Trump Started A Plan To Eradicate Hiv. He Never Finished It.

In 2019, midway through his marathon and frequently combative State of the Union address, President Donald Trump made a promise that garnered him a rare bipartisan standing ovation.

“Together,” he pledged from the podium, “we will defeat AIDS in America.”

The announcement of an ambitious plan to end the HIV epidemic by 2030 caught even his own top health officials by surprise. A few months earlier, the heads of several health agencies had shown Trump new data proving it was possible — for the first time since cases first exploded in the 1980s — to halt the spread of the virus. They had carefully tailored their pitch to appeal to a president staring down a reelection fight, still smarting from his failed crusade to repeal the Affordable Care Act, and hungry for a legacy win on health care. By 2030, they told him, the HIV epidemic in the U.S. could be a thing of the past.

“He looked at me, and he said, 'Can we really do that?'" recalled Brett Giroir, then the assistant secretary of health. "And I said, 'Yes, sir, we can do that. But more importantly, you can do that.”

Giroir and other officials left that Oval Office meeting optimistic. But they didn’t know they had Trump’s official backing until he announced their plan to Congress and a primetime national audience of tens of millions of people.

“Wow. How’d that happen?” former Health Secretary Alex Azar recalled thinking as he sat with the rest of Trump’s Cabinet in the House chamber. For a bureaucrat trying to get a new project off the ground, he added, a SOTU shoutout is “sort of the dream scenario.”

Seven years later, Trump once again stunned many of those former health lieutenants — this time by systematically undermining his first-term efforts to fight HIV.

Since returning to the White House in 2025, Trump has slashed HIV prevention grants, gutted government offices and terminated advisory committees working on HIV policy. He has left states without support as they battled outbreaks of the virus and, for the first time in decades, let World AIDS Day go unacknowledged. In the first two budgets of his second term, Trump proposed eliminating funding for several HIV programs. While some of these actions were reversed by Congress or federal court orders, they have collectively imperiled the effort Trump once championed and put the 2030 goal further out of reach.

The U.S. was supposed to reduce new HIV cases to 9,300 or fewer by 2025. Though data for that year is not yet available, the most recent federal count, from 2024, was more than quadruple that target: nearly 39,000 new cases.

“It is safe to say we are not on track,” said Harold Phillips, who served as the chief operating officer for the Ending the HIV Epidemic Initiative in Trump’s first term. But rather than the administration sounding the alarm, he added, “it’s been total silence.”

Nineteen interviews with current and former Trump administration officials, rank-and-file federal health workers and outside HIV advocates who work closely with the government revealed previously unreported details about how a Republican president came to champion an illness primarily plaguing LGBTQ+ people and communities of color — and how that commitment crumbled after he returned to the White House.

Most of those people argued that, while the president himself never changed his mind about the importance of addressing HIV, the effort to end the epidemic fell victim to a host of other fiscal and ideological forces. The Department of Government Efficiency (DOGE) campaign to shrink the federal workforce took a heavy toll on teams working on HIV. New bans on the promotion of diversity, equity and inclusion — and what the government considers “wokeness” and “gender ideology” — have made it harder to study or direct aid to the LGBTQ+ and racial minority populations most at risk of contracting the disease. And conservatives’ general hostility to the CDC in the wake of the Covid-19 pandemic made the public health agency a prime target for cuts and restrictions.

Dr. Jay Bhattacharya, the head of both the National Institutes of Health and, temporarily, the Centers for Disease Control and Prevention, was adamant in an interview that the original goal of effectively ending the HIV epidemic by 2030 remains within reach. Recent scientific breakthroughs like a biannual shot that can prevent transmission of the virus, he argued, will be “gamechangers.”

“Reducing the transmission of HIV to near zero is feasible,” he said. “I'm filled with hope about this.”

Few inside or outside of the government shared his optimism.

Dr. Jonathan Mermin, who spent decades at the CDC and led its National Center for HIV, Viral Hepatitis, STD, and TB Prevention under both the first and second Trump administrations, said medical innovations aren’t a silver bullet, and can’t end the epidemic unless the government pours funding into programs that get them into the hands of the people who need them.

