Prevent And Protect: A Looming Crisis As HIV Treatment Cuts Threaten Black Communities

In recent months, HIV policy shifts have been quietly unfolding across the United States, and advocates warn the consequences could be devastating.

As of March 2026, at least 18 states have already reduced or restricted access to AIDS Drug Assistance Programs (ADAP), with five more states considering similar changes, according to public health advocates and data from the National Alliance of State and Territorial AIDS Directors (NASTAD).

The programs, funded through the federal Ryan White HIV/AIDS Program, help people living with HIV afford life-saving medications that can cost tens of thousands of dollars each year. For roughly 300,000 Americans living with HIV (about a quarter of the nation’s HIV-positive population), ADAP programs are often the last line of defense for treatment access.

David J. Johns, Ph.D., the CEO and executive director of the National Black Justice Collective (NBJC), says the changes could interrupt treatment for thousands of people across the country.

“There are 18 states that have already adopted what they’re calling cost-cutting changes to their HIV drug assistance programs,” Johns tells ESSENCE. “And there are five more states that we know of that are considering similar steps.”

Among the states implementing restrictions are Florida, Pennsylvania, Kansas, Delaware, Rhode Island, Arizona, Michigan, Nevada, Alaska and Oklahoma, with additional states exploring similar policy shifts.

“These changes are essentially making it harder for people to qualify for assistance to afford drugs that have increased significantly in cost,” Johns says.

One of the biggest concerns resulting from these policy changes is the soaring cost of HIV medications.

Biktarvy, currently the most widely prescribed HIV medication in the United States, now costs about $61,000 per year at wholesale, according to Johns.

“And I know a whole lot of Black folks—and non-Black folks—who don’t make $60,000 a year,” he says.

At the same time, enrollment in ADAP programs has surged roughly 30 percent in recent years, according to advocates, partly because many Americans lost Medicaid coverage when pandemic-era protections expired.

The expiration of enhanced Affordable Care Act tax credits at the end of 2025 also drove insurance costs higher. Average ACA premiums rose roughly 26 percent between 2025 and 2026, leaving more people unable to afford coverage.

Meanwhile, federal funding for the Ryan White program has remained largely flat for more than a decade, even as medication and care costs have climbed.

“The federal government has been investing in the same level of funding while the cost for drugs and care have increased,” Johns says. “This is a policy decision that elected leaders are making. And Black communities disproportionately are paying for it with our lives.”

Advocates say the ripple effects of these cuts will fall hardest on communities already disproportionately impacted by HIV.

Black Americans represent more than 40 percent of new HIV diagnoses despite making up just 13 percent of the U.S. population.

The disparities are particularly stark for Black women and Black transgender women.

“Black women account for more than 50 percent of all new diagnoses,” Johns shares. “Black trans women account for 46 percent of new HIV diagnoses.”

Geography also plays a major role. Many of the states implementing restrictions are in the South, where HIV rates remain among the highest in the country and where most Black Americans live.

“In the South in particular, Black women’s HIV rates are 14% higher than white women’s,” he says.

Black same-gender-loving men also remain among the groups most affected by the epidemic. According to national data, 35 percent of all new HIV diagnoses occur among Black same-gender-loving men.

Despite these risks, Black Americans remain underrepresented among people using preventive medications such as HIV Prevent and Protect

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