JACKSON, Miss. — Dark storm clouds lingered over a local community center in Jackson, Mississippi, where Pastor Andre Devine was hosting a luncheon. The menu featured hoagies filled with smoked turkey and ham, which attracted many attendees. However, the event also provided an opportunity for essential health services, including HIV screenings, flu vaccinations, and checks for blood pressure and glucose levels.

Amidst welcoming guests, Devine, who is the executive director of the nonprofit Hearts for the Homeless, shared concerns with his peers about the significant funding losses their organizations had faced in recent weeks. These financial setbacks were a direct result of the Trump administration’s decision to cut research funding and reclaim over $11 billion allocated to health departments nationwide.

These cuts forced Devine to reduce the food distribution efforts his organization managed. Meanwhile, colleagues from the healthcare nonprofit My Brother’s Keeper were worried about potentially closing their mobile clinic—an RV parked next to the community center that morning, providing HIV tests. According to June Gipson, CEO of My Brother’s Keeper, several staff members had already been furloughed due to the ongoing financial cuts.

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“Without salaries, people cannot continue to work,” Gipson stated.

Directors of community-based organizations in Mississippi, Alabama, Louisiana, and Tennessee reported to KFF Health News that they had to cut back on HIV testing and outreach programs due to delayed or reduced federal funding, or they were preparing to make cuts in anticipation of future reductions.

Gipson emphasized that reducing these programs could have devastating effects. Without adequate support for testing and treatment, individuals living with HIV could become increasingly ill and are more likely to spread the infection to others.

President Trump, during his first term, committed to ending the HIV epidemic in the United States and allocated substantial federal resources toward this initiative. However, his recent actions have drastically reduced funding, leaving those communities most at risk without necessary support.

Previously, Trump’s initiatives focused on seven Southern states, including Mississippi. These programs were directed at community groups and health departments that serve historically marginalized communities. These communities often face discrimination and have limited access to quality education, healthcare, and economic stability, which contributes to higher rates of HIV. In 2023, despite only making up 14% of the U.S. population, Black Americans accounted for 38% of new HIV diagnoses. The South continues to report half of the new HIV cases nationally.

The recent policy changes have involved cutting funds from programs that emphasize diversity, equity, and inclusion, which the administration labeled as wasteful and discriminatory with a Day One executive order.

Since then, the Trump administration has slashed millions in federal grants to health departments, universities, and nonprofits engaged in HIV prevention work. In April, they also halved the number of the CDC’s HIV branch offices, as revealed in an email from the CDC’s Division of HIV Prevention director, leading to significant staff layoffs.

The CDC, which provides over 90% of all federal funding for HIV prevention—approximately $1 billion each year—has seen its budget threatened under Trump’s recent proposals, which aim to eliminate all prevention funding, including for efforts to end the HIV epidemic.

The Foundation for AIDS Research (amfAR) estimates that these cuts could result in over 143,000 new HIV infections and about 127,000 AIDS-related deaths within the next five years in the U.S., with additional medical costs surpassing $60 billion.

Eldridge Dwayne Ellis, who coordinates the mobile testing clinic at My Brother’s Keeper, expressed concerns that the cuts extended beyond HIV services. “For many, we are their sole resource not just for testing, but for confidential support and emotional comfort,” he explained. “It’s baffling how these decisions can disregard the health of millions so carelessly.”

Quiet Tears

Ellis’s journey to his current role was unexpected; he transitioned from construction work to healthcare after a health scare of his own led him to the organization’s clinic. He was moved by their mission to empower individuals to take charge of their health.

Ellis recalled a recent incident with a young man who had been disowned by his family and was living on the streets. This vulnerable situation increased his risk for HIV, either through transactional sex or drug use. When the young man tested positive for HIV, he was overcome with silent tears, a response Ellis described as heart-wrenching due to the fear of mortality it represented. Ellis reassured him that his diagnosis was not a death sentence.

Ellis and his team immediately connected the young man to HIV care and continued to support him, ensuring he had access to the necessary treatment to manage his condition. Proper treatment is crucial not only for the health of individuals living with HIV but also for public health, as effectively managed treatment prevents the spread of the virus.

