In recent years, Wisconsin has been able to contain its HIV epidemic to about 300 new diagnoses a year.
But Brandon Hill, the president and CEO of Vivent Health, worries that those numbers could climb after the federal government drastically cut funding for prevention and treatment of HIV.
“Ultimately, people will not be able to get the level of care or HIV prevention services that they’re currently receiving — the one that’s currently keeping us at less than 300 new diagnoses in Wisconsin,” Hill told WPR’s “Wisconsin Today.”
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There are roughly 8,000 Wisconsinites living with HIV. One recent medical breakthrough that has helped keep new infections down is the development and distribution of preexposure prophylaxis, or PrEP. The U.S. Food and Drug Administration approved the drug in 2012. Hill said that he’s seen an increase in the use of PrEP, which he believes has kept the virus from becoming more prevalent.
“PrEP for HIV prevention is over 90 percent effective when the treatment regimen is followed,” Hill said.
Early this year, the U.S. Department of Health and Human Services considered dismantling the Centers for Disease Control and Prevention’s Division of HIV Prevention. Although the division remains, the federal government has drastically cut funding for HIV research and prevention programming.
Hill was recently elected president of the International Academy of Sex Research, which was founded in the 1970s.
One benefit of leading the global organization is to be able see what HIV-prevention strategies are working around the world and apply them to Wisconsin and the U.S. “There’s a lot particularly related to HIV that we’ve learned in the global context,” Hill said. “It’s great to have that knowledge exchange and see how we help end the HIV epidemic here in the U.S.”
Hill discussed how Vivent Health is navigating funding changes and how it is working to mitigate patient barriers to HIV prevention in Wisconsin.
The following interview was edited for clarity and brevity.
Kate Archer Kent: There are studies that say some population groups with higher rates of HIV, including sex workers, transgender individuals and prisoners, may face significant stigma and discrimination. Do you see a stigma affecting who has access to PrEP and HIV care?
Brandon Hill: Historically, there have been differentials by race, sexual orientation and economic status on who has awareness of new health technologies, and that was no different for PrEP.
We have seen it’s been slower to be adopted among trans, gay or bisexual men of color. … we do see new infections, and not decreasing (rates of new) HIV cases among that population. We need, I think, almost a million people who would be indicated for PrEP to take up PrEP in order for us to successfully reduce all new cases or new diagnoses in the U.S. So there’s a huge gap here, and the folks you mentioned are exactly the population that are in that gap.
KAK: In late May, the Trump administration cut a key research program that was developing a promising new HIV vaccine after decades of work. How are you affected by these moves?
BH: The federal government was sending no new award letters and no reimbursement from February to about June for the grants that were held. There was no guidance associated with the halting of reimbursing or renewing grants. That alone has had an impact on what services were available during that time period.
At Vivent Health, we were able to continue providing services. We treated our prevention services as key to the work that we do. It’s not just about treatment and care. Preventing HIV is also our responsibility in our communities, and we were able to keep the work moving forward, though not at maximum. I know other organizations were not, and it’s yet to be seen what impacts that could have.
Another indirect consequence is that it was very disruptive to the workforce of folks who do prevention. People were having to decide whether this was the space that they could continue to work in, with so much uncertainty on whether or not they would have funding for their role.
KAK: Did you have to make cuts?
BH: Fortunately, we did not have to make cuts. We have been really cautious since November on projecting how we would operate and and maintain everything, and we had some contingency plans and suspended some non-personnel related funding to make sure that we could bridge that gap. But I know that that’s not the case for every organization.
KAK: That was at the beginning of the year. What is the current situation with federal funds, and what are you projecting?
BH: We’re really in an unknown space. If you look the “Big, Beautiful Bill,” a lot of what has people concerned is to be enacted in 2027. So between now and 2027, the “how” will be figured out.
Now we have to understand how we will deliver the objectives of the grants that we currently have within the confines of the restrictions in the bill or the budget cuts that have been proposed. How do we deliver the objectives set for $750 million in HIV prevention funds with only $75 million? Huge, huge shifts will have to be made.
KAK: Where will they go?
BH: That’s the question. It’s unilaterally impacting every organization that provides HIV care, as well as Medicaid. About 40 percent of people living with HIV rely on Medicaid for their coverage. There’s nowhere to send people, and that’s what will create the dire strait.
KAK: So in terms of Vivent Health’s budget, how will you make ends meet?
BH: One of the unique things about Vivent Health’s model is we rely on multiple revenue streams. We rely on grant funding, public funding and medical reimbursement from both Medicaid and commercial insurance. Philanthropy and other funding is also so important to us because it moves the programs for the patients and clients. It goes directly to those individuals.
I do think that we’re well positioned to be stable. We can navigate the changes in reimbursement because we actually do generate revenue through the services we offer: the medical services, the pharmacy services, behavioral health and dental. So that helps us offset the things we’re not funded for, or where we lose funding.
I feel for our sister and brother organizations that aren’t able to provide a service that they’re reimbursed for. If you only have philanthropy or grant funding, those organizations are more likely to feel these shifts. We will undoubtedly feel them, but they might hit (other organizations) more directly.
