How a DOGE review can actually improve the programs that fight HIV/AIDS
President Donald Trump and Elon Musk's Department of Government Efficiency have been aggressively overhauling the bloated and cumbersome U.S. federal bureaucracy by re-examining contracts, questioning what taxpayer dollars are funding and who that funding is going to.
The public health sector hasn't been immune, with the Trump administration poring over the layers of bureaucracy and freezing or canceling millions in grants. Countless programs within the Department of Health and Human Services (HHS), including those designed to target the treatment and spread of HIV/AIDS, are, or will be, in the crosshairs.
As a former White House director of national AIDS policy who was one of the chief architects of the President's Emergency Plan for AIDS Relief (PEPFAR), the first director of the HIV/AIDS Bureau at the Health Resources and Services Administration (HRSA), and as an LGBT conservative with a career in medicine, business, and public health, I believe HIV/AIDS advocates should embrace and support such a review.
While it is critical that the United States' demonstrably effective long-standing strategy tackling the HIV/AIDS epidemic, and the resources dedicated to it, remain intact, many of these federal programs have not been re-evaluated in years, nor have they been audited for waste, fraud or abuse.
Advocates in support of maintaining the United States' aggressive approach to the HIV/AIDS epidemic should welcome the review of HIV/AIDS specific initiatives to ensure that they are optimally designed to meet the needs of the current epidemic.
Take the Ryan White CARE Act, for example, which funds essential healthcare services for uninsured and underinsured individuals living with HIV/AIDS in the U.S. The program, which received $2.5 billion in federal funding in FY 2024, hasn't been reauthorized by Congress since 2009. In that time, the expansion of healthcare coverage through Medicaid substantially reduced the number of people who needed Ryan White support for medical care and pharmaceuticals, yet its budget continued to grow.
A reauthorization process would allow for a close look at spending priorities embedded in Ryan White - an initiative that was designed before highly effective HIV/AIDS therapy was even available. Surely, the HIV/AIDS community would do well to see if that funding might be better reallocated elsewhere, such as toward substance abuse and mental health services, or other needed care.
DOGE can also remedy unnecessary bureaucratic overlap. The Ryan White program is run through the HRSA, and the Ending the HIV Epidemic initiative, started by Trump during his first term, is run through the Centers for Disease Control and Prevention (CDC). Despite the programs' complementary missions, they are siloed off into separate entities with their own budgets and staff, resulting in unnecessary administrative overhead costs and potentially wasteful spending.
The Trump administration is reportedly looking to streamline these two initiatives into one program run through the HRSA to consolidate the resources and make them more efficient. Advocates for a strong public health response to HIV/AIDS should be open to considering these kinds of commonsense reforms and not wringing their hands or fearmongering to voters.
While efficiency is needed, it would be a grave mistake to deprioritize funding for the HIV/AIDS epidemic as national policy. While new cases of the disease are on the decline in the U.S. due to advances in treatment and prevention efforts, data has shown that cutting those efforts leads to spikes in new infections, which in turn burden the healthcare system with costlier care and treatments down the line.
Another critical pillar of the U.S. approach to the epidemic is PEPFAR, which funds HIV/AIDS prevention, treatment, and care globally. PEPFAR's value is not only as a cost-effective success in saving millions of lives but also as a means of exerting significant diplomatic influence with dozens of partner nations.
Secretary of State Marco Rubio granted PEPFAR a waiver from the initial suspension of global health initiatives in the first days of the Trump administration. That does not mean that PEPFAR should be immune from an audit for inefficiency.
Like all federal programs, there must be improvements that can be made and waste that can be cut. PEPFAR's strategy and tactics, however, are undeniably working with an incredible return on investment. Keeping the program efficiently funded should be a bipartisan priority.
It's easy to panic over reports of specific cuts or reorganizations to HIV/AIDS programs. Opponents of the Trump administration have every reason to fearmonger around the issue, as federal funding for prevention efforts is generally popular.
But, if we genuinely care about the fight against HIV/AIDS, we must recognize that these programs, like the federal government itself, are not perfect. These HIV/AIDS programs are long overdue for auditing, evaluation and perhaps reorganization, and as long as our commitment to fighting the disease remains intact, the United States' efforts will be stronger for it.
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Yahoo
12 minutes ago
- Yahoo
Trump aides want Texas to redraw its congressional maps to boost the GOP. What would that mean?
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The Hill
15 minutes ago
- The Hill
ICE raids accelerate, protests spread
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Yahoo
16 minutes ago
- Yahoo
Musk regrets some of his Trump criticisms, says they 'went too far'
Musk regrets some of his Trump criticisms, says they 'went too far' Elon Musk, the world's richest person and Donald Trump's former advisor, says he regretted some of his recent criticisms of the US president (Kevin Dietsch) (Kevin Dietsch/GETTY IMAGESvia AFP) Elon Musk, the world's richest person and Donald Trump's former advisor, said Wednesday he regretted some of his recent criticisms of the US president, after the pair's public falling-out last week. "I regret some of my posts about President @realDonaldTrump last week. They went too far," Musk wrote on his social media platform X, in a message that was received favorably by the White House. Musk's expression of regret came just days after Trump threatened the tech billionaire with "serious consequences" if he sought to punish Republicans who vote for a controversial spending bill. Their blistering break-up -- largely carried out on social media before a riveted public since Thursday last week -- was ignited by Musk's harsh criticism of Trump's so-called "big, beautiful" spending bill, which is currently before Congress. ADVERTISEMENT Some lawmakers who were against the bill had called on Musk -- one of the Republican Party's biggest financial backers in last year's presidential election -- to fund primary challenges against Republicans who voted for the legislation. "He'll have to pay very serious consequences if he does that," Trump, who also branded Musk "disrespectful," told NBC News on Saturday, without specifying what those consequences would be. Trump also said he had "no" desire to repair his relationship with the South African-born Tesla and SpaceX chief, and that he has "no intention of speaking to him." But after Musk's expression of regret, White House Press Secretary Karoline Leavitt told reporters that Trump was "appreciative," adding that "no efforts" had been made on a threat by Trump to end some of Musk's government contracts. "The president acknowledged the statement that Elon put out this morning, and he is appreciative of it," Leavitt said. ADVERTISEMENT According to the New York Times, Musk's message followed a phone call to Trump late on Monday night. Vice President JD Vance and Chief of Staff Susan Wiles had also been working with Musk on how to broker a truce with Trump, the report said. - 'Wish him well' - In his post on Wednesday, Musk did not specify which of his criticisms of Trump had gone "too far." The former allies had seemed to have cut ties amicably about two weeks ago, with Trump giving Musk a glowing send-off as he left his cost-cutting role at the so-called Department of Government Efficiency (DOGE). But their relationship cracked within days, with Musk describing the spending bill as an "abomination" that, if passed by Congress, could define Trump's second term in office. Trump hit back at Musk's comments in an Oval Office diatribe and from there the row detonated, leaving Washington stunned. ADVERTISEMENT Trump later said on his Truth Social platform that cutting billions of dollars in subsidies and contracts to Musk's companies would be the "easiest way" to save the US government money. US media have put the value of the contracts at $18 billion. With real political and economic risks to their falling out, both already appeared to inch back from the brink on Friday, with Trump telling reporters "I just wish him well," and Musk responding on X: "Likewise." Trump had spoken to NBC on Saturday after Musk deleted one of the explosive allegations he had made during their fallout, linking the president with disgraced financier Jeffrey Epstein, who was accused of sex trafficking. bur-arp/aha
