HealthHIV Releases State of Aging with HIV Survey Results

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

HealthHIV has released its fifth annual survey on the State of Aging with HIV™, finding both positive and negative results from patients and providers alike. This report details survey findings and implications across five areas: HIV and Geriatric Care, Comorbidities, Behavioral Health, Access and Payment, and Workforce.

HealthHIV summarized the survey as follows:

"The survey revealed an HIV care system that delivers clinical wins. Over 98% of consumers reported being virally suppressed, and nearly 100% are taking antiretrovirals, the highest rates across five waves of the survey. The same data, however, show that the broader clinical reality of aging with HIV, multimorbidity, frailty risk, mental health burden, and the structural conditions of daily life, is not being managed with the same consistency."

Photo Source: HealthHIV

Key findings include:

Viral Suppression is High Among Older People Living with HIV/AIDS

Among People Living with HIV/AIDs (PLWHA) surveyed, 98% reported that their HIV was virally suppressed. This is significantly better than the national average of 62% (CDC, 2026).

While viral suppression was reported to be high, respondents indicated that age-related testing, screening, and other geriatric care were significantly lacking. Just 17% of respondents reported being screened for HIV-related medical frailty, with screenings for frailty declining from 25% of patients under the age of 65 being screened in 2022 to just 11% in 2026. HealthHIV found that patients with lower incomes were significantly less likely to be screened at all.

PLWHA Are Heavily Burdened by Comorbid Non-HIV Chronic Conditions

More than 80% of respondents indicated that they have at least one non-HIV-related chronic condition for which they are currently taking prescription medications, of whom 22% reported having to change their antiretroviral (ARV) medication due to a contraindication with another drug.

HealthHIV’s analysis of responses found that more than 25% of respondents have very high medical needs, but are underserved.

Photo Source: HealthHIV

Behavioral and Mental Health Issues Are Prevalent Among Older PLWHA

More than 75% of respondents indicated having moderate or high levels of stress, but fewer than 2% of respondents identified mental health as being an immediate need. Many respondents indicated that they had a “good” quality of life, but also carried high levels of stress. HealthHIV suggests that this finding indicates that respondents place more importance on the outward appearance of wellness while simultaneously ignoring or disregarding mental health as a part of a “good” quality of life.

Research has found that high levels of psychological stress can have negative impacts on PLWHA and their physical health and health outcomes. For example, traumatic and stressful life experiences have been associated with reduced adherence to treatment regimens, virologic failure, higher rates of mortality and opportunistic infections, increases in the use of recreational drugs in such ways that may result in behaviors detrimental to the health of both the patient and others, and arterial inflammation (Reif et al., 2013; Chow et al., 2023).

Access to and Paying for Medications and Treatment is Likely to Get Tougher for PLWHA in the Future

While existing programs and insurance coverage of ARV treatments are currently working, HealthHIV reports that those systems, like PLWHA who are aging, are becoming increasingly frail.

HealthHIV highlights reports that state AIDS Drug Assistance Program (ADAP) budgets are becoming increasingly strained, and that the reintroduction of waiting lists (Hopkins, 2026) in Iowa and Utah presages tough times ahead for PLWHA who are aging.

Photo Source: HealthHIV

According to the survey, fewer than half of respondents had retirement plans (largely because many didn't expect to live into their 50s), almost one-third reported food insecurity, and one in five avoided care due to cost.

Respondents to HealthHIV’s survey reported that transportation remains the strongest single barrier to accessing care and treatment, with lower-income patients being six times more likely to miss an HIV appointment because they cannot get to the appointment. Additionally, HealthHIV reports that more than half of Medicare enrollees still rely on the Ryan White HIV/AIDS Program (RWHAP) and ADAP to access HIV medications.

Providers Are Largely Unequipped to Effectively Treat Aging PLWHA

Providers who responded to HealthHIV’s survey reported that, while they understand that aging PLWHA face unique needs that require specialized care, they currently lack the staff, funding, or expertise to provide these services.