Despite improvements in some areas, only a third of Mississippians living with HIV were virally suppressed in 2022, a stark contrast to the national average of 65% and far below the suppression rates in parts of Africa.

My Brother’s Keeper has been instrumental in improving these statistics by helping individuals get tested and adhere to their treatment plans. However, their efforts have been severely impacted by funding cuts initiated in Washington. Their first significant financial loss was a $12 million grant from the National Institutes of Health, part of a 10-year project that was cut short. The NIH criticized the program for focusing on “non-scientific categories” and “equity objectives,” which they claimed were contrary to scientific inquiry.

The organization then lost a CDC grant aimed at reducing health disparities, a program that had expanded from its initial focus during the COVID-19 pandemic to include broader health screenings. This funding loss is critical because it affects not just HIV prevention but also the management of other significant health issues like heart disease and diabetes, which disproportionately affect low-income Black populations in the South. A recent study highlighted this disparity, noting that in 2021, the life expectancy for low-income Black individuals in the South was comparable to that in economically disadvantaged countries.

Following this, My Brother’s Keeper faced additional financial challenges when they lost CDC funding that covered laboratory costs for detecting HIV and other sexually transmitted infections. Mississippi, which has the highest rate of STDs among U.S. states, relies heavily on these services to prevent the spread of infections through timely testing and treatment.

Gipson explained that the cost of these lab tests ranges from $200 to $600 per person, a cost they can no longer subsidize for patients, many of whom are unable to afford it. This financial strain was compounded by further delays in receiving two other CDC grants for HIV prevention, totaling $841,000.

Public health experts familiar with the situation at the CDC, who requested anonymity due to fear of retaliation, acknowledged these delays. They noted that the decision to freeze federal grant payments was made at a higher level than the CDC itself, despite court orders earlier in the year to release the funds.

“Many organizations that depend on these subcontracted federal funds either haven’t been paid for their work or have had their funding terminated,” said Dafina Ward, executive director of the Southern AIDS Coalition.

To address the needs of underserved communities, these organizations provide not only health services but also food, housing assistance, and transportation. This network was partly supported by Trump’s initiative to end the HIV epidemic, which had shown promising results: between 2017 and 2022, new HIV infections in targeted cities and Southern states decreased by 21%.

However, disparities remain substantial, with Black Americans being eight times more likely to be diagnosed with HIV compared to their white counterparts, and the South continues to be the most affected region. At the start of the year, Ward was optimistic as testing increased and pre-exposure prophylaxis (PrEP) drugs became more popular. But now, she fears that grassroots organizations may not survive the ongoing financial instability.

“We’re witnessing a complete reversal of efforts to genuinely work towards ending HIV in this country,” she lamented.

A Closed Clinic

In Hattiesburg, southeast of Jackson, Sean Fortenberry’s eyes filled with tears as he entered a small room that had until recently been used for HIV testing. Fortenberry has managed to keep his position at Mississippi’s AIDS Services Coalition by shifting his responsibilities, but he is deeply concerned about the future.

When Fortenberry tested positive for HIV in 2007, the support he received from his family and doctor was crucial. “I never felt alone, and that was incredibly important,” he shared. “Others aren’t so fortunate, so when I found this job, I was determined to help.”

However, the coalition was forced to freeze its HIV testing clinic and pause its mobile testing services at homeless shelters, colleges, and churches late last year. Kathy Garner, the group’s executive director, explained that the Mississippi health department, which funds the coalition with CDC’s HIV prevention dollars, instructed her to halt outreach activities in October before the state renewed the group’s annual HIV prevention contract.

Kendra Johnson, director of communicable diseases at Mississippi’s health department, acknowledged that initial delays in disbursing HIV prevention funds were due to staffing shortages within the department. However, the situation worsened when Trump took office. “We were collaborating with our federal partners to align our new goals with the updated HIV prevention strategies,” Johnson stated. “But we faced further delays due to paused communications at the federal level.”

The AIDS coalition remains operational largely thanks to federal funding from the Ryan White HIV/AIDS Program and the Department of Housing and Urban Development. However, Garner warned, “If most of these federal dollars are cut, we would have to close.”

