guest Contributor

In 2023, Tennessee Governor Bill Lee, rejected nine million dollars in federal HIV funding from the Centers for Disease Control & Prevention (CDC). This meant that the pass-through grant contracts associated with the Integrated HIV Programs for Health Departments to Support Ending the Epidemic in the United States CDC-RFA-PS20-2010 grant and the Tennessee Integrated HIV Surveillance and Prevention Programs for Health Departments CDC-RFA-PS18-1802 grant ended in May of 2023.[1] The decision meant a significant cut in funding for HIV prevention, education, and treatment for public health centers and many community-based organizations. The adverse effects of the decision are materializing, and experts continue to sound the alarm about how devastating the outcomes will impact the state.

Photo Source: The Tennessee Conservative

The governor stated he refused the funds to decrease dependence on federal funds and be more independent as a state. He also expressed that the move was to make it easier for organizations and public health departments to access funding without having to deal with bureaucratic red tape.[2] However, analysis shows that the decision was politically motivated. Lee is on public record expressing disapproval of two organizations that were HIV grant recipients, Planned Parenthood and a task force on transgender health issues.[3] Refusing CDC funding means that the state is no longer required to distribute funding based on science, evidence-based data, and research. The goal of the state was to replace the CDC funds with state funding.

In response to Tennessee’s refusal of funding, the CDC decided to try and circumvent the legislature. It decided to directly provide four million dollars in funding to United Way of Greater Nashville.[4] This would allow United Way to distribute funds to nonprofit organizations, such as Planned Parenthood, to continue their HIV prevention efforts. However, four million dollars is only half of the nine million dollars refused.

When the state government replaced the lost CDC funding with state funding, it was mainly local health departments that were guaranteed funding to make up for the cuts.[4] This meant the state health departments could make decisions concerning funding distribution that did not require alignment with CDC requirements. This was eventually followed by an announcement to reallocate funding away from the most at-risk priority communities, such as men who have sex with men, to new groups. The new groups are first responders, pregnant women, and survivors of sex trafficking. Studies are showing that this will result in unnecessary deaths and poor health outcomes because this group is not where the need resides.

Photo Source: Clinical Infectious Diseases

A study published in July of this year in the journal Clinical Infectious Diseases spells out the negative ramifications of Tennessee’s state resource allocation. Men who have sex with men, transgender women, and heterosexual Black women are the evidenced-based identified priority demographic most affected by HIV in Tennessee.[5] The study projected conservative estimates the Tennessee decision would mean 166 preventable HIV transmissions, 190 additional deaths, and 843 life-years lost over 10 years. The study’s more pessimistic or worst-case scenario projections were 1359 preventable HIV transmissions, 712 additional deaths, and 2,778 life-years lost over 10 years.[5] 

Comparatively, this means the reallocation in funding would be prohibitively damaging to the original priority group with negligible benefit for the new priority pivot. “Under Reallocation, MSM would comprise most of the HIV transmissions (77%), followed by TGW (8.6%) and HSBW (6.8%). First responders would contribute 0.5%, pregnant people 0.2%, and SST 6.9% to the total HIV transmissions over 10 years.”[5] The newly suggested priority populations only comprise %1 of all Tennesseans living with HIV compared to the CDC-defined priority populations, which comprise %99 percent.[6]

Funding losses have already begun to negatively affect agencies serving vulnerable populations. Before the change, CDC grant money provided stability for HIV programming for five years at a time. The new state-provided funds happen on a one-year cycle. The one-year budget rides on the auspices of the state legislature, which votes on it each year.[7] Reduced funding means loss of staff for many organizations. According to Amna Osman, CEO of Nashville CARES, “There’s no sustainable grant funding to support these positions…Employees really want some stability.”[7]

Moreover, the new funding plan routes money mainly to metro state health departments and groups associated with them. This translates into a drastic cut to resources for those in rural areas in addition to groups who, under the new reallocation priorities, would not be able to garner funding from the state. 

