Retrospective Analysis of HIV Pre-exposure Prophylaxis (PrEP) Awards Under Executive Order 14168 on Gender Ideology in the U.S. 2012-2025

BackgroundHIV PrEP-specific research is vital to advancing better health outcomes and reducing HIV transmissions in the United States. Executive Order (EO) 14168 targeting gender ideology will narrow the scope of research on gender and sex by research institutions. Implementation of EO 14168 is limiting communications and manuscript publications based on restricted terms, including "gender", "transgender", "LGBT" and more. MethodsAward titles and abstracts were sourced from the Tracking Accountability in Government Grants System (TAGGS) for "PrEP" or "pre-exposure prophylaxis" relevant to HIV from 2012 to 2025. These award titles and abstracts were coded based on inclusion of restricted terms from EO 14168. The characteristics and amounts for award disbursements were analyzed. Data was subset based on elected presidential budgetary periods for political analysis. ResultsOf 388 unique award titles, 118 (30.4%) would be considered excluded based on the restricted terms of EO 14168. Transgender and gender were most represented restricted terminology. Mental health research grants (n = 244; 39.8%) compromised the majority of excluded award disbursements. Both Democrat and Republican states saw reductions in total HIV PrEP-specific research funding. The amount of excluded award disbursements totaled nearly $160 million (USD) from restricted terms. DiscussionApplied retrospectively, EO 14168 and its implementation would have reduced the total funding to HIV PrEP-specific research by nearly $160 million (USD), impacting economic activity from the NIH by $400 million (USD) from 2012 to 2025. HighlightsO_LIEO 14168 on gender ideology greatly impacts HIV PrEP-specific research C_LIO_LI$160 million (USD) lost if EO 14168 was applied retrospectively C_LIO_LIGender and transgender most frequent restricted terms C_LIO_LIMental health research grants most likely to be negatively impacted C_LIO_LINearly $400 million (USD) of economic activity potentially lost since 2012 C_LI