HIV Funding Cuts Threaten Access to Care, Advocates Warn

Thousands of low-income Americans living with HIV are facing potential disruptions in their access to vital medications as states grapple with budgetary constraints and a lack of increased federal funding. The situation prompted a recent advocacy effort on Capitol Hill, drawing attention from celebrities and health experts alike.

‘Real Housewives’ Advocate for HIV Prevention

Stars from the Real Housewives franchise – including Nene Leakes (Atlanta), Candiace Dillard Bassett (Maryland), and Luann de Lesseps (New York) – visited Washington, D.C., on Wednesday to advocate for HIV prevention and expanded access to care. Their involvement was organized by MISTR, a major online provider of PrEP (pre-exposure prophylaxis), a daily pill to prevent HIV infection.

Several of the Housewives shared personal connections to the HIV epidemic, noting its disproportionate impact on Black women. Dillard Bassett, a former White House staffer during the Obama administration, emphasized that addressing the epidemic is not solely a financial issue. “The science to end HIV already exists,” she stated.

Bipartisan Concern, but Funding Remains Stagnant

Senator Tammy Baldwin (D-WI), the first openly gay senator, delivered opening remarks at the event, stressing that HIV prevention and treatment should transcend partisan politics. “Saving people from HIV is an American thing,” she said.

But, both Democratic and Republican-led states are reducing services for people with HIV. According to a recent report from the KFF, a health policy research nonprofit, eighteen states plus Washington, D.C., have already cut funding for AIDS Drug Assistance Programs (ADAPs), with two-thirds considering further reductions. Five additional states are also contemplating cuts.

ADAPs Under Pressure

ADAPs provide crucial medications to low-income and uninsured Americans living with HIV. These programs are funded by the Ryan White HIV/AIDS Program, which allocates federal funds to states. Federal funding for these programs has remained largely unchanged since 2014, while healthcare costs continue to rise, forcing states to make difficult choices.

Florida Faces the Most Dramatic Cuts

Florida has implemented the most significant changes, lowering ADAP eligibility from 400% of the federal poverty level to 130%. State officials cite rising health insurance premiums and a lack of additional Ryan White funding as the reasons for the cuts. The state has pledged a two-month transition period to allow patients to find alternative resources.

“This is an extremely drastic change to their program,” said Lindsey Dawson, director of LGBTQ health policy at KFF. “There are blue states too that are having to reduce eligibility for their programs, but it just isn’t happening in such a dramatic way.”

These cuts will affect over 10,000 people in Florida, potentially leaving them to navigate pharmaceutical company assistance programs. The state also plans to discontinue coverage of Biktarvy, a widely prescribed antiretroviral medication, impacting even more individuals.

National Trends and Contributing Factors

Pennsylvania, Kansas, Delaware, and Rhode Island have also reduced income eligibility requirements for ADAP, though to a lesser extent than Florida. New Jersey is considering implementing a waitlist for ADAP services, a measure not used in over a decade.

The funding challenges are attributed to several factors, including stagnant federal funding, rising medication costs, and the expiration of Affordable Care Act subsidies that previously helped offset healthcare expenses. “Drugs have gotten more expensive, more people with HIV are relying on Ryan White, and the funding hasn’t kept pace with inflation,” Dawson explained.

While the Trump administration did not directly mandate these cuts, recent federal actions have raised concerns among experts. The termination of a promising HIV vaccine program and Medicaid cuts signed into law during the Trump administration have also negatively impacted people living with HIV, as approximately 4 in 10 Americans with HIV rely on Medicaid.

Disproportionate Impact on Women and LGBTQ+ Community

As healthcare costs increase, the safety net for people living with HIV is shrinking, disproportionately affecting the LGBTQ+ community and Black women. New HIV diagnoses occur at a higher rate among Black women, who accounted for 1 in 5 new diagnoses in the United States in 2022.

Advocates emphasize the importance of education and awareness, particularly among women who may not realize their risk or the availability of preventative measures like PrEP. Shelley Washington, a campus pastor in Houston, Texas, working to expand access to HIV treatment, noted that many women are unaware they should consider precautions against the virus.

Looking Ahead

“HIV today is highly treatable and manageable when people have consistent access to care,” Dillard Bassett concluded. “The challenge is making sure that everyone has access.”