Photo Source: The New York Times

The motivation behind the original CDC funding was to concentrate efforts on HIV prevention, education, and treatment for those most in need in Tennessee. Prevention requires testing, surveillance, access to PrEP, and more. Before the funding reallocation, a third of those most in need of PrEP did not know where they could access it. Now, issues of access have worsened. Osman states she has heard from community members who say, “Well, I’m hearing there’s no dollars for prevention education for HIV. Then, that means ‘I think there’s no money for me to get a service,”[7] Memphis, Tennessee is second in the nation regarding the rate of new HIV cases. Over 7,500 people in Shelby County alone are living with HIV or AIDS.[8] That number is second only to Miami, Florida.[8]

HIV prevention and testing is not just about HIV. Testing involves STI testing. STI testing benefits the entire community as a public health safeguard as well as a tool in the fight to prevent HIV transmission. People living with HIV do not live in a vacuum, nor do those living with STIs. Effectively focusing funding and infrastructure on the populations that science and health professionals have identified as significantly at risk is the only way to reverse the tide in all of Tennessee’s communities. Only time will tell if voting and continued public and professional outcry, in combination with pressure from the medical community, will result in the legislature changing its course.

[1] Talley, P. (2023, January 17). Dear Colleagues Letter. Retrieved from https://wpln.org/wp-content/uploads/sites/7/2023/01/Notification-HIV-Funding-Changes.pdf

[2] Stillman, J. (2023, April 22). Tennessee Rejected HIV Funds From Feds, But The State Was Just Outsmarted. Retrieved from https://www.hivplusmag.com/politics/tennessee-rejected-hiv-funds-from-feds-but-the-state-was-just-outsmarted

[3] Cha, A., Nirallil, F. (2023, Januery 26). HIV at center of latest culture war after Tennessee rejects federal funds. Retrieved from https://www.washingtonpost.com/health/2023/01/26/tennessee-federal-hiv-funding/

[4] Watts, M. (2023, April 17). Federal HIV funding rerouted to nonprofits, bypasses Tennessee health department entirely. Retrieved from https://www.tennessean.com/story/news/local/2023/04/17/hiv-federal-funds-will-reroute-to-tennessee-nonprofits-state-cut-out/70116510007/

[5] Borre, E. D., Ahonkhai, A. A., Chi, K. K., Osman, A., Thayer, K., Person, A. K., Weddle, A., Flanagan, C. F., Pettit, A. C., Closs, D., Cotton, M., Agwu, A. L., Cespedes, M. S., Ciaranello, A. L., Gonsalves, G., Hyle, E. P., Paltiel, A. D., Freedberg, K. A., & Neilan, A. M. (2024). Projecting the potential clinical and economic impact of human immunodeficiency virus prevention resource reallocation in Tennessee. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciae243

[6] Ridings, M. (2024, July 11). Study Finds That Tennessee’s Shift in HIV Prevention Funding Will Lead to Poorer Health Outcomes for its Residents. Retrieved from https://www.massgeneral.org/news/press-release/tennessee-shift-in-hiv-policy-will-lead-to-poorer-outcomes

[7] Sweeney, C. (2024, October 22). Tennessee replaced its federal HIV funding with state money. Public health experts say the change is causing damage. Retrieved from https://www.wkms.org/health/2024-10-22/tennessee-replaced-its-federal-hiv-funding-with-state-money-public-health-experts-say-the-change-is-causing-damage

[8] Paul, A. (2024, August 13). Memphis ranks second in the nation in highest number of new HIV cases. Retrieved from https://wreg.com/news/memphis-ranks-second-in-the-nation-in-highest-number-of-new-hiv-cases/l

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. 

