The Disproportionate Toll Of HIV Care Cuts On Black People
Black Lives On The Line: The Disproportionate Toll Of HIV Care Cuts
When NeNe Leakes sashayed onto Capitol Hill recently, she wasn’t there to deliver one of her legendary, and often hilarious, “reads.” Instead, the Real Housewives of Atlanta icon joined a contingent of “Bravolebrities” for HIV Advocacy Day to protest proposed budget cuts that threaten to gut prevention and care for the most vulnerable.
Bringing her signature brand of “tell-it-like-it-is” energy to the halls of Congress, NeNe highlighted a mission that was deeply personal and rooted in a recent realization about the tools available for Black women’s survival. “One of my girlfriends recently said to me, ‘Girl, are you on PrEP? I’m taking PrEP,'” Leakes shared during the advocacy day. “And I was like, ‘Why are you on PrEP?'”
That moment of inquiry—the “I need to understand, I need to know” curiosity NeNe is known for—highlights a massive gap in public health outreach. Leakes admitted that while she understood the science behind PrEP, she was struck by how many folks in her community remain in the dark about its benefit or are priced out of the protection it provides. “Confidence to speak and educate my community feels good,” Leakes told the Washington Blade, noting that in cities like Atlanta, Miami, and Houston, ignorance and a lack of access contribute to the staggering rates of infection that haunt Black life and impact Black survival.
These numbers represent far more than a collection of statistics. They offer a map of systemic neglect. According to the latest CDC data, Black Americans account for 40% of people living with HIV despite being only 13% of the population. This burden falls with vicious precision on those already pushed to the margins.
Black gay and bisexual men are particularly impacted, as they account for 26% of all new HIV diagnoses in the United States despite making up less than 1% of the total population. Black transgender women are acquiring HIV at more than 10 times the rate of their white counterparts, while Black cisgender women are diagnosed at nearly four times the rate of women overall. For those navigating housing instability or the complexities of drug use, the risk is even more acute; Black people who inject drugs face a significantly higher HIV prevalence than any other racial group.
Beneath the spectacle of reality stars in the rotunda lies a sobering reality: we are witnessing a dangerous political tug-of-war over domestic HIV funding, and Black bodies are being treated as collateral damage. From proposed federal budget slashes to state-level maneuvers stripping away funding for the AIDS Drug Assistance Program (ADAP), the message is clear. The lives of Black queer and trans folks, Black women, and those who are unhoused are being devalued in real-time.
The conversation around HIV has long been framed through a lens that overlooks Black women, leaving them dangerously underserved by testing and prevention campaigns. Unlike their white counterparts, who are often proactively offered PrEP during routine checkups, Black women are rarely targeted for these life-saving interventions. This lack of visibility creates a false sense of security, particularly for those in seemingly stable, monogamous relationships.
NeNe Leakes pointed to this exact blind spot, noting that many Black women believe they are “safe” because of their relationship status. However, a woman’s safety is often tied to factors outside her control, including a partner’s undisclosed sexual habits or drug use. As fellow advocate Candiace Dillard Bassett noted during the Hill visit, “It’s so important that we have these conversations, not just in forums like this, but around your kitchen tables, in your group chats, on the street—wherever we are.”
Without targeted education, many Black women don’t realize that PrEP is a tool for their autonomy—a way to protect their own bodies regardless of their partner’s choices. Jordan J. Edwards, Deputy Director at the BQ+ Center for Liberation of the Normal Anomaly Initiative, observes that this education gap is a structural wall.
“I’ll talk to a Black woman, and she’ll be like, ‘What is [PrEP]? Ain’t that a gay man [thing]?’” Jordan says. “She doesn’t know she needs to be tested because she’s engaging with one partner, but that partner may also be doing injection drugs or having sex with someone other than her. Black women are not having those conversations because they aren’t being prompted or educated to have them.”
To understand the weight of these cuts, we have to look at where we stand. These funding rollbacks are the predictable result of structural inequities and a healthcare system that often treats Black patients with suspicion instead of care.
For many in our community, the Ryan White HIV/AIDS Program is the only thing standing between them and a medical crisis. It provides a comprehensive system of care that includes primary medical treatment and other essential support services.
This program is the backbone of viral suppression—the point at which the virus is so low in the blood that it cannot be transmitted to others, often referred to as U=U. In plain language, treatment is prevention. But when budget cuts weaken that backbone, the entire structure of community health begins to fracture.
Jordan Edwards knows this struggle intimately. He has been living and thriving with HIV since 2013, but even as a leader in the HIV advocacy space, he has felt the sting of insurance gaps and rising costs.