HealthHIV found that just 1.2% of provider respondents specialized in gerontology, compared with 21% with specializations in HIV medicine. Moreover, they found that workforce turnover is eroding the institutional knowledge and awareness of both the history of the HIV epidemic and the cultural and lived experiences of aging PLWHA.

Photo Source: HealthHIV

Regarding aging-care readiness among patients, providers reported troubling trends. Among them, only half were aware of the protections afforded to them under the Americans with Disabilities Act (ADA), a fact that is particularly important for end-of-life planning. Fewer than one-fourth of providers offer advance care planning, which is compounded by the fact that only 16% of caregivers report having adequate support.

In Closing

HealthHIV has made available the final report for its fifth State of Aging with HIV™ survey on its website at healthhiv.org/stateof/agingwithhiv/. On May 6th, HealthHIV hosted an educational webinar, and free access to this on-demand webinar is available online, along with the presentation slides. 

At this point in history, more than half of PLWHA are over the age of 50, making this research essential to maintaining a robust and effective HIV care continuum. 

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Centers for Disease Control & Prevention. (2026, March 16). Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States, 2023 Cycle (June 2023—May 2024). Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: HIV Data: Medical Monitoring Project. https://www.cdc.gov/hiv-data/mmp/behavioral-clinical-characteristics-pwh-2023.html

[2] Chow, F. C., Mundada, N. S., Abohashem, S., La Joie, R., Iaccarino, L., Arechiga, V. M., Swaminathan, S., Rabinovici, G. D., Epel, E. S., Tawakol, A., & Hsue, P. Y. (2023, October). Psychological stress is associated with arterial inflammation in people living with treated HIV infection. Brain, Behavior, and Immunity, 113, 21-28. https://doi.org/10.1016/j.bbi.2023.06.019

[3] HealthHIV. (2026). Findings and implications from HealthHIV State of Aging with HIV Fifth Annual Survey. Washington, DC: HealthHIV: State of. https://healthhiv.org/stateof/agingwithhiv/

[4] Hopkins, M. J. (2026, May 14). The ADAP “Perfect Storm” Returns; Over 1,000 Patients Being Denied Care. Nags Head, NC: ADAP Advocacy: Blog. https://adapadvocacyassociation.blogspot.com/2026/05/the-adap-perfect-storm-returns-over.html

[5] Reif, S., Mugavero, M., Raper, J., Theilman, N., Leserman, J., Whetten, K., & Pence, B. W. (2011, February). Highly Stressed: Stressful and Traumatic Experiences among individuals with HIV/AIDS in the Deep South. AIDS Care, 23(2), 152-162. https://doi.org/10.1080/09540121.2010.498872

The ADAP “Perfect Storm” Returns; Over 1,000 Patients Being Denied Care

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

What’s old is new, again! The “Perfect Storm” that confronted state AIDS Drug Assistance Programs for nearly a decade and resulted in patients living with HIV/AIDS being denied access to care is now the reality…again! 

According to the National Alliance of State and Territorial AIDS Directors (NASTAD), two states—Iowa and Utah—have implemented waiting lists for their ADAPs, becoming the first to do so in thirteen years. 1,106 patients living with HIV/AIDS are impacted in Iowa, and another 10 in Utah (NASTAD, 2026b).

Photo Source: NASTAD

The reimplementation of waiting lists comes after 12 years of flat funding for ADAP at the federal level and 2 decades of declining state-level funding (NASTAD, 2026a). These conditions have been exacerbated with the passage of the One Big Beautiful Bill, which decimated the social safety net (Segal, 2025). 

ADAP waiting lists were commonplace in the 2000s and into the mid-2010s, with waiting list rosters reaching their peak in 2011, with 9,298 Persons Living with HIV/AIDS (PLWHA) impacted across eleven states (The Henry J. Kaiser Family Foundation, 2017). In 2003, eight patients died while on ADAP waiting lists, including 5 in Kentucky and three in West Virginia (Connolly, 2004).