HRSA Offers Guidance on Doxy-PEP to Stem the Tide of Rising STIs Among PLWHAs

By: Ranier Simons, ADAP Blog Guest Contributor

According to the Centers for Disease Control & Prevention (CDC), there were 2.5 million reported cases of gonorrhea, chlamydia, and syphilis in the United States in 2022.[1] The rates of sexually transmitted diseases (STIs) have been increasing globally, which is of particular concern for people living with HIV/AIDS (PLWHA). One strategy that is proving highly successful in combatting the spread of STIs is Doxy-PEP (post exposure prophylaxis).

Photo Source: The Washington Post

The presence of HIV in the body can, in some cases, make it harder to treat STIs.[2] Additionally, an STI can increase the HIV viral load in PLWHA who are not on treatment regimens.[3] For those with good antiretroviral adherence, an STI is not likely to change someone from undetectable to detectable. However, the numerous harms STIs inflict on the body make it essential to reduce STIs' impact on PLWHA. The Health Resources & Services Administration (HRSA) recently issued a letter to Ryan White HIV/AIDS Program (RWHAP) colleagues emphasizing their role in lowering the risk of STIs for PLWHA, as well as awareness of new clinical guidelines on the use of doxy PEP in preventing bacterial STIs.[4]

Doxy-PEP is the administration of 200 mg of doxycycline within 24-72 hours of condomless anal, vaginal, or oral sex and should not exceed a maximum of 200mg in any 24hr period.[5] Studies have shown that Doxy-PEP reduces syphilis and chlamydia infections by more than 70% and gonococcal infections by approximately 50%.[5]

Men who have sex with men (MSM) and transgender women (TGW) have been identified as groups disproportionately affected by STIs. Thus, CDC guidelines recommend that medical professionals target MSM and TGW who have had a bacterial STI in the past twelve months to offer education and counseling on the benefits of Doxy-PEP. After counseling and education, if desired, providers should provide prescriptions for Doxy-PEP to be self-administered.[5]

Photo Source: The PrEP Clinic

HRSA’s letter specifically encourages RWHAP recipients to adopt the CDC guidelines and integrate Doxy-PEP into their protocols and clinical programs. The letter also urges state AIDS Drug Assistance Programs (ADAPs) to add Doxy-PEP to their drug formularies to facilitate equitable access and coverage for their eligible populations. In case they are unaware, HRSA reminds RWHAP colleagues that purchasing Doxy-PEP is an allowable cost. “RWHAP Parts A, C, and D recipients may contribute RWHAP funds to ADAPs to purchase medications and/or health care coverage and medication cost sharing for ADAP-eligible clients.”[4]

Proper administration of Doxy-PEP requires STI testing every three to six months, as well as evaluation of the appropriateness of continued utilization of doxy PEP.[5] Increasing the number of those utilizing the antibiotic intervention will also increase the instances of contact with care professionals. Increased contact means more opportunities for strengthening linkages to care and exploration of other points of need. One of the main goals of RWHAP is to improve the health outcomes of PLWHA. Adoption of Doxy-PEP practices and protocols would be another tool to add to comprehensive whole-person care along with established practices such as harm-reduction and risk-reduction counseling, facilitating access to PrEP, and regular STI testing.

Photo Source: The PrEP Clinic

Notably, HRSA’s letter highlighted the RWHAP Part F's AIDS Education and Training Center (AETC) Program and the RWHAP Part F Special Projects of National Significance Addressing STIs: “Ask. Test. Treat. Repeat.” Initiative.[6,7] Both programs provide training and information on the proper implementation of Doxy-PEP and ways to adopt and normalize routine testing of STIs. This letter from HRSAs HIV/AIDS Bureau is more than just an F.Y.I. It is a tangible outreach of support for RWHAP colleagues. 

Ryan White-funded organizations work tirelessly to stretch federal dollars to improve the health and well-being of the vulnerable populations of PLWHA they serve. Clear guidance on Doxy-PEP and the proliferation of educational resources directly acknowledges that the federal government is an active partner with and sees and embraces the efforts of RWHAP recipients.

