Shifting Funding Priorities Could Mean More HIV Infections and Deaths | ID Week 2024

Allison Agwu, M.D., MSc.

More data and research are needed about the impact of policies that shift funding for HIV prevention away from populations most at risk for infection, Allison Agwu, M.D., MSc, said during a presentation on Hot Topics in HIV at ID Week 2024, which is being held this week in Los Angeles.

Agwu, who is professor, pediatric and adult infectious diseases at Johns Hopkins University in Baltimore, presented an analysis done by Ethan Borre, M.D., Ph.D., at the Massachusetts General Hospital, that showed Tennessee’s plan to shift funding for HIV prevention could lead to poorer outcomes, more deaths and increased costs.

In January 2023, Tennessee rejected $6.2 million in funding from the Centers for Disease Control and Prevention (CDC) for HIV prevention. CDC provides funding for HIV testing kits, condoms and pre-exposure prophylaxis (PrEP) with a priority focused on men who have sex with men, transgender women, people who inject drugs and heterosexual black women. Instead, the state would reallocate separate funding for HIV testing for first responders, pregnant women and survivors of sex trafficking.

The analysis done by Massachusetts General Hospital used a model called the Cost-Effectiveness of Preventing AIDS Complications (CEPAC), which is a computer-based simulation model to predict outcomes for disease. Researchers teamed up with Tennessee-based community organizations Nashville CARES and Friends For All Memphis, as well as investigators from Vanderbilt University, Yale University, and the national HIV Medicine Association.

Borre and his colleagues found that reallocating HIV prevention funding away from CDC-prioritized populations toward would result in additional HIV transmissions and deaths, including 166 additional HIV transmissions, 190 additional deaths, and 843 life-years lost over 10 years. It will also lead to $4.1 million in costs, or a 1,300% increase in costs per death prevented among people with HIV.

The research was published in June 2024 in Clinical Infectious Diseases.

“CDC HIV prevention funding has prevented countless HIV cases and deaths in Tennessee, and throughout the United States, especially amongst those at highest risk for HIV, including men who have sex with men, transgender women and heterosexual Black women. Rejecting this funding puts lives at risk,” Borre said in a news release.

The populations prioritized by Tennessee are small, just 1% of the state’s population at risk for infection, Agwu said during the ID Week session. She pointed out that during the period 2018 to 2023, HIV rates in Tennessee increased 40% among 15 to 19 year olds, which is an at-risk population.

An epidemiology study released in May 2024 by the Tennessee Department of Health found that non-Hispanic Black people had the highest burden of HIV across all gender, age group, and transmission risk categories. And 14% of new diagnoses occurred among people who inject drugs. Among cisgender females newly diagnosed with HIV in 2022, heterosexual sexual contact was the most commonly reported transmission risk.

Researchers Massachusetts General Hospital said their projection was a conservative estimate. A more pessimistic estimate is an additional 1,359 HIV transmissions, 712 additional deaths, and 2,778 life-years lost over 10 years.

They said reallocating funds away for the CDC’s priorities would worsen health disparities for sexual/gender minoritized populations and people of color. Black men who have sex with men at the highest risk for HIV infection in Tennessee.

Agwu urged attendees to advocate for HIV funding focused on priority populations. “We are facing continuous attacks on HIV funding, and the progress that we're making with all the things we’re talking about here could potentially be a risk,” she said.