The federal government has cut $29.2 million from Texas health agencies that test thousands of people for HIV directly in their communities, the latest in a series of cuts to statewide public health funding.
Texas was the nation’s largest recipient of PS21-2102 funding, with grants awarded to 11 community-based organizations (CBOs), primarily located in urban areas, over the past five years.
These organizations, which provide services directly in communities, are a key pillar of the HIV prevention network because they are generally more trusted than clinics and tend to be much more effective in detecting positive cases. Federal dollars have helped cover the costs of HIV testing, connecting Texans to care and paying for HIV prophylaxis, which almost completely protects against infection.
Without the grant, which the Centers for Disease Control and Prevention let expire on September 30, organizations found themselves in a difficult situation finding new sources of funding or reducing their services. The CDC did not respond to a request for comment.
“Community organizations are on the front lines of the testing part, they’re the ones that are out in their community,” said Philip Keizer, a professor at the University of Texas Medical Branch who studies HIV. “These community groups are critically important in reaching their community and getting people tested. »
Launched in 2021, PS21-2102 provided $239 million to community organizations across the country. Its elimination comes as President Donald Trump’s administration has launched a wide-ranging offensive targeting HIV eradication efforts both domestically and abroad.
“Early on in this administration, we’ve heard that HIV prevention is … under attack,” said Philip Huang, director of Dallas County Health and Human Services and vice chair of the state’s Public Health Funding and Policy Committee.
Beyond supporting HIV prevention, the federal government has also cut public health funding in Texas more broadly, including pandemic grants intended for vaccination efforts, laboratory capacity and investigations of infectious disease outbreaks. Job cuts at the federal level have wiped out both the administrative support and technical expertise that local health departments rely on, Huang said.
The uncertainty over funding has been extremely disruptive, he said. “It’s been chaotic, uncertain, so they’re all making our job of protecting the public…much more difficult.”
Unlike other HIV-related grants, PS21-2102 channeled funds directly to community organizations. Now, the federal government is providing a one-time sum of money to state health departments through May 2027. The CDC has awarded the Texas Department of State Health Services (DSHS) more than $5.2 million.
Nearly a quarter of that grant, or $1.2 million, will go to community organizations, while the rest will go to “projects that support HIV prevention and surveillance efforts funded by” another program, DSHS spokeswoman Lara Anton wrote in an email.
This sum represents only a fraction of the more than $3 million that Texas community organizations received each year from the CDC. While state health departments are encouraged, but not required, to send 10% of these funds to community organizations, advocates worry that states are prioritizing testing in clinical settings at the expense of supporting community organizations.
In Houston, Allies in Hope has provided HIV care for more than four decades. As of 2021, the organization received approximately $441,000 per year from PS21-2102, which was spent on various prevention measures, including outreach activities and a mobile unit, CEO William Jeffrey Campbell explained. The grant covered more than a quarter of the 2,000 tests the organization administers each year. Unless new sources of funding are found, the organization will have to scale back testing.
“That $441,000, with everything that goes into it, excludes a lot of the number of people that we’re able to test,” Campbell said.
As the next legislative session approaches, lawmakers have begun considering replacement funding at the state level, said state Rep. Venton Jones, a Dallas Democrat who is the first openly HIV-positive lawmaker to serve in the Legislature. He pledged to do everything in his power to replace the cut federal dollars, but cautioned that public funding is not a permanent solution.
“This is a major blow to our ability to respond to the outbreak,” Jones said. “Ultimately, we want to make sure that these funds are reinvested by the federal government, by the CDC, because they are essential.”
“Stealing from Peter to pay Paul”
Texas ranks fifth in the nation for new HIV diagnoses per capita, according to 2024 data from AIDSVua mapping tool developed at Emory University in partnership with Gilead Sciences.
Although clinics and community organizations are key components of an effective HIV prevention strategy, Keizer said siphoning funding from community organizations to support clinics is like “robbing Peter to pay Paul.”