[1] CDC. (2024, January 30). CDC’s 2022 STI Surveillance Report underscores that STIs must be a public health priority. Retrieved from https://www.cdc.gov/std/statistics/2022/default.htm

[2] U.S. Department of Health & Human Services. (2024, June 27). Sexually Transmitted Infections. Retrieved from https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/sexually-transmitted-diseases#:~:text=Many%20STIs%20do%20not%20have,if%20you're%20sexually%20active.

[3] Stanford, A. (2023, September). Undetectable viral load and HIV transmission. Retrieved from https://www.aidsmap.com/about-hiv/undetectable-viral-load-and-hiv-transmission

[4] HRSA. (2024, July 31). Letter to Ryan White HIV/AIDS Program Colleagues. Retrieved from https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/hab-doxy-pep-clinical-guideline-bacterial-sti-prevention.pdf

[5] CDC. (2024, June 6). CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. Retrieved from https://www.cdc.gov/mmwr/volumes/73/rr/rr7302a1.htm

[6] AIDS Education and Training Center Program. https://aidsetc.org/topic/sexually-transmitted-infections

[7] TargeyHIV.org. (2024). Addressing STIs: Ask. Test. Treat. Repeat. https://targethiv.org/intervention/addressing-stis-ask-test-treat-repeat?utm_source=bpURL

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.  

Ending the HIV Epidemic Data Shows Hits, and Misses

By: Ranier Simons, ADAP Blog Guest Contributor

Numbers may be boring, but when it comes to matters of life and death, numbers are essential, and quality data is indispensable. The Centers for Disease Control and Prevention (CDC) last week released its most recent HIV Incidence and Prevalence report.[1,2] The report is based on data from 2018-2022, with the data gathering completed in December 2023. The U.S. is not currently on track to reach Ending the HIV Epidemic (EHE) 2025 and 2030 prevention goals.[3] While progress is being made, there remains much work that needs to be done.

Photo Source: HIV.gov

Overall, estimated new HIV infection rates declined 12% in 2022 in comparison to 2018 among people 13 years of age or older.[2] The overall rate of decline encompasses higher levels of decline of specific groups. Bear in mind that the 12% decrease is attributed to a decline among men. No statistically significant change was observed among females. It is important to note the data is based on the sex assigned at birth (SAAS).[2] Although there was an overall decrease in the rate of new HIV infections, it is important to note that in 2022, 81% of all new infections were among males.[2]

A notable decrease, giving optimism for future trends occurred among young people. The largest reduction in HIV infections in 2022 compared to 2028 was among men ages 13-24, at 30%. The decrease was predominately among gay and bisexual men. The CDC suggests the data shows efforts to reach that demographic are working regarding testing, treatment, and PrEP uptake.

Concerning race and ethnicity, the new report indicated an 18% decrease in the HIV infection rate among people identifying as Black/African American.[2] In 2022, 37% of all new infections were among Black/African American persons, and the highest rate of infection was observed among the same group. The 18% decrease is undoubtedly a positive progression. However, people identifying as Black/African American are only 12% of the general population. Thus, the high infection rate informs the existence of factors causing disparities that need to be examined and corrected. The highest rates of new infection in 2022 in the US (per 100,000 people) were Black/African Americans at 34.1, those identifying as multiracial at 21.6, and Hispanic/Latino persons at 20.7.[2]

Photo Source: CDC

Regionally, data indicates a welcome improved trend in the South. Even though 49% of new infections in 2022 were in the South, the region experienced a 16% decrease in new infection rate.[2] Regional rates were 14.5 South, 11.0 West, 8.9 Northeast, and 7.4 Midwest.[2] The South historically has a heavy burden of HIV in comparison to the rest of the country. Much of that has been driven by socioeconomic factors. The region has the highest poverty rate and lowest household median income.[2,5] The South is also characterized as having the highest knowledge gap of HIV status in the US. In 2022, the report indicates that 14 out of 100 people 13 years of age and older in the South were unaware of their HIV status.[2] Lack of knowledge of status could mean untimely receipt of medical care and treatment.

