Analysis | Federal budget constraints may hurt older Americans with HIV (2024)

Federal HIV spending isn’t keeping pace with longer patient life spans

Researchers say that by the end of the decade, 70 percent of people in the United States living with HIV will be older than 50. Thanks to advances in medicine, the diagnosis is no longer a death sentence.

“I’ve been fortunate to take care of some people with HIV for over 30 years,” said Melanie Thompson, a physician in Atlanta who said she is frequently told by patients, “You’re my longest relationship.”

But there’s a catch: People living with HIV are at increased risk for other health problems, such as diabetes, depression and heart disease.

As their health needs increase, more is required of the Ryan White HIV/AIDS Program, the comprehensive federal system that provides HIV primary medical care, medications and essential support services for low-income people living with the virus.

But core funding for the national network of clinics hasn’t changed much in the past decade.

According to a KFF analysis, inflation-adjusted spending has dropped from a peak in the early 2000s, despite the program serving tens of thousands of new patients.

Laura Cheever, who oversees the Ryan White program, said budget constraints make it hard to prioritize the needs of older people with HIV, especially when many people with the virus haven’t been diagnosed or aren’t receiving services at all.

“When a lot of people aren't getting care, how do you decide where that next dollar is spent?” Cheever said.

President Biden’s budget request for fiscal 2025 asks for a funding bump of less than 1 percent for the program.

But that program, launched by the Trump administration in 2019, was targeted by House Republicans last year in their push to slash the budget of the Centers for Disease Control and Prevention.

Their argument? The initiative, launched just a year before the global coronavirus pandemic drew resources and attention from other public health priorities, wasn’t meeting its goal to cut new HIV infections dramatically by 2030.

Around the same time, Republicans were threatening a different HIV program from a different GOP administration: the President’s Emergency Plan for AIDS Relief, or PEPFAR, launched by George W. Bush.

Advocates worry these cases signal a larger erosion in bipartisan support for HIV prevention and treatment that threatens to undermine years of progress lowering transmission and mortality rates — especially if older people with the virus don’t get adequate care.

“It’s tragic and shameful that elderly people with HIV have to go through what they’re going through without getting the proper attention that they deserve,” said Jules Levin, executive director of the National AIDS Treatment Advocacy Project, who, at age 74, has been living with HIV since the 1980s.

“This will be a disaster soon without a solution.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.

Trump keeps baselessly claiming that Biden will be on drugs at the debate

New this a.m.: Trump is spreading baseless claims that Biden was “higher than a kite” during his State of Union address this year, seeking to undercut a potentially energetic performance from his opponent at tomorrow’s night’s first general election debate, The Post’s Hannah Knowles reports.

Trump senior adviser Danielle Alvarez said in a statement yesterday that Biden “will be highly prepared and alert on debate night” because of a “perfectly calibrated dosage.” Campaign staff, Republican lawmakers and online influencers have all amplified the idea that the 81-year-old will need an injection to debate, with one Trump adviser even sharing a video of a syringe.

Yes, but: There is no evidence that Biden has used or plans to use performance-enhancing drugs for public remarks. Trump lodged similar evidence-free allegations in 2016 against Hillary Clinton and in 2020 against Biden.

Democrats suggest that the presumptive Republican nominee is trying to preempt a disconnect between the Biden who shows up onstage and the “brain-dead zombie” that his campaign has portrayed at every turn. Still, the claims have gotten extensive news coverage in the lead-up to the CNN debate. Rep. Ronny Jackson (R-Tex.), who served as White House physician under Trump, made headlines with a formal letter to Biden demanding a drug test.

Biden says he has long abstained from drugs and alcohol, attributing the decision to not drink to growing up in a family that had its share of problems with alcohol abuse.

CDC issues dengue alert in U.S.

The CDC is alerting U.S. clinicians, health authorities and the public about a rising risk of dengue virus infections amid a record global incidence of the mosquito-borne viral disease, our colleague Lena H. Sun reports.

By the numbers: In the first half of 2024, countries in the Americas have reported more than 9.7 million dengue cases, double the total for all of 2023, according to a CDC advisory. Infectious-disease experts say cases will probably continue to increase with summer travel and rising global temperatures.

Why it matters: Epidemics in the Americas raise the number of travel-associated cases as well as local transmission in the continental United States. Since January, 745 dengue cases have been identified among American travelers infected abroad. Last year, there were 1,829 travel-associated cases in the United States.

Meanwhile …

The CDC is convening a panel of independent advisers for a three-day meeting starting this morning, where they will discuss and make recommendations on a slew of new and existing vaccines.

Today’s agenda: Shots from Pfizer, GSK and Moderna to protect adults against the respiratory syncytial virus. The advisory committee will also tackle vaccines for chikungunya and dengue.

Lena sends us this note:

The Food and Drug Administration has begun testing more dairy products for evidence of the H5N1 virus, as part of its ongoing investigation of the bird flu outbreak in U.S. dairy herds.

More than 120 dairy herds in 12 states have tested positive for bird flu since March, according to the Agriculture Department.

The FDA is now sampling 155 products, including aged raw milk cheese, cream cheese, butter and ice cream, to ensure pasteurization inactivates the virus, Donald A. Prater, acting director of the FDA’s Center for Food Safety and Applied Nutrition, said at a news briefing yesterday.

The sampling is expected to take several weeks, he said. Earlier FDA testing of dairy samples showed that pasteurization kills the virus, affirming assessments that the nation’s milk supply is safe.

Health-care spending has increased steadily since 1972

Technological advances over the past five decades slashed food expenses but had the opposite effect on health-care costs, per a Post analysis of Consumer Expenditure Survey data.

“We’re healthier than we were decades ago,” said Larry Levitt, executive vice president of health policy at KFF. “But the increases in health spending have been wildly out of whack with improvements to health.”

Levitt noted that other wealthy nations, where governments intervene to control health-care costs, have achieved similar or better health outcomes at a fraction of the price. U.S. health spending per capita is nearly double the average of comparable countries.

Partly driving these soaring costs is industry consolidation, leading to a market dominated by large providers, reduced competition and steeper prices. Researchers estimate that hospital mergers alone led to a billion-dollar increase in private health-care spending from 2010 to 2015.

Want to see how your spending habits differ from previous generations? Find out here.