CDC eliminates $29 million for HIV prevention in Texas

The federal government has cut $29.2 million from Texas health organizations that test thousands of people for HIV directly in their communities, the latest in a series of public health funding cuts statewide.

Texas was the nation’s largest beneficiary of PS21-2102 funding, with grant money going to 11 community-based organizations (CBOs), mostly in urban areas, over the last five years.

These organizations, which provide services directly in communities, are a key pillar of the HIV prevention network because they generally enjoy more trust than clinics and tend to be much more effective in finding positive cases. The federal dollars helped cover the costs of HIV tests, connect Texans to care and pay for HIV prophylaxis, which almost completely protects from infection.

Without the grant, which the Centers for Disease Control and Prevention allowed to expire on Sept. 30, organizations have been left scrambling to find new sources of funding or pare back services. The CDC did not respond to a request for comment.

“The front line in the testing portion of it really are the community-based organizations — they’re the ones that are in their community,” said Philip Keiser, a professor at the University of Texas Medical Branch who studies HIV. “These community groups are critically important in getting out there to reach their community and get people tested.”

Rolled out in 2021, PS21-2102 provided $239 million to community-based organizations across the country. Its elimination comes as President Donald Trump’s administration has launched a far-reaching offensive targeting HIV-eradication efforts both domestically and abroad.

“From the start of this administration, we heard that HIV prevention was … under attack,” said Philip Huang, director of Dallas County Health and Human Services and the vice chair of the state’s Public Health Funding and Policy Committee.

Beyond support for HIV prevention, the federal government has also slashed public health funding to Texas more broadly, including pandemic-era grant money going toward immunization efforts, lab capacity and investigation of infectious disease outbreaks. Job cuts at the federal level have wiped out both the administrative support and technical expertise local health departments rely on, Huang said.

The uncertainty about funding has been incredibly disruptive, he said. “It’s been chaotic, uncertain, so they’re all making our job of trying to protect the public … much more difficult.”

Unlike other HIV-related grants, PS21-2102 channeled funding directly to CBOs. Now, the feds are giving a one-time pot of money to state health departments through May 2027. The CDC awarded the Texas Department of State Health Services (DSHS) over $5.2 million.

Almost a quarter of that award, $1.2 million, will flow to CBOs, while the rest will go to “projects that support the HIV prevention and surveillance efforts funded through” another program, DSHS spokesperson Lara Anton wrote in an email.

The sum is a fraction of the more than $3 million Texas CBOs had been receiving annually from the CDC. With state health departments encouraged, but not required, to send 10% of those funds to CBOs, advocates worry states will prioritize testing in clinical settings at the expense of supporting CBOs.

In Houston, Allies in Hope has been providing HIV-related care for more than four decades. Starting in 2021, the organization received about $441,000 annually from PS21-2102, which went to various prevention measures, including outreach and a mobile unit, CEO William Jeffrey Campbell explained. The grant covered more than a quarter of the 2,000 tests the organization administers yearly. Unless it can find new sources of funding, the organization will have to reduce testing.

“That $441,000, with all that it encompasses, that takes out a good chunk of the number of people that we are able to test,” Campbell said.

Going into the next legislative session, lawmakers have started considering replacement funding at the state level, said state Rep. Venton Jones, a Dallas Democrat who is the first openly HIV-positive lawmaker to serve in the Legislature. He vowed to do everything he can to replace the eliminated federal dollars, but warned state funding isn’t a permanent solution.

“This is a huge hit to our ability to respond to the epidemic,” Jones said. “Ultimately, we want to make sure that those funds are put back by the federal government, by the CDC, because those are critical.”

“Robbing Peter to pay Paul”

Texas ranks fifth in the nation for new HIV diagnoses per capita, according to 2024 data from AIDSVu, a mapping tool developed at Emory University in partnership with Gilead Sciences.

While both clinics and CBOs are key parts of an effective HIV prevention strategy, Keiser said, siphoning funding from CBOs to support clinics is like “robbing Peter to pay Paul.”