The category of transmission was another positive area showing a decrease. There was a 10% decrease in new infections attributed to male-to-male sexual contact (MMSC) and a 27% decrease when grouping together MMSC and injection drug use (IDU).[2] There were no changes detected regarding heterosexual contact and IDU, nor infections among females. In 2022, 67% of all new HIV infections were a result of MMSC. Among male new infections, 83% were attributed to MMSC. Thus, the 10% decrease is a step in the new direction.

These trends are just a few of the positive highlights revealed in the latest CDC HIV surveillance report. While positive, statistics show that the US is not on track with EHE goals and lags improvements made in other developed countries. Hopefully, this new data will continue to drive optimism as well as drive continued scientific, financial, legislative, and social bolstering of the multifaceted fight to eradicate HIV.

[1] CDC. (2024, May 21). Estimated HIV Incidence and Prevalence. Retrieved from https://www.cdc.gov/hiv-data/nhss/estimated-hiv-incidence-and-prevalence.html?CDC_AAref_Val=https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-3/index.html

[2] CDC. (2024, May 21). HIV Surveillance Supplemental Report: Estimated HIV Incidence and Prevalence in the United States, 2018–2022. Retrieved from https://stacks.cdc.gov/view/cdc/156513.

[3] CDC. (2024, March 30). Ending the HIV Epidemic in the US Goals. Retrieved from  https://www.cdc.gov/ehe/php/about/goals.html

[4] Carson-Holt, E. (2024, May 2024). HIV transmissions down by 12%. One age group in particular is bringing those numbers down. Retrieved from https://www.lgbtqnation.com/2024/05/hiv-transmissions-down-by-12-this-age-group-in-particular-is-bringing-those-numbers-down/

[5] AIDSVU. (2024). Deeper Look: HIV in the South. Retrieved from https://aidsvu.org/resources/deeper-look-south/#:~:text=The%20heavy%20burden%20of%20HIV,factors%20like%20poverty%20and%20unemployment.

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.  

Understanding Atlanta’s Persistently High Rate of HIV

By: Ranier Simons, ADAP Blog Guest Contributor

Since the 1950s, Atlanta is commonly known as “Hot Lanta” popularized by the Allman Brothers Band’s song because of its hot and humid climate.[1] But the weather isn't the only thing "hot" in Atlanta as the metro area surrounding the city has become a burning epicenter of new diagnosis for HIV.

Photo Source: ANIZ

Proper data collection and analysis take time. This is especially true regarding public health surveillance and research. It is better to have robust sourcing of quality data collection than analysis of rushed volumes of collected data.[2] The Centers for Disease Control & Prevention (CDC) recently released a national HIV data analysis of infection rates from 2021. Overall, the national rate of new HIV infections has been decreasing over the past few years. However, this is not entirely true for the South.[3] Reporting indicates problematic infection trends in several southern metropolitan areas, one such area being metro Atlanta. 

Data shows that in 2021, metro Atlanta had the third highest new HIV infection diagnosis rate of metropolitan areas, only bested by Miami, Florida, and Memphis, Tennessee.[3] This data gives added context to preliminary data observed presently in 2024. According to Dwayne Ford, director of HIV prevention services with AIDS Atlanta, there are more reported positive individuals living with HIV in the first quarter of 2024 than in the first quarter of 2023.[4]

Various treatment and prevention tools exist, so healthcare professionals and community groups are trying to identify where more work needs to be done to reverse Atlanta and Georgia’s new infection rates. While metro Atlanta is the third highest ranking in new infections for metropolitan areas, Georgia is fourth overall as a state. One challenging area of concern is funding. Georgia is one of the few states that have not expanded Medicaid. If Georgia fully expanded Medicaid as allowed under the Affordable Care Act, over half a million Georgia residents would become eligible for health insurance.[5] 

