On April 16th, a draft of one of President Trump’s internal budget documents was leaked online. The proposed budget included a nearly $1 billion cut to HIV prevention, care, and treatment, and a major change to the structure of the Department of Health and Human Services, which oversees and funds those efforts.

Our Lives sat down with Bill Keeton, Chief Advocacy Officer at Vivent Health in Milwaukee to understand what this could mean for Wisconsin residents living with, or at higher risk for contracting HIV. Vivent Health is the nation’s second-largest HIV provider, and is based in Milwaukee, WI.

What cuts have been proposed, and why are they significant?

What we’ve got is a leaked draft of proposal documents between the White House and the Department of Health and Human Services, which is the federal public health apparatus for our country. HHS houses a number of different programs and grant opportunities that support access to preventative care and treatment services for folks who are vulnerable to contracting HIV. They also provide services to ensure that folks living with HIV have access to medical care, dental care, behavioral health and wellness care, social services like food pantries and housing programs, case management, and access to their medications, regardless of insurance.

So, when we talk about a reorganization of HHS, that is coupled with reductions in spending for programs at the CDC, which includes a proposal to eliminate the CDC division of HIV prevention. Those dollars continue to fund the services on the ground that people are relying on like traditional HIV prevention, access to condoms, education on HIV risk, and testing.

Testing is probably one of the most important things that the CDC funds for a number of reasons: getting an HIV test still comes with a tremendous amount of stigma for folks, but we’ve done a good job of using CDC funded resources and programs to provide free, anonymous, confidential HIV testing to people throughout the state. Testing means we can get people care and services to stay healthy, but it also means we can track the public health risk.

So what would these budget cuts mean for on-the-ground efforts?

Right now, there are no other big national organizations or agencies that can make up a $1 billion funding cut. There isn’t another pot of money to tap into if the federal funding stream is cut or reduced.

The big concern is that when you start looking at HIV and consolidating those programs with other public health programs, does that mean that money that has historically gone to just HIV is now subsidizing other programs? Are we taking money away from those programs that really need it? Are we going to have the same level of commitment to HIV that we’ve had historically?

We need to know that those dollars are still there to deliver the care and treatment.
We also need to know that the people who are responsible for processing the grant application and cutting the checks still have jobs.

And this conversation is all happening at a time when we can reasonably talk about ending HIV as an epidemic because we are getting to the point where new transmission is rare, and where people with HIV can live long and healthy lives. So, the question remains: why would we talk about eliminating resources at a time when we can reasonably talk about achieving one of the greatest victories in public health?

How would these cuts directly affect Wisconsin residents?

We at Vivent have direct contracts with the Ryan White Program from HHS in DC. The Ryan White program provides money to state programs like the Wisconsin Department of Health Services, which does really important surveillance work in the state. They look at new transmission levels, which populations are most vulnerable, and what the disease really looks like on the ground.

The Ryan White Program also gives grants to organizations including Vivent Health, some large hospital systems, UW Health, Froedtert, state public health departments, and other community-based organizations that do HIV care and treatment work. Those dollars are spread across the state to develop a robust network so that regardless of where somebody lives in the state, chances are there’s an aid service organization or clinician not too far away.

The state of Wisconsin also gets money to ensure access to medications through something called the AIDS Drug Assistance Program. That program is designed to make sure that low-income individuals have access to medications, because we know those medications are expensive.

Cutting money in the Ryan White Program is not just cutting federal bureaucrats. It’s cutting the ability for the federal government to invest in organizations like ours directly and their state public health department partners who using that money to deliver real services that will impact the lives of people living with, and at risk for HIV.

What advocacy work is currently happening to help prevent these cuts from happening?

There are a number of organizations working to prevent cuts like these, especially at the federal level. One such organization is AIDS United. I’m a member of their Board of Directors, and the Co-Chair of their Public Policy Committee. There’s also the AIDS Budget and Appropriations Coalition and the Federal AIDS Policy Partnership.

At Vivent Health, we’ve been doing our best to educate other aid service organizations about the threat that these cuts provide, and then also provide avenues for those organizations to reach out to their members of Congress. We are really encouraging folks to educate their patients and the folks who they serve so they can directly reach out to their members of Congress as well.

For those people who want to get involved, Vivent Health has what we call our Action Network, which we use to mobilize advocates and grassroots folks across the state to reach out to their elected officials. We provide them with an online form where folks can fill out their name and address, and it’ll automatically figure out who their member of Congress is. From there, they can send a message to their member of Congress letting them know how dangerous these cuts would be for the health of the communities that make up their districts.

We also participate in something called AIDS Watch, which flies folks out to DC once a year so they can get on the hill and meet with their members of Congress in-person. That just happened at the end of March this year.

What is the most important thing for folks to know right now?

Right now, these cuts have been proposed, but haven’t actually happened yet. For folks who are in care, receiving PREP, or living with HIV, I would tell them to keep going to the clinic or provider they have been going to.

One of our mottos is that we are “fighting like hell to make sure these changes don’t come to fruition.” There’s an army of folks out there that are working on your behalf. And if you’re interested in joining the fight or getting engaged, what we need right now are voices. We need Congress to understand that these cuts are not acceptable to them, and that it’s not going to work in their communities.

It’s important to remember that an ounce of prevention is worth a pound of cure. If we can’t afford $1 billion in HIV prevention, care, and treatment, it will be even harder to afford Billions of dollars in the coming years for new healthcare costs associated with new HIV diagnoses, continuing HIV transmission, and the inordinate amount of costs that will inevitably be borne out by taxpayers and healthcare consumers.