The federal government promised to end the HIV epidemic by 2030. A new report from the National Alliance of State and Territorial AIDS Directors (NASTAD) tells a very different story.
Twenty-three states are now cutting or considering cuts to their AIDS Drug Assistance Programs (ADAP), the safety net that helps people living with HIV afford life-saving medications. The reason is painfully straightforward: federal ADAP funding has been frozen at $900.3 million since 2014. Adjusted for inflation, that represents a 31% decline in purchasing power since 2005, according to KFF. Today’s funding buys the same as it did in 1999.
Meanwhile, the number of people relying on ADAP jumped 56% between 2007 and 2024, climbing from 165,000 to over 257,000 clients. The math stopped working years ago. Now states are making people pay for Washington’s neglect.
Who Carries the Weight
Black Americans make up 12% of the U.S. population but account for 40% of people living with HIV and 38% of new diagnoses, according to the CDC. Half of all HIV diagnoses among young people ages 13 to 24 are among Black youth. The viral suppression rate for Black people with HIV (53%) trails white Americans (63%).
These disparities exist because of systemic barriers, not personal failure. Poverty, lack of insurance, and underfunded public health systems keep Black communities at higher risk. Cutting medication access makes every one of those gaps wider.
Florida’s Emergency Cuts
Florida offers the starkest example. An emergency rule effective March 1 slashed ADAP eligibility from 400% of the federal poverty level ($63,840 annually) down to just 130% ($20,748), according to the Tampa Bay Times. That single change could cut off approximately 16,000 Floridians from their HIV medications.
The state also removed Biktarvy from its drug formulary. Biktarvy is the most prescribed antiretroviral in the country, used by 52% of ADAP clients nationally, with an average wholesale price of $61,000 per year.
Black Floridians are 17% of the state’s population but represent roughly 40% of its HIV cases. A preliminary analysis projects the cuts could lead to 4,312 additional HIV infections in Florida alone between 2026 and 2030, according to AIDS United.
Other states are heading in the same direction. Pennsylvania, Kansas, Delaware, and Rhode Island have all reduced income eligibility thresholds. Arkansas, Louisiana, and New Jersey are considering bringing back waiting lists for medication access.
Why This Matters
Cutting HIV medication access does not just hurt individuals. It fuels new infections. Research shows that four in ten new HIV transmissions come from people who know their status but have fallen out of care, according to KFF. Every person pushed off ADAP is a potential link in a chain of new infections that could have been prevented.
The timing compounds the crisis. Enhanced ACA premium tax credits have expired, meaning marketplace insurance premiums for subsidized enrollees are projected to jump 114%, from an average of $888 to $1,904 annually. Southern states with the highest HIV prevalence saw the steepest premium increases.
The Takeaway
This is not a budget problem. It is a priorities problem. Congress has had over a decade to increase ADAP funding and chose not to. The communities most affected (Black Americans, LGBTQ+ communities, people in the South) cannot afford to wait for political will to catch up. Contact your representatives and demand that ADAP funding reflects the reality of 2026, not 1999.