The organization provides housing or housing assistance to approximately 400 people each year. Studies have shown that individuals in stable housing are much more likely to adhere to HIV treatment and are significantly less likely to die than those who are unhoused.

Funding cuts have impacted every state, but the South is particularly vulnerable when it comes to HIV, according to Gregorio Millett, director of public policy at amfAR. Southern states have the highest poverty rates and a critical shortage of rural clinics. Additionally, several Southern states have not expanded Medicaid, leaving many low-income adults without health insurance.

Moreover, Southern states are less likely to invest state funds in HIV prevention. Last year, Alabama, Louisiana, Kentucky, Mississippi, and Missouri allocated no state funds for this purpose, as reported by NASTAD, an association of public health officials who manage HIV and hepatitis programs. In contrast, states like Michigan, Colorado, and New York contribute significantly to their HIV prevention budgets from state resources.

“In the South, we depend on the federal government,” Gipson from My Brother’s Keeper emphasized. “We needed federal intervention during slavery, during the civil rights movement, and we still need it for healthcare. The red states are going to suffer, and we’re going to start suffering sooner than anyone else.”

‘So Goes Mississippi’

When questioned about the delays and cuts to HIV prevention funding, the CDC referred inquiries to the Department of Health and Human Services (HHS). Andrew Nixon, the department’s director of communications, responded via email: “Critical HIV/AIDS programs will continue under the Administration for a Healthy America (AHA) as part of Secretary [Robert F.] Kennedy’s vision to streamline HHS to better serve the American people.”

Nixon did not respond to a follow-up question regarding whether the Trump administration considers HIV prevention critical.

On April 4, Gipson received a portion of her delayed HIV prevention funds from the CDC. However, she remained hesitant to rehire staff given the ongoing uncertainty.

Like many other community organization directors, Gipson is pursuing grants from foundations and companies. Pharmaceutical companies such as Gilead and GSK, which produce HIV drugs, are among the largest non-governmental contributors to HIV testing, prevention, and care. However, private funding for HIV has never approached the approximately $40 billion that the federal government allocates annually for these purposes.

“If the federal government reduces or eliminates its support, the entire system will collapse,” warned Alice Riener, CEO of the community-based organization CrescentCare in Louisiana. “What we’re seeing in Mississippi is just the beginning, and the concerning part is how quickly the infrastructure we’ve built could collapse and how long it would take to rebuild it.”

Southern health officials are feeling the strain of these cuts, as state budgets are already tight. Mississippi’s state health officer, Daniel Edney, spoke with KFF Health News on the day the Trump administration terminated $11 billion in COVID-era funds intended to help states enhance their public health infrastructure. “There’s not much fat left, and we’re cutting to the bone now,” Edney remarked.

Mississippi desperately needed this financial boost, as the state ranks among the lowest in health metrics, including premature death, access to clinical care, and teen births. However, Edney noted some positive trends: the state recently improved from the 50th to the 49th worst health ranking, and its rate of new HIV cases was declining.

“The science tells us what we need to do to identify and care for patients, and we’re making progress,” he said. “But trends can shift rapidly, so we can’t afford to slow down.”

If efforts are reduced, researchers warn, the resurgence of HIV will initially go unnoticed as the virus silently spreads among marginalized populations before they seek hospital care. As untreated infections proliferate, the impact will eventually become significant enough to affect national statistics, resulting in a resurgence that will cost lives and take years, if not decades, to reverse.

Outside the community center on that stormy morning in March, Pastor Devine expressed his concerns not only about the loss of his health department grant but also about a $1 billion cut to food distribution programs at the U.S. Department of Agriculture. He listed the potential repercussions he feared: people dependent on food assistance would be forced to choose between buying groceries, paying bills, or seeking medical care, pushing them further into poverty, emergency rooms, and potentially criminal activities.

Deja Abdul-Haqq, a program director at My Brother’s Keeper, agreed with Devine’s assessment. “As goes Mississippi, so goes the rest of the United States,” Abdul-Haqq declared. “Challenges may originate here, but they spread nationwide.”

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues. It is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.