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Trump cuts place critical HIV funding in question [1]
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Date: 2025-02-20
Since 1985, Project Lazarus has been on the frontlines of the HIV and AIDS crisis in New Orleans. Initially a hospice for people with AIDS that provided a comfortable space free of stigma as people approached the end of their lives, the center has transformed over the years into a transitional living facility. Today, its focus is on providing food, housing, counseling and medical care for a small community of people living with HIV, helping them transition to independent living.
On any given day, the residents of Project Lazarus might make a vision board, attend group therapy, tend to the courtyard garden, or eat a square meal cooked up by a staff nutritionist.
“People used to come through our doors and not leave,” Ian Bicko, the director of Project Lazarus, told Verite News. “Now, people do; they walk out usually more supported and, hopefully, in a better place in life.”
For Bicko, who lives with HIV, the work that Project Lazarus does is proof that an HIV diagnosis no longer needs to be a death sentence. Instead, HIV can be a manageable long-term health condition. But it requires ample support, even for those who have stable jobs and housing. Bicko himself receives federal support to pay for his own medical care and prescription medication.
But right now, approximately 70% of Project Lazarus’ budget is at stake: money that pays for staff members’ salaries, upkeep on the Marigny properties that house over 20 people, group counseling and even pantry supplies – not to mention individual medical care.
That is because the federal money that helps fund Project Lazarus, as well as a whole slate of HIV/AIDS-related services and programming in the city, has been put on the chopping block by the Trump administration.
Experts worry that the Trump administration’s abrupt moves to dismantle large parts of the federal bureaucracy have jeopardized the global fight against HIV and AIDS.
At stake locally are programs that provide comprehensive wraparound services for people living with HIV or AIDS, including money to pay for costly medical care and prescriptions as well as housing and food – funded in part through a three-decade old grant program called Ryan White that provides millions of dollars in support to the New Orleans area. Local advocates worry that without this support, people living with HIV may be put in dire straits, and the community as a whole may see a resurgence in diagnoses.
“We’ve already seen an epidemic here,” Bicko said. “And that didn’t just affect the most vulnerable people that are houseless and often overlooked now, it affected really wealthy, really affluent, really normal, everyday people, so you’d see the return of that.”
Millions for HIV/AIDS services annually
New Orleans and Louisiana have been hit hard by HIV and AIDS since the disease first emerged in the 1980s. Today, the U.S. South accounts for the largest share of new HIV diagnoses of any region in the country.
Public health professionals point to a slate of factors driving the South’s vulnerability to HIV and AIDS, from poverty and racism to increased stigma and poor sexual education, all of which increase the likelihood that someone might contract HIV.
At both the local and national levels, the groups at the highest risk of infection are men who have sex with other men, intravenous drug users and members of low-income and historically marginalized communities, especially Black communities.
As of last year, the Louisiana Department of Health recorded approximately 8,500 people living with HIV or AIDS in the metropolitan New Orleans area. Though Black people only comprise about 33% of the area’s population, 63.7% of the region’s HIV and AIDS patients are Black.
The same racial discrepancy was seen statewide, where 60% of the approximately 23,000 people who live with an HIV diagnosis identify as Black. Only a third of Louisiana’s overall population identifies as Black, according to recent census data.
Since 1991, the federal government has provided significant money to address the HIV/AIDS crisis through the Ryan White HIV/AIDS Program, funding everything from transportation for medical appointments to home-delivered meals, not to mention paying for medical care and prescriptions, for people living with HIV and AIDS.
Outside of Medicare and Medicaid, the Ryan White program is the largest source of federal funding for HIV care in the country. In the most recent calendar year, Congress appropriated over $2.5 billion to the program.
New Orleans receives approximately $14 million of this money to help the city combat the HIV/AIDS epidemic. That money is largely funneled through the city Health Department to various groups across the greater New Orleans area.
“We fund approximately 13 agencies that are direct service providers,” said Vatsana Chanthala, director of the Ryan White Services and Resources program at the Health Department. Those providers include CrescentCare, a community health center started in the early days of the HIV/AIDS crisis, and Project Lazarus, among others, Chanthala added.
Reaching ‘undetectable’
Public health professionals burn through a good-sized chunk of the alphabet when discussing resources available to the community of people living with HIV. There’s ADAP (AIDS Drug Assistance Program), through LAHAP (the Louisiana Health Access Program), which provides support and funding for prescriptions; HOPWA (Housing Opportunities for Persons with AIDS), through the OCD (Office of Community Development) , which provides funding for housing needs. The CDC (Centers for Disease Control) provides funding for prevention efforts. And of course there’s RWHAP — Ryan White — which itself includes component programs running from Part A to Part F.
The programs are designed primarily to provide services for low-income HIV patients. That’s especially important because living in poverty increases the risk of being infected by HIV, and an HIV diagnosis increases the risk of someone falling into poverty.