The reality is that ADAP programs quite literally save lives.

Research published in Clinical Infectious Diseases found that, despite ADAPs serving less than 25% PLWHA in the United States, ADAP clients account for almost a third of the entire viral suppression rate, with viral suppression rates ranging from 81.2% to 91.4% for ADAP client, compared with the overall viral suppression rate of 60% to 66.3% (McManus et al., 2026).

While Iowa and Utah are the first to reintroduce waiting lists, they are unlikely to be the last, particularly given the Trump Administration’s proposed budget, which has been characterized as having an open disdain for federal healthcare and social assistance programs.

Photo Source: Rolling Stone

In April 2026, the White House’s Fiscal Year 2027 Budget proposal calls for the wholesale elimination of the Housing Opportunities for Persons With HIV/AIDS (HOPWA) program, referring to the program as “…outdated by focusing on housing low-income, homeless, and at-risk HIV-positive individuals, as the prognosis and medical care for HIV have significantly improved since the 1990s” (Office of Management and Budget, 2026).

In addition to waiting lists, NASTAD’s April 2026 ADAP Watch also reported that 19 programs are facing budget deficits, citing the following reasons:

• Increasing drug costs/expenditures per client
• Increasing health insurance premium costs
• The expiration of enhanced premium tax credits
• Increasing client enrollment
• Decreasing 340B drug pricing program rebate revenues, and
• Changes in federal allocations or supplemental funding (NASTAD, 2026b)

Two states—Indiana and Utah—have also introduced ADAP enrollment caps, with Indiana capping enrollment at 4,500 patients and Utah at 225 full-pay clients in addition to the aforementioned waiting lists. The travesty happening to Floridians living with HIV/AIDS is an entirely different situation, with one HIV advocate calling it “an open season on people living with AIDS,” and another to pen her pre-obituary as a "protest" as that state attempts to kick thousands of patients off its ADAP services.

Photo Source: ADAP Advocacy

Additional cost-containment measures, including the previously reported lowering of income eligibility thresholds across various states (Hopkins, 2026), are likely to be implemented in the coming year, with little end in sight unless federal and state legislators decide to reprioritize PLWHA.

ADAP Advocacy will continue to monitor and report on changes to ADAP waiting lists as new developments occur, as it is taking steps to launch a national advocacy campaign to confront them.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Connolly, C. (2004, May 20). States Offering Less Assistance For AIDS Drugs Federal Spending Is Up, but So Is Demand, Survey Finds. The Washington Post. https://www.washingtonpost.com/wp-dyn/articles/A41229-2004May19.html 

[2] Henry J. Kaiser Family Foundation, The (2017, August). AIDS Drug Assistance Programs (ADAPs). Menlo Park, CA: The Henry J. Kaiser Family Foundation: Fact Sheet. https://files.kff.org/attachment/Fact-Sheet-AIDS-Drug-Assistance-Programs

[3] Hopkins, M. J. (2026, March 26). Ryan White Programmatic Funding Balances on a Precarious Precipice. Nags Head, NC: ADAP Advocacy: Blog. https://adapadvocacyassociation.blogspot.com/2026/03/ryan-white-programmatic-funding.html

[4] McManus, K. A., Killelea, A., Rogers, E. Q., Liu, F., Horn, T., Steen, A., Keim-Malpass, J., Hamp, A., & Rogawski McQuade, E. T. (2026, March 25). State AIDS Drug Assistance Programs’ Contribution to the US Viral Suppression, 2015–2022. Clinical Infectious Diseases, ciag034. https://doi.org/10.1093/cid/ciag034

