Florida HIV support systems are dealing with a two-front war. First, the state changed who could access its drug assistance program, and now the president's budget would cut over a billion dollars in testing and prevention.
"This crisis mode that we're in now with these newly proposed cuts to more prevention and surveillance is creating for us the perfect storm where this could be the plague of our century," said Dr. Elizabeth Sherman, an HIV clinician in South Florida.
Earlier this month, President Donald Trump released his Fiscal Year 2027 budget proposal. The plan calls for $1.5 billion in cuts to HIV testing and prevention, according to the HIV+Hepatitis Policy Institute.
That's the same amount Trump proposed in his 2026 budget, but those cuts were rejected by the U.S. Congress.
"Congress rejected these massive attacks on HIV prevention last year, and we will urge them to do the same again this year," said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in a press release.
HIV testing on the chopping block?
The cuts call for a reduction of $800 million in the Centers for Disease Control and Prevention's testing capabilities. The CDC is one of the biggest providers of HIV testing across the country.
In Florida, that accounts for 30% of the state's funding for tests, Sherman said.
"What we'll see here in Florida with these types of cuts, cuts to routine HIV testing, cuts to HIV surveillance, cuts to linkage to care services. Without all of that, the HIV virus will spread in the dark," she said. "And by the time you see the impacts of those cuts, you're already going to have an uncontrolled outbreak."
After Trump proposed his HIV cuts last year, a study published on behalf of the Infectious Diseases Society of America showed what would happen if the CDC's testing ended in October. Results showed a projection of 13,000 new HIV cases, or a 10% increase, by 2030 across 18 states, Florida among them.
Florida alone was projected to see an additional 1,300 cases by the same year.
Florida routinely ranks among the top states with the highest HIV diagnoses. According to the CDC's latest data, Florida ranks No. 3, behind Texas and California.
Since 2020, HIV cases have been showing increases yearly until 2024, when they saw a slowdown in the rate of transmission.
Orange County is one of 48 priority jurisdictions due to its high rate of new diagnoses, according to the CDC. In 2023, Orange County cases reached a six-year peak of 453 diagnoses. In 2024, the count fell to 423 new cases.
"We've made substantial progress in Florida," Sherman said. "Even though Florida ranks third in the nation for HIV diagnoses, this doesn't have to be a public health threat."
Other funding proposals would see cuts to housing assistance from Housing Opportunities for Persons with AIDS (HOPWA), and the elimination of Part F of the Ryan White Program, which includes AIDS education and training.
The housing assistance has been crucial in maintaining a healthy and stable lifestyle for low-income patients living with HIV.
"It's nearly impossible to maintain that strict adherence that I was talking about that's required for HIV medications if you do not have stable housing," Sherman said.
Florida's funding cuts
In Florida, low-income HIV patients are dealing with another disruption that came earlier in the year when the Florida Department of Health announced the AIDS Drug Assistance Program would no longer serve people with incomes up to 400% of the federal poverty level. The ADAP helps underinsured and uninsured people diagnosed with HIV afford life-saving medication.
The department's change made it so that only those with an income up to 130% of the poverty level -- individuals earning $20,000 or less per year -- could qualify for assistance.
In March, Gov. Ron DeSantis signed a bill that would pause that change in eligibility until June 30.
However, the bill didn't reset everything back to the status quo. ADAP previously provided insurance premium assistance for those using Affordable Care Act Marketplace insurance and helped patients access expensive medications (costing $2,000 to $4,000 per month). Now it does neither.
Currently, legislators preparing for a special session are trying to renegotiate ADAP funding in the Florida state budget for the fiscal year beginning July 1.
HIV advocates are also working with lawmakers on Capitol Hill to increase the federal funding for ADAP, according to the HIV+HEP Policy Institute.
Even with possible relief on the horizon, the tumultuous landscape creates an uncertain future for those with HIV and those who work to combat the virus that causes AIDS.
Beating HIV relies on four pillars that need to be funded: testing, treating, responding, and preventing, Sherman said, but in Florida, three of those pillars -- testing, treating, and preventing -- are being knocked down.
Sherman said it's kind of like cutting the lines of a parachute.
"What is that going to do? You're going to have a crash landing," she said.
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