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By Tim Fitzsimons
The Trump administration unveiled Monday its budget proposal for 2020, which contains a request for $ 291 million to fund the president's plan to "end the HIV epidemic."
The new funds are meant to make the budget an "ambitious but necessary effort" and would go largely to the Centers for Disease Control and Prevention, the HIV / AIDS program Ryan White and the Indian Health Service.
"For the first time in modern history, the United States has the capacity to end the epidemic through the availability of biomedical interventions such as antiretroviral therapy and pre-exposure prophylaxis." (PrEP), "says the budget.
The budget indicates that the funding requested is the "first step" towards the end of the HIV epidemic in America.
The president's plan marks the first time the federal government has called for funding biomedical interventions as a prevention strategy. After decades of promoting condoms, which according to the CDC's own data have halted about 80% of HIV infections, the government supports PrEP, which is more effective at more than 92%.
Since the drug Truvada was approved as PrEP in 2012, HIV diagnoses have been abandoned in cities where access to this drug is widespread, such as New York, San Francisco and Washington, D.C.
Of the total $ 291 million requested from the Department of Health and Social Services, $ 120 million is dedicated to "Additional Care and Treatment for People Living with HIV through the HIV / AIDS Program Ryan White As well as PrEP outreach activities with community health patients receiving funds from Ryan White. Indian health services to receive $ 25 million, National Institutes of Health's AIDS research centers, which study best practices for HIV programs, receive $ 6 million, says AIDS Institute .
Nearly half of the budgeted amount, $ 140 million, is earmarked for CDC "to reduce new HIV infections by working closely with state and local health departments for intensive testing and patient transfer." to care ". These measures would be concentrated in areas with high HIV rates. transmission that the president's plan targets for intensive prevention efforts.
The $ 140 million allocated to the CDC represents an 18% increase over what it received last year, according to Jen Kates, Vice President of Global Health and HIV Policy at the Kaiser Family Foundation . "It's a pretty big jump," she added.
"In the context of HIV-specific programs, these are important resources, as long as they are approved by Congress," Kates added. "This is a start, and this level of money is important for these programs and could catalyze some changes if it is deployed in a way that respects public health principles and reaches the communities that need them the most."
"The administration's AIDS and health policies are at war with each other internally. What one hand gives, the other takes away.
Peter Staley
The request for $ 291 million does not include an additional $ 58 million allocated to the CDC "to deal with the consequences of the opioid epidemic on infectious diseases", which has resulted in increased rates of HIV and hepatitis C in some parts of the country.
A number of HIV / AIDS activists have welcomed the increase in national funding, but others have lamented the reduction in funding allocated to the fight against the global HIV pandemic, as well as the proposed cuts in Medicare and Medicaid.
"Although Trump's budget includes several budget cuts that we can not afford, we can all support HIV-AIDS," said Carl Schmid, deputy executive director of the AIDS Institute. Schmid called on Congress to appropriate the funding requested for HIV / AIDS despite other cuts: "This opportunity is too important to be ruined".
Peter Staley, a long-time advocate for HIV / AIDS and a founding member of the Treatment Action Group, said, "According to the program they described, targeting only 48 countries and states, the level of funding seems just.
But Staley predicted that the cuts proposed in the government's health care programs would run counter to the program to fight the HIV epidemic.
"Without the expansion of Medicaid, they will never achieve the goals at 5 and 10 years," he explained. "The administration's AIDS and health policies are at war with each other internally. What one hand gives, the other takes away.
Kates of the Kaiser Family Foundation has endorsed Staley's concerns. She said cuts proposed in the president's emergency plan for the fight against AIDS and the Global Fund, which fund treatment and prevention in poor countries, could undermine the most well-intentioned efforts in the world. national level to end the HIV / AIDS epidemic.
"With infectious diseases, the reduction in resources has led to an increase in infectious diseases," she said. "The virus does not work in the way of seeing these borders or borders."
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