“Public health dreams without resources are fantasies,” said Mermin, who quit after being placed on administrative leave for months in 2025 and now serves as dean of Columbia University’s School of Public Health. “And the rate that we are seeing up to this point [of reducing HIV infections] is much too slow to meet the goals of elimination of new infections by 2030.”

The first Trump administration zeroed in on HIV as a priority, in large part, because many of its top health officials had served in the trenches when AIDS first swept across the country in the 1980s, killing more than 120,000 people by 1990.

Robert Redfield, Trump’s then-CDC director, had worked on HIV and AIDS since his days as a U.S. Army physician at the beginning of the epidemic. Joe Grogan, his Domestic Policy Council director, served as executive director of the Presidential Advisory Council on HIV and AIDS during the George W. Bush administration, and went on to work at Gilead Sciences, a pioneer in developing the HIV prevention drug PrEP, before joining the Trump administration. And Anthony Fauci, who would become Trump’s chief medical advisor during the Covid-19 pandemic, had produced decades of groundbreaking HIV research and played a key role in creating PEPFAR, the international effort to tackle AIDS that saved tens of millions of lives.

These and other health officials were inspired in part by remarkable progress in the UK, which had set the same goal of halting HIV transmission by 2030. The year Trump launched his own version of the plan, the British government announced that it had brought new HIV infections down by nearly a third between 2015 and 2019, reaching the lowest levels the country had seen in decades.

In the U.S., meanwhile, years of progress in reducing HIV had stalled out, leaving the country battling tens of thousands of new diagnoses each year. But data had emerged proving that ending the HIV epidemic wasn’t just possible — it could be done soon. New forms of PrEP had proven wildly effective in halting transmission of the virus, and new technology enabled people unable or unwilling to visit a clinic to discreetly test themselves for the infection at home. Health officials identified 48 ZIP codes — plus Puerto Rico and Washington, D.C. — where HIV infections were the greatest, and put together a plan to flood them with resources to stop the spread.

Azar, Trump’s health secretary, greenlit that strategy as soon as Redfield, Giroir and the other officials brought it to him, and brainstormed with them on how to get Trump’s stamp of approval.

“Everybody on this was locked in, saying, ‘Wow, we could do something really historic here,’” Azar recalled. “We actually have the tools that, with some muscle and execution, we could actually take one of the major disease threats off the table. That’s quite an opportunity and a legacy item for the president.”

As they worked to get other White House officials on board before pitching Trump himself, they put together a presentation specifically designed to win over the mercurial president. One of the slides presented to the White House, obtained by POLITICO Magazine, featured a grinning portrait of Trump with a caption proclaiming him “the public health president” who could make health care affordable, solve the opioid epidemic and “end AIDS in America.”

When they presented the plan to Trump in the Oval Office, Giroir was blunt about the need to prioritize communities the disease had hit hardest, even if it wouldn’t be politically advantageous for the Republican Party.

"I was pretty explicit that this program is going to be focusing on where the disease is, and these are gay Black men in the South, and these are transgender women," he said. "These are 100 percent not likely your constituents, but that’s where the problem is."

Trump, Giroir said, appeared not only unbothered but “very excited.”

“It was not a political thing,” he recalled. “It was not an issue. It was really more like, ‘Can we really get this done?’ It was like a light went off.”

As Trump and his White House aides deliberated on the proposal, a former official granted anonymity to share details of private conversations said the president recalled how “devastating” the HIV epidemic had been for New York City as he was making his fortune there. Though Trump never directly mentioned his mentor Roy Cohn, who died of AIDS-related complications, it was obvious that the president had been deeply affected by the disease, the person said.

At the urging of Grogan, then the director of the Domestic Policy Council, Trump decided a few days before the 2019 State of the Union address to include the HIV proposal. He kept it in his prepared remarks even as aides made other cuts and edits until just minutes before he went live, including in the motorcade on the way to the Hill, the former Trump official said.

“We were blown away, we were not expecting it, especially since it never came up when he was running for president,” said a former senior health official who worked on HIV, granted anonymity to share details of private conversations. “We didn’t think it was going to be a priority.”

Trump’s public embrace of the plan had Redfield so optimistic that he envisioned not only ending the scourge of HIV, but applying a similar strategy to knock out one disease after another, saving taxpayers billions and preventing widespread human suffering.