People can get tested at clinics or at their doctor’s office, but the onus typically falls on the patient to seek out the care. In contrast, because CBOs more directly reach vulnerable groups, for instance by setting up testing stations at bars or nightclubs, they tend to be more “efficient” at finding HIV-positive individuals, meaning they find more positive cases for each test administered.

Between 2012 and 2017, CBOs diagnosed a new case of HIV in 1.4% of CDC-funded tests, compared to only 0.5% for CDC-funded tests administered by local health departments; that translates to a rate of new diagnoses three times as high.

Trust also matters. In Austin, Vivent Health Vice President of Health Center Operations Emma Sinnott said much of the organization’s clientele may not trust clinics or worry that visiting a clinic could out them.

“There’s a lot of stigma in the community, and they don’t want people to know their sexuality,” Sinnott said. “Outreach allows access, testing and meeting people where they’re at.”

Vivent Health had been using its PS21-2102 award to fund outreach HIV testing and awareness. Sinnott said the grant money made up 30% of the organization’s funding for HIV prevention.

Although Vivent Health, as one of the state’s larger organizations, can better absorb the initial shock of losing the grant, the cut will limit its capacity for outreach events and reduce access to newer post-exposure prophylaxis medications like injectables, Sinnott said. While the organization will try to keep testing panels for sexually transmitted diseases free for as long as possible, Sinnott worries it will eventually need to charge for them.

Vivent meets a particular need by focusing on the populations most impacted by HIV and with the least access to testing, said Laura La Fuente, assistant director of Austin Public Health, which also provides HIV testing.

“We want to ensure that there are access points across a public health system with various partners to ensure that individuals can get tested and can get treatment,” La Fuente said.

“Penny wise and pound foolish”

The first Trump administration made eradicating HIV a pillar of its public health strategy, setting an ambitious goal of ending the HIV epidemic by 2030. In contrast, the last two years have been rough for HIV prevention efforts.

In the wake of the COVID-19 pandemic, which left Republicans distinctly wary of the CDC, the administration has tightened the agency’s leash, and many public health programs fell victim to the Department of Government Efficiency’s push to slash spending across the federal government.

In 2025, the National Institutes of Health eliminated at least $759 million in grants for HIV research. The administration has also sought to axe or alter numerous HIV-related programs, including the Ending the HIV Epidemic initiative, part of the Ryan White HIV/AIDS Program and a program supporting housing for people living with AIDS.

“The first year the Trump administration was back, they zeroed budget proposals on HIV prevention programs,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said. “We’ve been on the defensive, and this is not where we were in the last administration with President Trump.”

Experts emphasized that HIV prevention is economically advantageous regardless of the administration’s ideological stance.

A single case of HIV can cost up to $1 million in treatment over a patient’s lifetime, said Anthony Fojo, a medicine professor at Johns Hopkins Medicine. The more positive cases are found and treated, the fewer transmissions occur, which means running 1,000 HIV tests to find a single positive case still saves hundreds of thousands of dollars in the long run, he explained.

“It’s kind of penny wise and pound foolish to cut funding for testing, because it’s a lot cheaper to test and screen things than to treat additional infections down the road,” Fojo said.

In San Antonio, Black Efforts Against the Threat of AIDS was the nation’s largest recipient of PS21-2102 money. Last year, the grant covered 20% of the approximately 5,000 HIV tests the organization administered. Now, it’s looking for alternate sources of funding: writing more grants, educating local leaders and seeking more support from the city.

Each year, 300 to 400 people are newly diagnosed with HIV in San Antonio, Executive Director Michele Durham said. Reduced funding means reduced testing capacity, translating to more people living with HIV without knowing it and who could unwittingly pass on the disease.

“For us to let up off the gas right now is just not our smartest move as a community and as a nation,” Durham said.

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This story was originally published by The Texas Tribune and distributed through a partnership with The Associated Press.