From Readiness to Reality: Protecting EHE in a Time of Crisis

Contact: De’Ashia Lee, director@anea.org

June 17, 2025- On May 22, 2025, the ACT NOW: END AIDS Coalition (ANEA) hosted a congressional briefing focused on the urgency of sustaining and accelerating the federal Ending the HIV Epidemic (EHE) initiative. The briefing brought together community leaders, public health experts, and Congressional staff to discuss the progress, barriers, and opportunities within EHE jurisdictions across the U.S.

As part of this effort, we are proud to unveil our EHE Readiness Assessment Report, a landmark resource that provides jurisdiction-level data to evaluate how prepared communities are to implement EHE strategies equitably and effectively. This assessment reflects the voices and experiences of people living with HIV, advocates, and service providers, and is designed to inform decision-making at every level.

But this important work is happening against a backdrop of deeply concerning policy shifts.

The Trump administration’s FY2026 budget proposal, which recently passed the House, includes devastating cuts to HIV prevention and care. The House budget proposes slashing over $400 million in federal HIV funding, including $214 million from the CDC’s HIV prevention programs and $190 million from the Ryan White HIV/AIDS Program. These cuts threaten to roll back decades of progress, gut community programs, and leave thousands without access to care, treatment, and prevention tools that are proven to work.

Make no mistake: these cuts are not just dangerous; they are fiscally irresponsible and ethically reprehensible. According to a 2021 study, the average lifetime cost of treating one person with HIV in the U.S. is approximately $420,285 (Bingham et al., 2021). Meanwhile, Kaiser Family Foundation reports that Medicaid alone accounted for nearly half (45%) of all federal HIV spending in FY2022, a reminder of how critical public programs are to sustaining care (Dawson, Chidambaram, & Mathers, 2025). For every person we prevent from acquiring HIV, we save hundreds of thousands of dollars in future healthcare costs. By cutting HIV prevention programs now, we are not saving money nor achieving “efficiency”. On the contrary, such divestments will instead guarantee exponentially higher costs later, both in terms of lives unnecessarily affected by HIV and associated health outcomes, and in terms of dollars.

The EHE Readiness Assessment offers a clear message: communities are working hard to meet the goals of the Ending the HIV Epidemic initiative, but they cannot do it alone, and certainly not under the weight of disinvestment.

Among our key findings:

• 70.8% of respondents reported they have a system in place for regularly conducting community needs assessments to identify HIV testing priorities.

• Respondents overwhelmingly reported the use of traditional avenues for community engagement, including participating in HIV planning councils and town halls (91%), attending health department and community-based organization meetings (91%), and engaging in special service days to promote testing and awareness (74%). Additional strategies included mobile outreach at community events (83%), using peer navigators and community health workers (70%), and deploying social media and marketing materials (83%) to expand reach.

• Awareness of how EHE funds are allocated to reach high-impact communities was mixed: one-third of respondents reported being extremely aware, while 29% were moderately aware, 24% slightly aware, and 14% not at all aware. Notably, white respondents were more likely to report being extremely aware of the allocation process, while BIPOC respondents more often reported being only slightly or not at all aware — highlighting a transparency and equity gap in funding communications.

• On the issue of PrEP (Pre-Exposure Prophylaxis) preparedness, responses were split, suggesting that community-based organizations are not uniformly prepared to provide PrEP across priority populations. BIPOC respondents were more likely to agree their communities were ready and supported, while white respondents expressed more uncertainty — a trend that may reflect differing levels of perceived vulnerability and prioritization by providers.

  
  

These insights confirm that jurisdictions are making efforts to meet the goals of the EHE strategy and adapt to evolving science. But they also underscore persistent gaps that must be addressed through increased coordination and investment.

Jurisdictions need support, coordination, resources, and political will to build systems of care that are rooted in equity, justice, and led by those most impacted. Those who are closest to the problem are closest to the solutions; and they require the resources with which to achieve those solutions.

Now is the time for action. We call on our partners, our policymakers, and our communities to use this data as a catalyst for continued, robust advocacy. To push back against harmful cuts. To fight for health justice. And to remind this nation that ending the HIV epidemic is still possible, but only if we choose to invest in it.

About ANEA: We are a national coalition of community-based organizations, health departments, national partners, and activists committed to ending the HIV epidemic in the United States.

1. Bingham, A., Shrestha, R. K., Khurana, N., Jacobson, E. U., & Farnham, P. G. (2021). Estimated Lifetime HIV-Related Medical Costs in the United States. Sexually transmitted diseases, 48(4), 299–304. https://doi.org/10.1097/OLQ.0000000000001366

2. Dawson, L., Chidambaram, P., & Mathers, J. (2025, April 1). 5 key facts about Medicaid coverage for people with HIV. KFF. https://www.kff.org/hivaids/issue-brief/5-key-facts-about-medicaid-coverage-for-people-with-hiv/