Photo Source: Atlanta Journal Constitution

This would enable over half of the Georgian residents who are uninsured and enrolled in the Ryan White program to be moved to Medicaid. They would still be able to get all the care they received under Ryan White in addition to other services not available through Ryan White. That, in turn, would free up approximately $53.7 million of Ryan White funding to help non-Medicaid eligible people living with HIV not presently accessing services.[4] Treatment is prevention since increasing the number of people on ART means increasing viral suppression, lowering the number of those able to transmit HIV. Moreover, expanding Medicaid would mean increasing access to PrEP since Ryan White Funding cannot be used for PrEP medications nor its associated medical visits and laboratory testing.[6] African American and Hispanic males comprised the majority of reported new HIV infections yet have much lower utilization of PrEP in comparison to white residents.[3]

Access is a significant issue for low-income residents and the African American and Hispanic populations, which are disproportionately represented in new infection numbers. However, stigma is also still an issue.[3] In African American and Hispanic communities, HIV stigma remains a barrier to care, testing, and support. Efforts to encourage and expand testing lose impact when those who discover their positive status do not seek treatment. It is vital to bolster efforts to get newly diagnosed individuals into treatment as soon as possible and to help them remain in treatment. Support is needed since fear and privacy concerns hinder vulnerable populations from wanting their medications discovered by friends and family. Additionally, fear of the stigma of being seen at public clinics or other healthcare facilities hinders proper follow-up care and testing.

Support and prevention are the two areas many concerned parties are focusing on. Expanding prevention efforts such as PrEP access, education, and culturally competent messaging are imperative. Improving upon existing measures to help those negatively affected by social determinants of health, such as lack of transportation and insurance, is also necessary. 

Photo Source: endhivatl.org

The Fulton County Department for HIV Elimination recently launched a new website, ENDHIVATL.ORG,  in response to the metropolitan Atlanta area epidemic. Citizens can use the site to find service providers based on the services they provide and their proximity to where they live. The site also provides up-to-date information concerning how and where to access PrEP and other medical and non-medical services. To help address stigma, the site has a prominently displayed section entitled ‘Positive & Proud.’ It contains personal stories of local community members living with HIV regarding their lives in general and their experiences with utilizing the Department for HIV Elimination services. There is even a section of the site dedicated to assisting healthcare providers.

Atlanta’s high rate of HIV infection has persisted for years. While rates have declined slightly, they are still disproportionately higher than the rest of the country. Hopefully, continued efforts to highlight the status quo, maintain awareness, and provide further support and prevention will soon result in improved lives and outcomes.

[1] Kane, Deborah (2024, April 10). What is the nickname of Atlanta Georgia? NCESC. Retrieved from https://www.ncesc.com/geographic-faq/what-is-the-nickname-of-atlanta-georgia/

[2] Chiolero, A., Tancredi, S., & Ioannidis, J. P. A. (2023). Slow data public health. European journal of epidemiology, 38(12), 1219–1225. https://doi.org/10.1007/s10654-023-01049-6

[3] Gaines, J. (2024, April 1). New HIV case rate in metro Atlanta third highest in nation. Retrieved from https://www.ajc.com/news/atlanta-news/new-hiv-case-rate-in-metro-atlanta-third-highest-in-nation/6TDMS6CUTZG7RPVPRLE6O3JZCY/

[4] 11Alive. (2024, April 4).HIV cases on the rise in metro Atlanta - What local clinic says about it. [Video]. YouTube. https://www.youtube.com/watch?v=h2jh2TgxfcQ&list=WL&index=1

[5] Equality Foundation of Georgia. (2022). Implications of Medicaid expansion on Georgia's HIV Budget. Retrieved from https://georgiaequality.org/wp-content/uploads/2022/01/REPORT-Medicaid-Expansion-and-Ryan-White.pdf?emci=61ee3ed9-f179-ec11-94f6-c896650d4442&emdi=ea000000-0000-0000-0000-000000000001&ceid=

[6] Department of Health and Human Services. (2021, November 16). HRSA Letter to Ryan White Program Colleagues. Retrieved from https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/hiv-care/prep-dcl-november-2021-508.pdf

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. 