“This ensures that people are getting care, staying in care and reaching ‘undetectable,’” Chanthala said of Ryan White-funded programs.
For people with HIV, becoming “undetectable” means that antiretroviral drugs are so effective at suppressing the virus that it can’t be detected in blood tests. And if the virus is undetectable, then it is untransmittable to others through sex. Characteristically, public health professionals have a shorthand for this: ‘U=U.’
“HIV is now a manageable chronic health condition,” said Dorian Alexander, a prominent local advocate for people living with HIV.
Alexander, who has lived in New Orleans for over four decades, was first diagnosed with HIV in 2006. He relies on Ryan White money to afford his monthly prescription of Odefsey, a drug used to treat HIV. Without insurance and additional financial support, that prescription could cost him almost $4,000 per month.
“If these federal cuts are allowed to stay in place, then people won’t be able to get the medications to keep the virus suppressed and then they won’t be undetectable,” Alexander said. “It would mean that I would have to ration my HIV meds.”
Rationing his meds could increase Alexander’s viral load and put him at risk of become symptomatic and transmitting the virus to others. He also worries it could make his HIV more drug-resistant in the future.
According to the federal Health Resources and Services Administration, money spent on treatment for HIV has had a real impact: among those receiving Ryan White-funded care, 90.6% were considered virally suppressed, meaning they couldn’t sexually transmit HIV, in 2023 — up from 69.5% in 2010.
Alexander is quick to note that he’s not the most at risk in the local community of people living with HIV. Many others rely on funding not only to afford prescription medicine but also to pay for medical and dental care, addiction counseling and even housing. Losing Ryan White could be catastrophic for the people who rely on those wraparound services, he said.
Alexander remembers when long-term, effective treatment was unavailable to people living with HIV. He lost his own partner to AIDS in 1995, just a year before scientists discovered that a triple therapy of antiretroviral drugs could keep the virus at bay – a development that would prove to be a game-changer in treating HIV.
“We worked really hard to get the science to where it needs to be and to get the funding to where it needs to be, but if that goes away, imagine what the impact is going to be – and that’s just on the treatment side,” Alexander said.
Alexander also said that he’s concerned that, from his vantage point, the New Orleans Health Department and the agencies it funds don’t appear to have a plan in place as to what they’re going to do if all of the federal funding is withdrawn.
He pointed to the Trump administration’s recent efforts to freeze approximately $40 billion in humanitarian aid delivered through USAID as a dire example of what may happen. Though that effort is now stalled by the courts, considerable damage has already been done.
“We saw how fast and how riveting they have crippled USAID, the same can come for Ryan White,” Alexander said. “Nothing is in place to protect it.”
Department officials previously told Verite News that they were having discussions with federal officials about why the funding should remain and trying to identify alternative revenue sources should those talks not go the city’s way.
City officials have indicated that they may draw upon the city’s reserve fund to make up for losses in federal grants – but it’s not yet clear which programs city leadership would prioritize funding.
Alexander also worries about the full breadth of attacks on measures that make health care more equitable and accessible in general.
He pointed to the Affordable Care Act as a landmark piece of legislation that helped both those living with HIV and those who are most at risk of contracting it. The ACA provided money for states to expand Medicaid coverage, which helped more low-income people get access to health insurance, and mandated private insurers to cover more services, including preventive care. Louisiana expanded Medicaid in 2016.
Experts say that increased coverage resulting from the ACA has increased access to regular testing for HIV; preventive pre-exposure prophylaxis, or PrEP, medication; and treatment for people living with HIV.
But some congressional Republicans have signaled that they may roll back Medicaid coverage. There are also challenges to the ACA in the courts. One case making its way to the Supreme Court challenges the requirement for private insurers to cover preventive services – in part based on one employer’s argument that paying for an employee’s PrEP violates the employer’s religious rights.
“This is not just about funding specifically for HIV, this is an attack on all the safety nets that we have in place right now,” Alexander said.
The cuts are “definitely going to happen,” said Mandisa Moore-O’Neal, executive director of the Center for HIV Law and Policy, a national group that combats HIV stigma in the legal system. “It’s very clear what moment we’re in, and there’s divestment in the federal government.”
Moore-O’Neal also said she was worried that without the critical resources that these funds provide, low-income people with HIV will be more likely to end up in the criminal justice system, which could lead to increasing stigma.
Louisiana is among more than three dozen states where someone can be convicted of a felony for exposing someone else to HIV, Moore-O’Neal noted that Louisiana also requires those convicted of this felony to register for the sex offender registry.
She said she hopes that private philanthropy will step in to help some of the services that support people living with HIV – but warns that in the long-term, HIV and AIDS service providers will need the support of the federal government.
“Two things are true: This is a moment to see what private philanthropy has in it. It’s also true at the same time that no one can actually build the footprint of the federal government,” she said.
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