A quiet crisis is unfolding across the United States, threatening to reverse decades of progress in the fight against HIV. As states grapple with budget constraints and rising healthcare costs, access to life-saving HIV treatment is being curtailed, disproportionately impacting Black communities already bearing the brunt of the epidemic. The changes, largely affecting access to AIDS Drug Assistance Programs (ADAP), are raising alarm among advocates who warn of a potential surge in new infections and preventable deaths.
As of March 2026, at least 18 states have reduced or restricted eligibility for ADAP, programs funded through the federal Ryan White HIV/AIDS Program. These programs are a critical lifeline for roughly 300,000 Americans – about a quarter of the nation’s HIV-positive population – helping them afford medications that can cost upwards of $60,000 per year. Five additional states are currently considering similar cuts, according to data from the National Alliance of State and Territorial AIDS Directors (NASTAD). NASTAD provides data and advocacy related to HIV/AIDS programs across the US.
The financial burden of HIV medication is a key driver of the crisis. Biktarvy, currently the most widely prescribed HIV treatment in the U.S., carries a wholesale cost of approximately $61,000 annually, according to David J. Johns, Ph.D., CEO and executive director of the National Black Justice Collective (NBJC). “And I understand a whole lot of Black folks—and non-Black folks—who don’t make $60,000 a year,” Johns stated. This economic reality, coupled with a surge in ADAP enrollment – up roughly 30 percent in recent years – is straining already limited resources.
The increase in ADAP enrollment is linked, in part, to the unwinding of pandemic-era protections that expanded Medicaid coverage. Millions of Americans have lost Medicaid benefits as states reassess eligibility, pushing more individuals onto ADAP or leaving them without access to care. Further exacerbating the problem, average premiums for Affordable Care Act (ACA) plans rose approximately 26 percent between 2025 and 2026, making insurance unaffordable for many, according to the Kaiser Family Foundation. KFF is a non-profit organization providing research and analysis on health policy issues.
Disproportionate Impact on Black Communities
The cuts to ADAP and rising costs are not impacting all communities equally. Black Americans continue to be disproportionately affected by HIV, representing more than 40 percent of new diagnoses despite comprising just 13 percent of the U.S. Population, according to the Centers for Disease Control and Prevention (CDC). CDC data on HIV provides detailed statistics and trends.
The disparities are particularly acute among Black women and Black transgender women. Johns notes that Black women account for over 50 percent of all new HIV diagnoses, while Black transgender women represent 46 percent. Geographic location too plays a significant role, with states in the South – where HIV rates are highest and a large proportion of Black Americans reside – being among those implementing the most restrictive policies.
“In the South in particular, Black women’s HIV rates are 14% higher than white women’s,” Johns explained. Black same-gender-loving men are also significantly impacted, accounting for 35 percent of all new HIV diagnoses nationally.
The Importance of Treatment and Prevention
Consistent medication is crucial for individuals living with HIV to suppress the virus and prevent transmission. Interruptions in treatment can lead to viral rebound, drug resistance, and increased risk of spreading the virus. “Missing doses means the virus can come back,” Johns warned. “If someone has been undetectable, it can turn into resistant to medication. What has been working for you might not work at all in the future.”
Alongside treatment, preventative measures like pre-exposure prophylaxis (PrEP) are vital in curbing the spread of HIV. Still, Black Americans remain underrepresented among PrEP users, despite facing a disproportionately high risk of infection. Increased access to PrEP, coupled with comprehensive sexual health education, is essential to address these disparities.
The current cuts to HIV programs stand in stark contrast to the national goal, set by the Trump administration in 2019, to end the HIV epidemic by 2030. Johns argues that the current trajectory is moving the country in the opposite direction. “The sitting president himself set a goal in 2019 to end the HIV epidemic by 2030,” he said. “What we know is that all of these cuts are moving us in the opposite direction.”
What Can Be Done?
Advocates emphasize several steps individuals and communities can take to address this growing threat. Knowing your HIV status is paramount, and organizations like the National Black Justice Collective offer resources, including at-home testing kits. If coverage is lost, it’s crucial to avoid interrupting treatment and seek assistance from local AIDS service organizations, which can connect individuals with emergency medication programs and support services.
Perhaps most importantly, advocates are calling for increased political action. They urge constituents to pressure Congress to increase funding for the Ryan White program to reflect the rising cost of care. “This is fixable,” Johns asserted. “But it requires political will. And political will requires constituent pressure.” Supporting organizations working on the ground, such as the Black AIDS Institute, the National Black Justice Collective, and TruEvolution, is also vital to expanding resources and combating stigma within Black communities.
The situation demands urgent attention. The consequences of inaction – increased infections, preventable deaths, and a widening of health disparities – are too significant to ignore. The future of the fight against HIV hinges on a renewed commitment to funding, access, and equity.
The next key date to watch is the upcoming Congressional budget negotiations, expected to begin in late summer 2026, where advocates will be pushing for increased funding for the Ryan White HIV/AIDS Program. Stay informed and engaged in these conversations. Share this information with your networks and let your elected officials know that ending the HIV epidemic remains a priority.