CROI 2024 Highlights: Conference on Retroviruses and Opportunistic Infections

By: Ranier Simons, ADAP Blog Guest Contributor

The fight against HIV and other viruses like HCV and SARS-CoV-2 is a worldwide team effort. That is why the Conference on Retroviruses and Opportunistic Infections (CROI) convened from March 3rd through March 6th, 2024 in Denver, Colorado. Since 1993, CROI has brought together scientists, clinical scientists, and epidemiologists to present original groundbreaking research and collaborate to advance the treatment and prevention of HIV and other viral infections and opportunistic diseases.[8] CROI is one the first places research showing the effectiveness of triple-drug therapy for HIV was shared. It was also one of the first places where the results of the SMART study were shared, which proved that early treatment of HIV provides the best outcomes.[8] This year, 4,000 attendees gathered at CROI. Participants presented a multitude of novel and emerging therapies and studies. What follows are just a few notable highlights.

Photo Source: CROI

Long-Acting Injectables Blaze Forward

GSK’s long-acting injectable, cabotegravir, has already shifted the antiretroviral therapy (ART) paradigm. Coupled with rilpivirine, it is one-half of Cabenuva, the first complete ART injectable approved by the U.S. Food & Drug Administration (FDA). Cabenuva allows people who live with HIV (PLWH) to change from taking daily pills to the Cabenuva injection monthly or every two months. Studies have proven it is effective for those who have medication adherence challenges. It also presents an option for PLWH who wish to make medication management a less intrusive part of their lives.

ViiV Healthcare, the HIV-focused subsidiary of GSK, presented data from a clinical trial for a revolutionary new ultra-long-acting cabotegravir at CROI.[7] The new formulation has a higher concentration and double the half-life, potentially allowing it to be dosed every four months instead of every two.[7] Further clinical trials will be conducted to explore the use of the new formulation of cabotegravir as PrEP and as a treatment for PLWH. GSK’s goal is to have the first long-acting injectable for HIV prevention on the market by 2026 and for HIV treatment by 2027. The company also aims for an annual long-acting injectable by the first part of the 2030s.

DoxyPEP for STIs

DoxyPEP stands for doxycycline post-exposure prophylaxis. It is the practice of taking 200mg of oral doxycycline within 24 to 72 hours of condomless sex. Clinical trials have shown that DoxyPEP is effective in reducing the incidence of bacterial STIs such as syphilis and chlamydia. Results of Doxy PEP clinical studies of reducing STIs have been so promising that the CDC proposed guidelines for DoxyPEP usage in October 2022. However, those guidelines are not finalized.[1] 

Infectious disease professionals at CROI presented new data regarding DoxyPEP usage out in the real world among populations of people, mainly cisgender MSM and transgender women. Previous data was from clinical trials in contrast with new data that examined the results of DoxyPEP uptake in over 3,700 clients of sexual health clinics across San Francisco. Usage resulted in a 58% reduction in bacterial STI cases overall, a 67% reduction in chlamydia, and a 78% reduction in syphilis cases.[2] The real-world data indicated that when offered, there was a demand for DoxyPEP, and people consistently integrated it into their sexual health routine. As the Centers for Disease Control & Prevention (CDC) finalizes formal guidelines, DoxyPEP may potentially be solidified as another viable form of population wide STI prophylaxis.

Weekly Oral Antiretroviral Therapy

Long-acting injectable HIV therapy is not an optimal treatment modality for everyone. Nevertheless, other options for medication adherence that do not involve a daily regimen are needed for optimal health outcomes. At CROI, Gilead Sciences and Merck presented data from a clinical trial for a possible weekly oral antiretroviral therapy (ART) solution.

