Colorado public health officials started the year with a plan to bring down new HIV infections across the state. Less than three months in, possible cuts to federal funding could halt that progress and leave the state worse off than before.
The Colorado Department of Public Health and Environment projected that new HIV diagnoses will total 482 in 2024 — virtually unchanged from 479 in 2023.
Population growth is one factor that has kept that number from falling, but the state wants to “give a little push” by doubling down on prevention, said Leslie Frank, who analyzes data for the division focused on HIV, viral hepatitis and other sexually transmitted infections.
The health department’s strategy includes encouraging doctors to offer HIV testing to all patients, since not everyone wants to disclose their drug use or sexual practices, and to increase funding for groups that perform testing at Pride events and bars, said Megan Canon, syndemic program manager at the agency.
The state also is putting additional funds toward helping people find and pay for medication that can prevent HIV infection, she said. The total budget for HIV prevention has remained about the same year-over-year, though, at $7.1 million.
“Every new HIV case that we identify is a concern, because HIV is preventable,” she said.
But The Wall Street Journal reported Tuesday that the Trump administration is considering deep cuts to the Centers for Disease Control and Prevention’s HIV prevention program, which distributes most of its $1.3 billion budget to state and local health departments, and to other organizations working to prevent infections with HIV, viral hepatitis, other sexually transmitted infections and tuberculosis.
Administration officials said they could cut the prevention budget roughly in half and might move the division’s work to another office under the U.S. Department of Health and Human Services.
The Colorado state health department received about $3.5 million in federal grants for HIV prevention this year and requested $4.5 million for the fiscal year starting in June. Local health departments and nonprofits also can receive CDC funding directly.
Cutting that division’s work would be “devastating,” and the Ryan White program, which funds HIV treatment for low-income people, couldn’t replace it, said Rachel Klein, deputy executive director of the AIDS Institute. Despite popular misconceptions, that funding can’t go toward prevention, she said.
The CDC funding helps pay for testing, contact-tracing and helping guide people to preventive medication, said Matthew Fischer, director of prevention programs at Colorado Health Network.
Last year, the network’s clinics tested about 3,000 people for HIV, provided clean syringes to 5,000 and helped 500 find preexposure prophylaxis medication. PrEP can reduce the odds that someone at high risk will contract HIV by more than 90%.
Human immunodeficiency virus spreads via semen, vaginal secretions, blood or breastmilk. Without treatment, it can progress to acquired immune deficiency syndrome, or AIDS, when the immune system can no longer keep up and people can die of infections they otherwise would have survived.
In the 1980s, HIV was essentially a death sentence, but antiviral drugs now allow people to have near-normal lifespans. The drugs also suppress the virus to the point that an infected person’s partners are no longer in danger.
Colorado is on its way to meeting the goal of “ending the epidemic” the first Trump administration set, which it defined as reducing new infections by 90% by 2030, Fischer said.
But taking away prevention resources would wipe out that progress and lead to more infections, he said.
“Every time you have one (infection), it can spiderweb out if the person doesn’t know,” he said.
The state health department is monitoring developments at the federal level, Canon said. Colorado faces a $1.2 billion budget hole this year, which would make it difficult for the state to replace any lost federal funding.
Clinics that work with underserved populations, such as those at risk of HIV, already try to capture private funding and any state money they qualify for, Fischer said. They don’t have significant untapped sources of funds that could replace the CDC money, he said.
Most people don’t see the work of testing and treating people for HIV, which prevents them from passing it to their future partners, Fischer said. But if that work doesn’t happen, it raises the odds that people will unknowingly transmit the virus, increasing risks for everyone, he said.
“We may have done ourselves a disservice by not being louder about the good work public health is doing,” he said.
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