“Not a ‘scale back,’ this is a dismantling of our program”: HIV funding cuts impact vulnerable communities

Philadelphia has many resources for those living with the human immunodeficiency virus, or HIV — including testing, medical assistance and treatment. And organizations like Philadelphia FIGHT supplement this by providing education, in addition to care, for those fighting the disease. 

“For those that come through our program, they don’t just rebuild their lives, they thrive with their new lives,” said Teresa Sullivan, the director of HIV Prevention and Education at the organization. 

One of Philadelphia FIGHT’s largest resources is Project TEACH.

The eight-week course educates those with HIV about mental health, living with the diagnosis (which, if untreated, can become AIDS or lead to cancer or heart disease, among other things), and what resources are out there. The program also features a graduation for participants and alumni connections post-graduation. 

“You may have gotten that diagnosis in prison,” Sullivan said. “You may have gotten that diagnosis but never connected to why you need to be in treatment, and how important it is to lower the community viral load, and how to go on and thrive instead of just living your life.” 

Project TEACH has helped thousands of Philadelphians over the last 20-plus years, but recent funding cuts are threatening it and other similar programs. In addition, state and federal cuts could make the costs of prescription drugs and HIV support services higher. 

“This is not a ‘scale back,’” she said. “This is a dismantling of our program.”

Nationwide, statewide and local cuts

The Philadelphia Department of Public Health’s cuts come following several other funding cuts. 

The Pennsylvania Department of Health recently changed some of its income requirements for HIV assistance. 

The Special Pharmaceutical Benefits Program (SPBP) provides approved HIV medications to low-income Pennsylvanians who are uninsured or have limited healthcare coverage. In a recent memo,  the Pa. DOH said they will lower income limits due to increased enrollment and the rising cost of medications. 

In an email, the Pa. DOH said there has been a “$67 million increase in cost of medications to SPBP” over the last two years. 

Additionally, the state also revised eligibility requirements and spending guidance for  Ryan White Part B program grantees. The program provides federal funding to states to support those with HIV who have limited resources. In a memo, the DOH emphasized grantees should focus on “core” services, such as mental health services, emergency financial assistance and housing, when spending the reduced allocations. 

For Aaron Richterman, a medical doctor and assistant professor of infectious diseases and health policy at the University of Pennsylvania, the effect of these changes for his patients is likely to be higher costs and a “multiplier for bad outcomes.” 

“I’ve been practicing in Philadelphia for five years,” he said. “And this is the first time since I’ve been here where there are people that I have seen with HIV where I legitimately don’t know how I’m going to get them HIV medicine.” 

Federal cuts could also remove more services. The recent government shutdown hinged on conflict between Democrats and Republicans about providing Affordable Care Act tax credits. Democrats argue that, without these credits, healthcare costs will soar for many Americans. Democrats have also tried to negotiate more healthcare coverage for things such as HIV support services. 

The final budget and appropriation of services will depend on these ongoing negotiations, and it is possible that it could cut these HIV support services. 

HIV tends to disproportionately affect low-income and impoverished communities, Richterman explained, adding that cutting eligibility for other social protection programs, like SNAP food assistance, can compound the negative effects on those struggling with HIV. 

“SNAP is not an HIV program and it’s not a health program, but SNAP improves the lives of people with HIV,” he said. “In some of my work, I’ve shown that broadening the eligibility for SNAP leads to decreases in HIV rates at the state level. So these kinds of programs, which can alleviate things like poverty, allow people to have more bandwidth to engage in their care.” 

He said people often sacrifice health care when other basic needs are not accounted for. 

“When someone doesn’t have food to eat, or when someone doesn’t have stable housing, taking a pill every day is not necessarily top of mind,” he said. 

Increased risks 

Richterman said that HIV rates have remained somewhat stagnant in Philadelphia and nationwide over the past few years. 

According to AHEAD, an interactive government dashboard that measures HIV infections, Philadelphia’s rate of HIV diagnosis has dropped since 2017. That year, the number of people with an HIV diagnosis per 100,000 was nearly 500. Preliminary data from 2024 shows a drop to 303 people per 100,000. 

Richterman said removing funding could affect this progress. 

“A small loss of control of an infection, like HIV, can have ripple effects,” he said. “One infection can become another, then it can become another, and then you can end up with this sort of cascading type of impact when resources aren’t there.” 

This is especially important with HIV, as people in treatment have an undetectable viral load which greatly lessens transmission of the virus. But, Richterman said, this concept is not well understood and people often have a stigma about a positive diagnosis. 

“Every week in my clinic, I’ll encounter people who don’t fully understand it and don’t believe it,” he said. “So, there’s lots of work to be done for people to understand how successful they can be, and how this can be the smallest problem in their life, if we can have them engage with care successfully.” 

Richterman said this is why educational resources are so important – as they lessen this stigma in communities and allow more people to enter treatment. 

The educational efforts of Project TEACH will be devastated by the funding cuts, Sullivan said. 

“These cuts will result in a reduction of 80% of the program employees, and some of those employees are people living with HIV,” she said. “There will be a 70% reduction in TEACH classes and graduations.”

Project TEACH also works to maintain an “active alumni network” – allowing those affected by HIV to network, reconnect with each other and meet monthly for information about living with the disease. 

“It’s another way to keep people engaged and connected to their community, and that will have an 82% cut,” Sullivan said. 

“Even if you don’t know someone that’s living with HIV, this is a health condition that needs to be addressed because the stigma of it continues to go on and we continue to see people not surviving,” she said. “We don’t call our city ‘The City of Brotherly Love’ for nothing, right?” 

Without treatment, Richterman said there can be a “wide spectrum of consequences” beyond AIDS. 

“There are many cancers that can develop,” he said. “For women with HIV that’s untreated, they can be at a very high risk for cervical cancer. We can see very high risk for lymphomas and blood cancers if people are not treated. And as the virus progresses, we also see risks of those other inflammatory-type conditions, so kidney disease, heart disease, and these kinds of things.”

For now, Sullivan said the organization is doing its best to work with the resources it has been allotted. But, she is hoping the hard work Project TEACH has done for decades in the community is “not erased” by these cuts.

“We don’t want to go back to the beginning of epidemic,” she said. “We want to move into a future where we can see the epidemic of HIV in the lifespan of people living with HIV and our supporters and allies.” 

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