“I recently had to switch healthcare providers because of increased income. In moving up in the tax bracket, I ended up no longer qualifying for certain assistance and needed to get health insurance, which means I no longer have access to certain types of resources,” Jordan shared. “I was in a gap in between where… with insurance, I had to really do a lot of research. Does this insurance provider cover my HIV medication? Will my provider be in its care network? All of this means I might be losing access to the things that might save my life, or, at least, contribute to my quality of life.”
When we talk about “funding cuts,” we are talking about people like Jordan losing the doctors they trust. These cuts represent the theft of hope that innovation provides from those who need it most. Dr. Ralston Lockett, DNP, APRN, FNP-C, AAHIVS, a clinical leader and HIV prevention expert, warns that these gaps create a dangerous ripple effect.
“When assistance programs are reduced, we see immediate gaps in access,” Dr. Lockett explains. “For many Black patients living with HIV, this can mean interruptions in antiretroviral therapy, increased risk of viral rebound, and higher likelihood of transmission. These are not just individual impacts—they affect community-level viral suppression efforts.”
The tragedy of this moment is that we actually have the tools to end the epidemic. Pre-Exposure Prophylaxis (PrEP) is a medical marvel. Yet, AIDSVu data reveals a glaring racial gap: while Black people represent the majority of those who could benefit from PrEP, we have the lowest rates of use compared to our white counterparts.
Dr. Lockett notes that funding cuts deepen this divide rather than merely maintaining the status quo.
“Cuts to prevention programs disproportionately impact patients who already face structural barriers to care,” he says. “Without affordable access to PrEP, we lose a critical tool in preventing new HIV infections, particularly in communities that are already overrepresented in new diagnoses.”
Perhaps the most insidious part of these proposed cuts is how they destabilize the organizations that actually do the work to address HIV in Black communities. While large clinics might survive a budget dip, small, Black-led community-based organizations (CBOs) are being destabilized by shifting government priorities. Jordan shared a devastating example: a research project at his organization that was ready for contract was suddenly halted because of government cuts.
“We lost, I mean, I don’t know, $500,000 in one day because of these funding cuts,” Jordan recalls. “The Normal Anomaly is able to reach populations because we are not relying on clinics to support people in our community. We’re at the barbershops, the grocery stores, the churches, the clubs, reaching people experiencing homelessness. If we don’t have the funding to meet the most vulnerable people where they are, then we know nobody else will be willing to do the work to reach them, and they’ll be the main ones to suffer.”
This isn’t an isolated incident. According to a Kaiser Family Foundation analysis, domestic HIV funding is increasingly under fire in budget negotiations. These are racialized policy decisions that determine who gets to live a long, healthy life and who is left to navigate a labyrinth of red tape that might end with long-term illness or even death.
We cannot afford to wait for the government to decide our lives are worth saving. As we look at the potential for “food apartheid” in our neighborhoods or the rolling back of SNAP benefits and affordable housing programs, we must recognize that HIV care is part of a larger struggle for Black liberation. These budget cuts target the same communities already battling environmental racism and economic disenfranchisement.
Our current political climate mirrors the terrifying early years of the epidemic, when the federal government dismissed HIV as “gay cancer” and refused to provide even the most basic funding for those dying in the streets. Back then, survival didn’t come from the state; it came from the radical grit of Black and queer folks creating their own safety nets out of pure necessity. We must reclaim that legacy of collective resistance, moving away from a reliance on systems never meant for our benefit and toward a future where we protect our own.
It means intentionally supporting Black-led organizations and demanding that our elected officials stop playing politics with our prescriptions. Jordan often speaks about the “currency” of care, noting, “If I can help someone else feel seen, valued and worthy… that’s the real currency. I know if feel seen, I’m going to go to the doctor and ask the important questions. I’m going to advocate for the support I need.”
As Dr. Lockett puts it, “Funding cuts risk reversing years of progress by widening disparities, increasing new infections, and undermining trust in care systems. Sustained investment is essential.”
These cuts are a choice. When we choose to defund HIV care, we are choosing to abandon Black queer youth, Black mothers living in the South, and our unhoused neighbor, who all deserve a future. We must refuse to be the ghosts of a new epidemic. Our survival has always depended on our ability to see one another when the state chooses to look away. Now, more than ever, we must force ourselves to look, to act, to stay vigilant, and to demand the resources we need to survive and thrive.
We ain’t new to this. We true to this.
Josie Pickens is an educator, writer, cultural critic, and abolitionist strategist and organizer. She is the director of upEND Movement, a national movement dedicated to abolishing the family policing system.
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