“I thought HIV would be the first one, and then hopefully we would do the same with Hepatitis C, and then every three or four or five years we could pick another disease entity that we believe we could eliminate — and start eliminating it,” he said.

Over the next seven years, those high hopes crashed headlong into a rougher reality.

A few months after the federal government released the first several million dollars for the Ending the HIV Epidemic Initiative, a different virus upended everything.

During the first wave of the Covid-19 pandemic, thousands of sexual health clinics shut down in-person services. Federal outreach to counties with high transmission rates, a key part of the plan to halt the spread of the virus, ground to a halt. And disease investigation specialists at local public health departments who usually work on HIV and STDs were redeployed to trace the spread of Covid.

By 2021, the toll was clear. Despite hundreds of millions spent on efforts to combat HIV, 1.2 million people in the U.S. were infected with the virus, an estimated one in eight were not aware of their status and just 58 percent were taking adequate medication to suppress their viral load and prevent transmission.

“I got totally consumed, and my immediate people got totally consumed, and the Public Health Service, which is always involved, got consumed,” said Giroir. “You’ve got to run to the fire, and that was the fire … It didn’t stop the program, but it put a big dent in the program.”

Covid also had a longer lasting impact on HIV: It turned many conservatives against the CDC in particular and public health efforts more broadly.

Republicans hammered the institution throughout the pandemic and on the 2024 campaign trail, and by the time Trump was reelected, Fauci had become a favorite GOP boogeyman. At the same time, Robert F. Kennedy Jr.’s Make America Healthy Again movement was expanding the party’s tent by railing against the health care establishment. Kennedy — who himself had long bashed the CDC as a “cesspool of corruption,” wrote a book excoriating Fauci, and claimed federal scientists are “killing children and they don’t care” — was placed in charge of the health department in 2025. Public health advocates were especially alarmed by the appointment because Kennedy, in his book about Fauci, questioned the scientific consensus that HIV causes AIDS.

“In the first Trump administration, there were individuals [in leadership] who understood public health. There were medical experts and scientific experts at the helm, helping the president make informed, scientific, evidence-based, data-driven decisions,” said Phillips, who helped lead the Ending the HIV Epidemic Initiative during Trump’s first term. “Now, those individuals are gone.”

After conservatives took control of Congress and the executive branch in 2025, the GOP set its sights on the federal bureaucracy, which it viewed as an insidious “deep state.” Trump’s own first-term HIV progress was one of many casualties.

House Republicans’ initial 2025 budget proposed eliminating all federal HIV prevention programs, including Trump’s Ending the HIV Epidemic Initiative. Though the version ultimately signed into law reversed many of those cuts, GOP leaders proposed many of them again in 2026, making advocates fear a post-Covid erosion of the once bipartisan commitment to combatting the disease.

“In conversations that we had with appropriators last year about proposed cuts to funding, oftentimes it wasn’t even about HIV in their minds or the specific programs that they were cutting. It was really just about, ‘CDC needs to be reined in,’” said Jeremiah Johnson, the executive director of the group PrEP4All, which lobbies for policies to make medicine more accessible to people at risk of contracting HIV. “The public backlash that occurred toward the CDC following Covid has hit HIV prevention activities, which have been particularly vulnerable to partisan rhetoric and attacks that are most of the time unfounded. It’s disheartening and alarming.”

Johnson and other activists are now bracing for another round of fiscal fights. The White House’s budget proposal for 2027 would slash HIV prevention funding from just over $1 billion down to around $220 million. And though a recent national survey of medical providers found that homelessness and housing instability are the top reasons HIV patients say they can’t keep up with their treatment, Trump’s budget eliminated the Housing Opportunities for Persons with AIDS program, which currently supports 100,000 households.

White House spokesman Kush Desai defended the defunding of what he called a “waste-ridden public health apparatus that has failed to deliver results” and said the administration is “retooling our health agencies to more efficiently fund promising research and effective clinical interventions.” He added that the administration “remains committed to combatting America’s HIV epidemic.”

Redfield blames some of the backlash from his party on what he considered “very aggressive government overreach” during the pandemic, including vaccine mandates and school closures. But he lamented that health efforts completely unrelated to Covid — such as tackling HIV — became collateral damage.

