Retrospective analysis of HIV pre-exposure prophylaxis (PrEP) awards under Executive Order 14168 on gender ideology in the U.S. 2012-2025

Objectives: To assess the potential impact of Executive Order (EO) 14168, which restricts the use of terms such as "gender," "transgender," and "LGBT," on HIV PrEP-specific research funding, communications, and publications in the United States. Study design: A retrospective analysis of federal grant awards related to HIV pre-exposure prophylaxis (PrEP) was conducted using public data sources. Methods: Award titles and abstracts were obtained from the Tracking Accountability in Government Grants System (TAGGS) for grants containing the terms "PrEP" or "pre-exposure prophylaxis" between 2012 and 2025. Grants were coded for the presence of EO-14168-restricted terminology. Award disbursement characteristics and funding amounts were analyzed, with data subset by presidential budgetary periods for political comparison. Results: Among 388 unique grants, 118 (30.4%) contained terminology that would be excluded under EO-14168. The most frequently represented restricted terms were "transgender" and "gender." Mental health research accounted for the largest share of excluded awards. Both Democratic and Republican states experienced reductions in HIV PrEP-specific funding under these exclusions. The total disbursements affected by restricted terminology amounted to nearly $160 million (USD). Conclusions: If applied retrospectively, EO-14168 would have reduced HIV PrEP-specific research funding by nearly $160 million (USD) from 2012 to 2025, with downstream effects of approximately $400 million (USD) in lost economic activity from the NIH. These restrictions could substantially limit HIV prevention research, particularly in populations disproportionately impacted by HIV.