People can get tested at clinics or at their doctor’s office, but it is usually the patient’s responsibility to seek care. In contrast, because community organizations reach vulnerable groups more directly, for example by setting up testing stations in bars or nightclubs, they tend to be more “efficient” in detecting HIV-positive people, meaning they find more positive cases for each test administered.
Between 2012 and 2017, the CBOs diagnostic a new HIV case in 1.4% of CDC-funded tests, compared to just 0.5% for CDC-funded tests administered by local health departments; this translates into a three times higher rate of new diagnoses.
Trust matters too. In Austin, Emma Sinnott, vice president of health center operations for Vivent Health, said much of the organization’s customer base may not trust clinics or fear that visiting one will exhaust them.
“There’s a lot of stigma in the community, and they don’t want people to know about their sexuality,” Sinnott said. “Awareness provides access, testing and meeting people where they are.”
Vivent Health had used its PS21-2102 award to fund HIV testing and outreach in the field. Sinnott said the grant money represents 30 percent of the organization’s funding for HIV prevention.
Although Vivent Health, as one of the largest organizations in the state, can better absorb the initial shock of losing the grant, the reduction will limit its ability to host outreach events and reduce access to new post-exposure prophylaxis medications like injectables, Sinnott said. While the organization will work to keep tests for sexually transmitted diseases free for as long as possible, Sinnott fears it will eventually have to charge for them.
Vivent fills a particular need by focusing on populations most affected by HIV and with the least access to testing, said Laura La Fuente, deputy director of Austin Public Health, which also offers HIV testing.
“We want to ensure that there are access points in a public health system with various partners to ensure that individuals can get tested and receive treatment,” La Fuente said.
“Penny Wise and Pound Foolish”
The first Trump administration made HIV eradication a pillar of its public health strategy, setting an ambitious goal of ending the HIV epidemic by 2030. In contrast, the last two years have been difficult for HIV prevention efforts.
In the wake of the COVID-19 pandemic, which has made Republicans distinctly distrustful of the CDC, the administration has tightened the agency’s leash, and many public health programs have fallen victim to the Department of Government Efficiency’s efforts to reduce federal government spending.
By 2025, the National Institutes of Health will cut at least $759 million in funding for HIV research. The administration has also sought to eliminate or modify many HIV-related programs, including the Ending the HIV Epidemic Initiative, part of the Ryan White HIV/AIDS Agenda, and a housing support program for people living with AIDS.
“The first year the Trump administration was back, they cut budget proposals on HIV prevention programs to zero,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “We’ve been on the defensive, and that’s not where we were under the last President Trump administration.”
Experts have emphasized that HIV prevention is economically beneficial, regardless of the government’s ideological position.
A single case of HIV can cost up to $1 million in treatment over a patient’s lifetime, said Anthony Fojo, a professor of medicine at Johns Hopkins Medicine. The more positive cases are detected and treated, the fewer transmissions occur, meaning that performing 1,000 HIV tests to find just one positive case saves hundreds of thousands of dollars in the long run, he explained.
“It’s a little costly and foolish to cut funding for testing, because it costs a lot less to test and screen for things than to treat other infections later,” Fojo said.
In San Antonio, Black Efforts Against the Threat of AIDS was the largest recipient of PS21-2102 money in the country. Last year, the grant covered 20% of the approximately 5,000 HIV tests administered by the organization. Now she’s looking for other sources of funding: providing more grants, educating local leaders and seeking more support from the city.
Each year, 300 to 400 people are newly diagnosed with HIV in San Antonio, said executive director Michele Durham. Reduced funding means reduced testing capacity, which results in more people unknowingly living with HIV and potentially unknowingly transmitting the disease.
“For us to turn down the gas now is just not our smartest move as a community and as a nation,” Durham said.
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This story was originally published by The Texas Tribune and distributed through a partnership with The Associated Press.
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