“You can’t have public health without public trust, and right now there’s a huge lack of public trust, including for CDC,” he said. “That’s really taken a toll.”

From the very inception of the Ending the HIV Epidemic Initiative, those involved said, Trump’s interest in tackling the scourge of HIV ran up against his administration’s other priorities. His failed first-term crusade to repeal the Affordable Care Act and subsequent efforts to chip away at it, for example, made it harder for some people with HIV to afford treatment. Trump also pursued changes to the Title X family planning program in his first term that drastically reduced access to STI and HIV testing and treatment services around the country.

This push-and-pull dynamic went into hyperdrive in his second administration.

On one hand, Trump’s 2025 and 2026 budget proposals called for maintaining funding for the Ending the HIV Epidemic Initiative, and last fall he renewed the charter for the Presidential Advisory Council on HIV/AIDS (PACHA). Bhattacharya has also said that combatting HIV is one of his top priorities. A scientist at the CDC’s Division of HIV Prevention, who like several other rank-and-file health officials was granted anonymity because of a fear of retaliation, said the agency leader appears to be genuinely dedicated to the issue.

“He’s reached out to us as an agency more in one week than [former acting CDC director] Jim O’Neill did the whole time he was there,” the person said shortly after Bhattacharya assumed the role in February.

On the other hand, Trump tried to cut the CDC’s budget in two and lay off tens of thousands of federal health workers — which wiped out teams working on HIV. While most of those orders were rescinded months later by a federal court, staffers in the HIV Prevention Communication Branch remain on administrative leave, receiving pay yet barred from working. Two CDC workers said that has compromised the agency’s ability to coordinate with states, update federal websites, develop training for public health workers and effectively message to the general public about how to stay safe. And, according to the American Federation of Government Employees, HIV workers who returned in the fall were tasked with dismantling their own departments and told not to start any new projects.

“It was shocking to see this coming from the same president that previously tried to build it up and actually finish the job,” said Demetre Daskalakis, a senior CDC official who joined the agency at the tail end of Trump’s first administration and resigned in protest in late summer 2025. “And we know that when you defund HIV, you're going to see more disease. You're going to see people being admitted with late stage HIV-related complications.”

The president also allowed the National HIV/AIDS Strategy to lapse and attempted to strip millions in HIV funding from state and local health departments in four Democratic strongholds — California, Colorado, Illinois and Minnesota — arguing their programs were “inconsistent with agency priorities” and rife with fraud. Trump’s executive order barring federal dollars from going to South Africa, meanwhile, derailed key HIV research there that U.S. scientists were depending on. And while the PACHA still exists on paper, the government has not called the advisory body together in more than a year.

“From what we can see, HIV does not appear to be uniquely singled out so much as affected by broader shifts in priorities and funding across both health and foreign assistance programs,” said Dr. Jerome Adams, Trump’s first-term surgeon general.

Other administration moves superficially unrelated to HIV have also taken a toll, particularly a trio of executive orders signed in 2025. One banned federal programs that promote diversity, equity and inclusion (DEI). Another outlawed funding for “gender ideology,” including outreach and support for transgender individuals. And a third, focused on homelessness, pledged to end funding for “so-called ‘harm reduction’ or ‘safe consumption’ efforts” like needle exchange services, arguing they “only facilitate illegal drug use and its attendant harm.”

“To me, a DEI program is something that doesn't work,” Bhattacharya said in an interview. “It's more ideological. It's more aimed at feeling good, rather than actually accomplishing a real health aim.”

He added that the federal government should only fund studies and health care programs that are “taking into account biological realities.”

“The idea isn't that we don't do research on how to help every American to be healthier, trans or not trans,” he said.

The fallout, however, has been swift. The Trump administration pulled offline a swath of resources about HIV, including guidance for outreach and treatment in gay, trans and racial minority populations. A federal judge ordered health agencies to restore the purged information after doctors who rely on it sued, but when they did, they added a note at the top of each page asserting that the contents were “extremely inaccurate and disconnected from truth.” At a time of decreased trust in the medical establishment, experts feared this note would further sow confusion and deter people from best practices.

