The Dangerous Consequences of HIV/AIDS Program Cuts: A Call to Protect Our Communities

By Therese R. Rodriguez, CEO, Apicha Community Health Center and Board Member, Amida Care

As the CEO of Apicha Community Health Center, a Federally Qualified Community Health Center (FQHC) with a long tradition of providing high quality and culturally responsive care for Asian and Pacific Islanders (API) and other communities most deeply impacted by HIV; and as a board member of the nonprofit Medicaid health plan Amida Care; I’ve witnessed firsthand the critical importance of HIV/AIDS programs.

Recent announcements by the U.S. Department of Health and Human Services (HHS) to significantly cut these programs, as well as potential spending cuts to Medicaid of up to $880B, are deeply concerning.

For decades, these programs have provided vital resources for people affected by HIV. Medicaid is the largest source of insurance coverage for people with HIV in the U.S. covering an estimated 40% of nonelderly adults with HIV.

Reductions in HIV programs undermine our progress and threaten the health of the very people who need these services the most.

In recognition of National Asian American and Pacific Islander HIV/AIDS Awareness Day (May 19), here are five reasons to focus on:

1. HIV Disparities in the AANHPI Community Are Alarming
Despite being an often-overlooked group in public health discussions, the AANHPI community is significantly affected by HIV. While new HIV diagnoses in overall population in U.S. decreased by 12%, HIV diagnoses in the NHPI community increased by 65% between 2017 and 2021.

Moreover, while there is limited specific data on HIV infection among men who have sex with men (MSM) within the AANHPI community, we know that MSMs accounted for 67% of all new infections in 2022 with the greatest risk for young men.

Apicha CHC undertook a needs assessment of LGBTQ APIs in 2022. That study of 344 respondents – surveyed in seven languages – found that LGBTQ APIs have low knowledge of availability of HIV testing.

Cuts to programs that target specific groups will only exacerbate the problem. API does not exist in a vacuum. The lack of information among API on HIV contributes to the increase in infection and spread to the larger community.

2. The Persistence of Cultural Stigma and Silence
Stigma surrounding HIV remains a significant barrier to care in the AANHPI community and discourage individuals from seeking testing, treatment, or preventive care, such as PrEP. Many cultures still view HIV as a taboo subject. Asians have the lowest PrEP utilization rates (4.5%) compared to the other racial groups. Additionally, within many AANHPI communities, HIV is still perceived as only affecting certain groups, such as gay men or people who use drugs, leading to a lack of prevention efforts to heterosexuals and women.

3. Underreporting and Lack of Disaggregated Data
A critical gap in addressing HIV in the AANHPI community is the underreporting of HIV cases and the lack of disaggregated data. Most national statistics group all AANHPI populations together, which masks important differences between subgroups. Some Southeast Asian American often have significantly higher rates of HIV compared to other AANHPI subgroups. Filipino Americans have some of the highest rates of HIV infection among Asian subgroups, but their experiences are often overlooked due to a lack of specific data.

Many studies only report on HIV for whites, African Americans, Latinos. AANHPI and Native Americans are lumped into an “Other” category. But this “Other” category has the greatest variability as compared to the other groups. They speak different languages and come from several different cultures. Collecting and analyzing data helps us understand the scope of the epidemic.

4. Limited Access to Culturally Responsive Health Services
While healthcare access in the U.S. has expanded through the Affordable Care Act and Medicaid, there are still significant gaps in services for the AANHPI community. Many immigrants and refugees face language barriers and lack access to culturally responsive healthcare providers.

Among our patients, one in four speak a language other than English. Moreover, we have found that some of our Cambodian, Chinese, and Vietnamese patients do not read nor write in any language.

HHS programs in language assistance and cultural competency training for providers are critical in bridging these gaps. FQHCs play a crucial role in providing this care. Reductions in funding will only worsen these barriers and contribute to increased HIV rates.

5. The Long-Term Cost of HIV: Why Prevention and Early Treatment Matter
The long-term costs of HIV—both in human and financial terms—are profound. Studies have long shown that it is more cost-effective to invest in HIV prevention and early treatment than to spend the higher medical costs of treating advanced HIV. Early HIV care can prevent the progression of the disease to AIDS, improve health outcomes and reduce avoidable hospitalization and ER use.

If funding for HIV programs is cut, we not only risk the lives and health of AANHPI individuals but also increase the cost to society as a whole due to the long-term consequences of untreated HIV, including increased transmission.

Moreover, the increased transmission of HIV correlates with the increased transmission of other sexually transmitted infections (STI), contributing to increases in gonorrhea, syphilis, and herpes. We are particularly concerned about the effect on maternal-child health, with increased congenital syphilis incidence in populations with high HIV prevalence.

Conclusion: Protect HIV Programs and Protect Our Communities

The recent cuts to HIV programs by the HHS are a dangerous step backward.

Overall, infection rates are going down in the U.S. but not in populations such as APIs and MSM.

“Why stop now?” The end of the epidemic is on the horizon. We cannot truly end the epidemic unless we end the epidemic in all populations. I am deeply concerned about the lasting consequences these cuts will have on the health and well-being of the AANHPI community.

Let’s stand together for an HIV-free future.