[5] National Alliance of State and Territorial AIDS Directors. (2026a). 2026 National Ryan White HIV/AIDS Program Part B ADAP Monitoring Project Annual Report: Stabilizing the Safety Net: Stewardship and Outcomes in a Volatile Landscape. Washington, DC: National Alliance of State and Territorial AIDS Directors. https://nastad.org/2026-rwhap-part-b-adap-monitoring-report

[6] National Alliance of State and Territorial AIDS Directors. (2026b, April). ADAP Watch: April 2026. Washington, DC: National Alliance of State and Territorial AIDS Directors: Resources: ADAP Watch. https://nastad.org/sites/default/files/2026-04/adap-watch-april-2026.pdf

[7] Office of Management and Budget. (2026). Budget of the U.S. Government. Washington, DC: Executive Office of the President: Office of Management and Budget. https://www.whitehouse.gov/wp-content/uploads/2026/04/budget_fy2027.pdf

[8] Segal, B. (2025, July 3). How the ‘One Big, Beautiful Bill’ Targets Medicare and Medicaid. GovFact.org. https://govfacts.org/money/social-safety-net/medicare-medicaid/how-the-one-big-beautiful-bill-targets-medicare-and-medicaid/

Treatment of HIV with ART Slows Advanced Biological Aging Process

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Research presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global conference in Munich, Germany, has found that early initiation of antiretroviral therapy (ART) for HIV reduces accelerated aging in people living with the virus (Ryan et al., 2026).

Photo Source: ESCMID

While this research is currently in pre-print form, meaning that it has not been peer reviewed for final publication, it could help to provide additional ammunition in the argument that initiating ART as soon as possible can help People Living with HIV/AIDS (PLWHA) live longer, healthier lives.

Researchers developed a plasma proteomic aging clock (PAC)—a tool used to estimate biological age, measuring the age of the body, as opposed to chronological age which measures a body’s age in terms of birth year to present. During the period prior to initiating ART, the PAC estimated that participants’ biological age was accelerated by a median of 10 years. With effective ART, this was reduced by nearly four years. 

How Does HIV Cause Accelerated Aging?

Research has suggested that, soon after the acquisition of HIV, the virus causes the human body to begin an accelerated aging process at the DNA level, contributing to the earlier onset of age-related diseases, such as heart and kidney diseases, medical and physical frailty, and cognitive difficulties (Rivero, 2022). Research published in 2022 found that this accelerated aging process begins within three years of the initial acquisition (Breen et al., 2022).

Earlier research also found that PLWHA may experience lipodystrophy—abnormal fat distribution—in both treated and untreated HIV, which can include the loss of subcutaneous fat in the face, extremities, and buttocks, as well as an increase in fat in the abdominal area, breasts, or at the top of the back, known as “buffalo hump.” This research also found that a combination of metabolic and immunologic changes can cause or exacerbate cardiovascular disease in PLWHA (Meir-Shafrir & Pollack, 2012).

Photo Source: MEDXY

What Does This Mean for People Living with HIV/AIDS?

Prior to 2012, people who had been diagnosed with HIV were not advised to begin ART until they had received an AIDS diagnosis after their CD4 (T-cell) count had fallen below 200 per microliter of blood (Castro et al., 1992). In March 2012, the Centers for Disease Control and Prevention (CDC) updated its treatment recommendations to recommend beginning ART as soon as possible, rather than waiting for an AIDS diagnosis (CDC, 2012).

This change has led to an overall decrease in the number of new diagnoses, in no small part due to the fact that PLWHA who are receiving ART and are virally suppressed have been shown to be unable to transmit the virus through sexual contact (CDC, 2024).