“We were freaking out after the inauguration, because almost immediately, these executive orders started coming down that — even if they didn’t say HIV in their title or in the body of the language — it was very clear that they were going to have profound implications for our ability to do the work that we were doing in those populations,” said Jeanne Marrazzo, the former director of the National Institute of Allergy and Infectious Diseases (NIAID), who was fired in 2025.

“You can’t talk about health disparities without talking about things like race and, in some cases, sexual orientation,” she said. “It’s back to this culture of blaming the victim that is just so reminiscent of the early days of HIV.”

After the Supreme Court blessed the Trump administration’s war on DEI last summer, plans for a cutting-edge lab at a historically Black medical school in Tennessee to study the prevalence of HIV in minority populations were put on ice. Cuts also delayed construction on a new lab in one of the poorest neighborhoods in Washington, D.C. — which once had one of the country’s highest rates of HIV infection — for nearly a year. Whitman-Walker, the health care organization constructing the lab, received a letter from the Trump administration saying the work no longer aligned with “agency priorities” because it focused primarily on LGBTQ+ people of color. Some of the cut funds were restored this spring after impacted groups sued.

Foreign funding cuts and new restrictions on international collaboration, however, have largely remained in place. An NIH official mentioned one study cancelled in the wake of the executive orders that focused on men who have sex with men suffering from antimicrobial resistant gonorrhea in Vietnam.

“They said we had to stop it because of ‘gender ideology.’ It was so frustrating,” the official said. “These are biological men having sex with biological men. There’s no D, there’s no E, there’s no I, there’s no T. You just don’t like the fact that men are having sex with men.”

Policy aside, HIV experts warn the administration’s rhetoric about transgender people, immigrants and other at-risk groups is already deterring people from seeking services, allowing more infections to spread unchecked.

“It’s detrimental to the overall goal,” said Mike Weir, the director of policy and legislative affairs for the National Alliance of State and Territorial AIDS Directors (NASTAD). “An undocumented immigrant, or even someone who is documented, with all the hostility we’re seeing, may not be comfortable going in and accessing testing or accessing treatments. And when we look at our demographic data for HIV, and we look at which populations are seeing increases, we see that Hispanic, Latino, gay men are the community seeing increases.”

Additionally, while health officials in Trump’s first administration argued that services like needle exchanges help get people struggling with addiction into treatment and reduce the spread of HIV, leaders in his second administration stripped information about safer consumption of drugs from federal websites, and funding for state and local efforts around the country is up in the air.

Even some staunch conservatives are worried, including Redfield, whose son almost died from a drug overdose and is now in recovery.

“There’s no doubt that if we want to get control of the AIDS epidemic in America and bring new infections down, we have really got to make sure we have effective programs for the transgender community, and we have got to have effective programs for the drug use disorder community,” he said.

Many fear that looming changes to Medicaid, as well as Congress’ decision to allow Obamacare subsidies for tens of millions of people to expire, will leave more Americans, including thousands of people with HIV, uninsured. More than a dozen states, already feeling the squeeze, have cut services for tens of thousands of people living with the virus, citing the rising costs of HIV medications and flat federal funding for safety-net programs like Ryan White, which provides free medication to low-income people with HIV and AIDS. Several more states are considering similar cuts.

Still, Bhattacharya remains “really hopeful” that the development of the long-acting, injectable preventive drug Lenacapavir will turn the tide and put the country back on track to end HIV by 2030.

“When these new technologies came out, my hope just soared,” he said. “It's completely game changing.”

Yet there are no new programs to get the drug, which can cost more than $25,000 a year for people without insurance, to those who need it most. And while many people may prefer it to taking a daily pill, getting the shot requires access to a clinic that many currently lack.

Many of the former Trump administration officials, rank-and-file government scientists and the leaders of national advocacy groups who spoke to POLITICO shared Bhattacharya’s optimism about the medication, but disagreed with his assertion that it will carry the country across the finish line by Trump’s original 2030 deadline.

Eliminating transmission of the virus, they said, also requires the reversal of several current policies and funding cuts, and a renewed focus on the issue from the highest levels of government.

“I’d love to sit down with him now and say, ‘Hey, Mr. President, remember that initiative you started?” Redfield said. “Let’s finish it.”

Sophie Gardner contributed reporting.