We have the tools to end the HIV epidemic in our lifetime. But 40 years of progress is at risk due to proposed cuts to federal funding for HIV prevention, housing, care and research. Dr. Esly Caldwell, a Caracole Board of Directors Member, has been treating individuals with HIV since the earliest days. In this powerful open letter, Dr. Caldwell reminds us how far we’ve come—and what we must do to continue the progress we’ve made.
An Open Letter on the Power of Prevention
We are living in a moment once thought impossible. About 40 years ago, the world faced an epidemic of a new virus that horribly killed nearly all who got it, worldwide—men, women, infants…HIV.
Today HIV is no longer a death sentence. With one daily pill or a long-acting shot, people can live full, healthy lives. With treatment, people living with HIV can become virally suppressed—meaning they cannot transmit the virus.
- We can test in minutes—at clinics, in communities, even at home.
- We can prevent HIV with a daily pill or a long-acting shot.
- We can educate before exposure, engage before crisis, and build trust before stigma takes hold.
- We can stop transmission—when prevention is prioritized, funded, and delivered with care. We are not hoping for a solution. We have one.
As a physician, then and now, I have witnessed this progress from the frontlines. I know what it took to get here—and what we stand to lose. In the 1980s and ’90s, we faced an epidemic without tools, without urgency and without the will to act. Today, we have all three.
And yet, right now, the US Department of Health and Human Services is making deep, harmful cuts to HIV prevention, care, housing and research.
These cuts would gut programs that work—and reverse four decades of medical, scientific and community progress. Every new HIV infection adds over $500,000 in lifetime costs. Defunding prevention isn’t just reckless and cruel. It’s expensive. And it’s wrong.
I serve on the Board of Caracole, a Cincinnati nonprofit that serves our community with proven, people-centered care: targeted outreach, education, testing and support. This work and work from other organizations like this across the country is what stops HIV in its tracks. But it can’t continue without public investment.
You have power. Use it. Call your US Senators and Representatives. Say this loud and clear: “Fully fund HIV prevention and care. Don’t take us backward.” Share the message: #SaveHIVFunding. Learn more: caracole.org/saveHIVfunding
Let’s not pause before the finish line. Let’s cross it—together.
Esly Caldwell, MD, MPH, FRCP(C), FAAFP, FACP
Esly Caldwell, MD, MPH, FRCP(C ), FAAFP, FACP, has had an extensive medical and leadership career, including serving as Medical Director of the Cincinnati Health Department, President of the Academy of Medicine and head of the Sickle Cell Department at UC Hospital. He continues to practice family medicine part-time, with a focus on providing care to patients with chemical addiction. Esly also volunteers with his wife on medical missions in Ecuador. He’s a Civil War history buff and has been both a licensed pilot and a spinning instructor.