The solution is a weekly dosage of Gilead’s Sunlenca (lenacapavir), and an experimental drug named islatravir from Merck. [3,4] The phase 2 trial compared 104 patients taking daily Biktarvy (bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg tablets) with a group taking the weekly oral lenacapavir with islatravir. Data indicated that 94.2% of subjects taking the lenacapavir/islatravir combination maintained their viral suppression compared to 92.3% of the Biktarvy group.[3,4] The study will continue for another 48 weeks as open-label. This means that the study is no longer randomized. Both the medical professionals and the subjects know precisely what they are being given. There is no placebo. Studies move forward to open-label from randomized controlled studies once a high level of efficacy is proven and high benchmarks of defined endpoints are reached. 

Protecting Pregnant Women from HIV Infection

Research has shown there are physiological changes in the female body that cause a threefold increase in the risk of contracting HIV while pregnant.[5] This is especially troubling for countries where HIV is at an endemic level. Medications for HIV treatment and prevention are powerful, and it is crucial to find safe pharmaceuticals that will not harm the mother or the developing fetus.

At CROI, data from a multi-country (South Africa, Uganda, and Zimbabwe) clinical study presented safe options. A monthly flexible vaginal ring containing dapivirine as well as oral daily tenofovir disoproxil fumarate/emtricitabine PrEP (Truvada) were shown to be safe for use for pregnant women. The dapivirine vaginal ring is established in some African countries to be used as HIV prevention for cisgender women who are not pregnant. Truvada has already been proven to be safe for pregnant HIV-positive mothers to use.

The study was a randomized trial where pregnant women aged 18-40 used the dapivirine ring or received the oral PrEP up until delivery or for 41 weeks and six days, depending on which came first.[6] Only 1% experienced stillbirth or miscarriage, 95% of the women’s pregnancies went to term, and 4% of the births were premature.[6] Most importantly, none of the women contracted HIV. The results indicate that both the ring and Truvada are safe for pregnant mothers and their unborn fetuses to protect them from infection.

CROI continues to be a catalyst for pushing HIV and other infectious disease research forward. Scientific communities meet there, spurring the most qualified and passionate minds to collaborate and innovate. Whenever a cure for HIV is found, it would not be surprising if someone at a future session of CROI first presents it.

[1] DiMarco DE, Urban MA, Fine SM, et al. Doxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted Infections [Internet]. Baltimore (MD): Johns Hopkins University; 2023 Sep. Available from: https://www.ncbi.nlm.nih.gov/books/NBK597440/

[2] Carstens, A. (2024, March 6). DoxyPEP aces first real-world test. Retrieved from https://www.thebodypro.com/article/croi-2024-doxypep-real-world-clinical-data

[3] Clinical Trials Arena. (2024, March 7). Gilead-Merck’s combination therapy maintains HIV suppression in trial. Retrieved from https://www.clinicaltrialsarena.com/news/gilead-merck-hiv-trial/?cf-view

[4] Taylor, P. (2024, March 7). Gilead and MSD say weekly oral therapy controls HIV. Retrieved from https://pharmaphorum.com/news/gilead-and-msd-say-weekly-oral-therapy-controls-hiv

[5] Salzman, S. (2018, March 9).New study shows women's HIV risk triples during pregnancy, quadruples postpartum. Retrieved from https://www.thebodypro.com/article/new-study-shows-womens-hiv-risk-triples-during-pre

[6] HIV.gov. (2024, March 5). Vaginal ring and oral Pre-Exposure Prophylaxis found safe for HIV prevention throughout pregnancy. Retrieved from https://www.hiv.gov/blog/vaginal-ring-and-oral-pre-exposure-prophylaxis-found-safe-for-hiv-prevention-throughout-pregnancy

[7] Reuters. (2024, March 5). GSK's new HIV drug formula could support longer dosing intervals. Retrieved from https://www.reuters.com/business/healthcare-pharmaceuticals/gsks-new-hiv-drug-formula-could-support-longer-dosing-intervals-2024-03-04/

[8] CROI Foundation. (2024). General information about CROI. Retrieved from https://www.croiconference.org/about/

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.