Why HIV program funds can’t be reshuffled to combat the opioid crisis

Robbing Peter to pay Peter? Presumably, but not yet.

President Donald Trump and first lady Melania Trump, left, speaks on the opioid crisis in the East Room of the White House in Washington, Thursday, Oct. 26, 2017. (AP Photo/Pablo Martinez Monsivais)
President Donald Trump and first lady Melania Trump, left, speaks on the opioid crisis in the East Room of the White House in Washington, Thursday, Oct. 26, 2017. (AP Photo/Pablo Martinez Monsivais)

President Donald Trump declared the opioid crisis a public health emergency Thursday, fulfilling a months-long promise to address an epidemic that’s killed tens of thousands. The declaration itself was well received as a symbolic move, but the lack of new funding and plan specificity was not.

“The money will be the biggest issue,” Dr. Rebecca Haffajee, assistant professor of health management and policy at the University of Michigan School of Public Health, told ThinkProgress. The declaration unlocks just $57,000 in funding, so “Congress will need to appropriate more quickly,” she said.

The funding that caught the eye of many was the reshuffling of money designated for HIV/AIDS programs to the opioid crisis:

White House officials told reporters prior to the announcement that the administration “would shift resources within existing programs aimed at delivering HIV/AIDS care to better serve those with both HIV/AIDS and substance use disorder.” Thing is, those funds have already been divvied out this year.


“That money is already gone,” Carl Schmid, deputy executive director at the AIDS Institute, told ThinkProgress. “I do not understand the logistics of this … and also if people in a city, state, or community program want to allocate money to substance use, they already can.”

Under a public health emergency, the acting Health and Human Services (HHS) Secretary Eric Hargan could waive certain requirements for the Ryan White HIV/AIDS program. Essentially, he can shift up to five percent of funds under two grants afforded in this program to the emergency declaration at hand: the opioid crisis. The secretary will presumably do this.

The decision shouldn’t affect grants afforded to localities already. If the secretary decides to extend the public health emergency, which only lasts 90 days, the move could theoretically affect next year’s grants. The two grants  — which amounted to $21 million in fiscal 2017 — is a modest amount.

Additionally, if communities wanted to use funds for substance use, they can do that as the program affords them that flexibility, said Schmid. Those on the ground are best equipped to make that decision. “I don’t know that there’s a significant impact, but it’s definitely not the answer,” he said.

The nation’s leading HIV/STD advocacy organizations said in a joint statement that Trump’s declaration — however well-intentioned — does not meet the needs of today’s crisis, and that relying on funding that is already repurposed is not the solution:

The opioid crisis is making the fight against HIV more challenging for public health responders on the ground. “Bringing down the rate of HIV infection is one of the United States’ great public health triumphs of the past quarter-century,” wrote Keith Humphreys, who served as senior policy adviser at the White House drug policy office from 2009 to 2010. “Now, thanks to the opioid epidemic, some of those hard-won gains may be reversed.”


Last year, the Centers for Disease Control and Prevention identified 220 specific counties at high risk of a spike in HIV infections tied to injection drug use. These areas saw high rates of poverty and unemployment, thus limiting their ability to access resources like syringe exchange programs and opioid treatment, said Humphreys.

In 2015, Scott County, Indiana saw an HIV outbreak; nearly 200 opioid users in rural Austin became infected with HIV by shooting up prescription pills with contaminated needles. A group of researchers concluded and published its findings in the New England Journal of Medicine that more investment is needed, not less:

“Although the proactive deployment of interventions for HIV prevention among persons who inject drugs is challenging in rural areas that have a low incidence of HIV but are at risk for an outbreak, the implementation of HIV testing and treatment, syringe-service programs, and medication-assisted treatment are necessary to help prevent a similar outbreak in the future.”

“We shouldn’t screw programs that are doing well at the expense of funding something else,” said Lucy Bradley-Springer, an associate professor at the University of Colorado Denver’s Division of Infectious Diseases and former member of the Presidential Advisory Council on HIV/AIDS. 

“You’d have to [have] been in a coma to not understand that drug use is related to HIV,” Springer told ThinkProgress. As such, HIV/AIDS programs need to continue to be prioritized. The federal government is continuing to spend an ample amount of money on HIV/AIDS, despite this administration’s effort to cut funding. Springer, along with a group of colleagues, resigned because the current administration was not prioritizing this issue, she said.

When asked what kind of investment is needed in HIV and substance use disorder programs, Springer said there should be more investment into syringe exchanges nationwide. There are only 221 syringe exchange programs nationwide; an Indiana county recently ended their program due to lack of funding. Currently, federal funds can only support certain components of the program; funds cannot go to sterile needles or syringes. Removing those funding barriers is a good place to start, she said.


As for funding to combat the opioid crisis more broadly, Senate Democrats did announce Wednesday a bill that would add $45 billion in new federal funds. There are no Republican co-sponsors and the Trump administration hasn’t endorsed it.

This post has been updated to revise an earlier error. We erroneously stated that the Ryan White grants had $2 billion; it had $21 million.