HIV Treatment Cuts Threaten Black Communities

In communities across the United States, quiet policy shifts are unfolding that could have devastating consequences for those living with HIV, particularly within Black communities. Advocates are sounding the alarm, warning that recent changes to AIDS Drug Assistance Programs (ADAP) could create a looming crisis.

Restricted Access to Life-Saving Medications

As of March 2026, at least 18 states have implemented cuts or restrictions to ADAP, with five more states considering similar measures. These programs, funded by the federal Ryan White HIV/AIDS Program, are a critical lifeline for approximately 300,000 Americans living with HIV, providing access to medications that can cost upwards of $60,000 per year. For many, ADAP is the last resort for affording treatment.

David J. Johns, Ph.D., CEO and executive director of the National Black Justice Collective (NBJC), explains that these changes are making it harder for people to qualify for assistance, especially as the cost of HIV drugs like Biktarvy continues to skyrocket. “These changes are essentially making it harder for people to qualify for assistance to afford drugs that have increased significantly in cost,” Johns tells ESSENCE.

A Disproportionate Impact on Black Communities

The ripple effects of these cuts are expected to hit Black communities the hardest. Black Americans represent over 40% of new HIV diagnoses, despite being only 13% of the U.S. population. The disparities are particularly stark for Black women, who account for more than 50% of all new diagnoses, and Black transgender women, who make up 46% of new HIV diagnoses.

Compounding the issue, many states implementing restrictions are in the South, a region with high HIV rates and a significant Black population. “In the South in particular, Black women’s HIV rates are 14% higher than white women’s,” Johns notes. Black same-gender-loving men also remain a heavily impacted group, accounting for 35% of all new HIV diagnoses.

Rising Costs and Stagnant Funding

Several factors are contributing to this crisis. Enrollment in ADAP programs has surged by about 30% in recent years, partly due to many losing Medicaid coverage after pandemic-era protections expired. Additionally, the expiration of enhanced Affordable Care Act tax credits at the end of 2025 led to a roughly 26% rise in average ACA premiums, making insurance less affordable.

Meanwhile, federal funding for the Ryan White program has remained stagnant for over a decade, even as medication and care costs have climbed. “The federal government has been investing in the same level of funding while the cost for drugs and care have increased,” Johns states. “This is a policy decision that elected leaders are making. And Black communities disproportionately are paying for it with our lives.”

The Consequences of Interrupted Treatment

For individuals living with HIV, consistent medication is crucial for suppressing the virus and preventing transmission. Interrupting treatment can lead to the virus rebounding, potentially becoming resistant to existing medications. “Missing doses means the virus can come back,” Johns warns. “If someone has been undetectable, it can become resistant to medication. What has been working for you might not work at all in the future.”

This drug resistance can limit future treatment options and increase the spread of the virus. Johns emphasizes the severity: “This is life and death. This is not red tape. It’s not about bureaucracy…” These cuts also contradict national goals to end the HIV epidemic by 2030, a goal previously set by the President.

How You Can Help

Advocates urge everyone to take action to protect themselves and support efforts to combat HIV. Here’s what you can do:

• Know your status: Utilize resources like the NBJC for free at-home HIV testing kits.
• Don’t stop treatment: If you lose coverage, consult a healthcare provider before stopping medication.
• Contact local AIDS service organizations: They can connect you with emergency assistance and support.
• Pressure policymakers: Urge Congress to increase Ryan White program funding.
• Support community organizations: Donate to groups like the Black AIDS Institute, NBJC, and TruEvolution.

Johns concludes, “The math doesn’t math. In a country that has the resources to end the HIV epidemic, choosing not to fund treatment is a political decision.” Staying informed and engaged is key to ensuring these vital programs remain accessible.