The President’s Fiscal Year 2027 Budget

The President’s Fiscal Year 2027 Budget

The Trump Administration released the President’s Fiscal Year 2027 budget, which sets its funding priorities for the coming year. While the proposed budget maintains funding for HIV care and treatment, it does so without additional investment in these proven interventions. 

At the same time, it proposes over $1.5 billion in cuts to prevention, housing, and related public health programs, including core components of the Ryan White HIV/AIDS Program and HIV PrEP. That split—between maintaining flat funding for care and reducing prevention funding—matters because the systems that support prevention and early engagement also sustain treatment and improve outcomes over time.

Proposed reductions to programs supporting HIV testing, treatment, and ongoing care include:

• The elimination of the Housing Opportunities for Persons with AIDS (HOPWA) program ($529 million) would remove a primary source of housing stability that supports retention in care.
• The discontinuation of the Minority AIDS Initiative ($56 million) would cut off targeted support for populations disproportionately affected by HIV.
• Complete sunsetting of Part F of the Ryan White HIV/AIDS Program ($74 million), including the AIDS Education and Training Centers, Special Projects of National Significance, and dental services, would reduce workforce capacity and limit dental services and the implementation of new care models.
• A $755.6 million reduction to the CDC’s Ending the HIV Epidemic (EHE) initiative would affect testing, outreach, and local response capacity in high-incidence areas.

In turn, the AIDS Drug Assistance Program (ADAP)—already under enormous pressure from rising enrollment, drug and insurance costs—has not kept pace with those demands, and is again flat-funded ($900.3 million). This puts eligibility and open access to HIV medications and coverage support at even greater risk.

Budget cuts extend beyond HIV, calling for an end to viral hepatitis prevention at the CDC and replacing it with a program that combines STD and tuberculosis prevention. A $100 million Substance Abuse and Mental Health Services Administration (SAMHSA) hepatitis C initiative that provides linkage to (curative) treatment, too, would no longer be funded. The budget further phases out opioid-related infectious disease programs. 

Altogether, these are not peripheral programs to the HIV, viral Hepatitis, STD, and public health response. These testing and outreach dollars work to support early diagnosis and linkage to care, including rapid starts and same-day test-and-treat approaches, where HIV PrEP prevents new infections. And with long-acting injectable PrEP now available, its viability and impact depend on delivery systems that factor in coordinated logistics, adequate staffing, clinic capacity, and follow-up. But progress remains slow and uneven, with roughly 31,800 new infections (CDC 2022), and reflects gaps in access and delivery that these cuts will likely further widen.

Proposed cuts to the National Institutes of Health (NIH), including the National Institute of Allergy and Infectious Diseases (NIAID), would slow research that informs prevention and treatment strategies. Also impacted by cuts are the Agency for Healthcare Research and Quality (AHRQ), which studies and improves on ways care is delivered; and the Administration for Strategic Preparedness and Response (ASPR), which leads the nation’s preparedness and response coordination for health emergencies, like mpox (formerly known as monkeypox).

The Administration’s own Ending the HIV Epidemic (EHE) initiative relies on these same systems. Achieving the EHE goal by 2030 depends on the care, prevention and treatment infrastructure that this budget reduces or removes.

The Administration further proposes consolidating HIV programs into a new “Administration for a Healthy America.” 

When federal funding is reduced, states don’t often make up the difference—they instead cut back their spending. We’re already seeing that with ADAP eligibility and access in states like Florida, along with reductions in Medicaid coverage, narrower formularies, and more utilization management—directly and negatively affecting both People Living with HIV and the health systems that support them throughout the country.

In short, the proposal reduces prevention funding from over $1 billion to approximately $220 million. At that level, jurisdictions will face reduced capacity to track local transmission, sustain testing efforts, and maintain consistent linkage to HIV care or HIV PrEP.