For PLWHA, early initiation of ART can help to slow down the accelerated aging process. This is true, also, for those currently receiving ART, which makes remaining on treatment and being virally suppressed even more important.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Breen, E. C., Sehl, M. E., Shih, R., Langfelder, P., Wang, R., Horvath, S., Bream, J. H., Duggal, P., Martinson, J., Wolinsky, S. M., Martinez-Maza, O., Ramirez, C. M., & Jamieson, B. D. (2022, July 15). Accelerated aging with HIV occurs at the time of initial HIV infection. iScience, 25(7), 104488. https://doi.org/10.5041/RMMJ.10089

[2] Castro, K. G., Ward, J. W., Slutsker, L., Buehler, J. W., Jaffe, H. W., Berkelman, R. L., & Curran, J. W. (1992, December 18). 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR, 41(RR-17). https://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

[3] Centers for Disease Control and Prevention. (2012). Changes in US HIV Treatment Guidelines [Transcript]. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: Audio Rounds. https://tools.cdc.gov/podcasts/media/pdf/AudioRounds_HIV_Tx_Guidleines.pdf

[4] Centers for Disease Control and Prevention. (2024, October 24). HIV Treatment as Prevention. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: HIV Public Health Partners: HIV Treatment. https://www.cdc.gov/hivpartners/php/hiv-treatment/index.html

[5] Meir-Shafrir, K. & Pollack, S. (2012, October). Accelerated Aging in HIV Patients. Rambam Maimonides Medical Journal, 3(4), e0025. https://doi.org/10.5041/RMMJ.1008

[6] Rivero, E. (2022, June 30). Study shows HIV speeds up body’s aging processes soon after infection. Los Angeles, CA: University of California Los Angeles: UCLA Health: News: Release. https://www.uclahealth.org/news/release/study-shows-hiv-speeds-up-bodys-aging-processes-soon-after

[7] Ryan, B., Oumelloul, M. A., Rouached, S., Juillerat, A. D., Giacccheto, L., Thorball, C. W., Schoepf, I. C., Arribas, J. R., Soldevila, B. R., Kootstra, N., Reiss, P., Jackson-Perry, D., Haerry, D. H-U., Günthard, H. F., Bartl, L., Dollé, C., Russenberger, D., Nanni, P., Kockmann, T., … Tarr, P. E. (2026, March 26). A Plasma Proteomic Ageing Clock Reflects Advanced Ageing in People with Untreated HIV and its Reduction Under Antiretroviral Therapy. medRxiv. https://doi.org/10.64898/2026.03.24.26348875

Connecticut’s Misguided Medicaid Proposal Places People Living with HIV/AIDS at Risk

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The Office of Connecticut Governor Ned Lamont released its Fiscal Year 2027 Recommended Budget Adjustments document (Office of Policy and Management, 2026), in which they recommend removing antiretroviral medications used to treat HIV from the Medicaid exclusion list and adding them to the state’s Preferred Drug List (PDL). Earlier this year, Colorado’s Department of Health Care Policy and Financing (HCPF) considered modifying its protected drug classes and allowing prior authorization for select drugs, a move that threatens to undermine that progress.

Photo Source: SHAHRZAD RASEKH / CT MIRROR

This week, ADAP Advocacy joined HealthHIV in issuing a joint statement on the proposal. Both organizations submitted public comment to the Connecticut General Assembly, maintaining that the health of Connecticuters living with HIV/AIDS is being put at risk if the protected drug class is weakened by adding antivirals to the state’s PDL. To read the public comment, click here.

What is a Medicaid Drug Class Exemption?

At issue in Connecticut is the exemption of medications used to treat HIV/AIDS from being included on the state’s PDL.

An “exemption,” in this case—also known as an exclusion or an exception—means that the medications are considered necessary for patients’ continued good health or survival, and therefore should not be included on the PDL, a tool that is specifically designed to restrict which medications will be covered for patients by limiting coverage to medications for the purpose of cutting costs or limiting expenditures. Exemptions are usually applied to entire classes of drugs and typically include medications used to treat HIV, cancer, and epilepsy. This practice is commonly referred to as the Protected Drug Class (PDC).

Exemptions can be whole—as is the case with medications used to treat HIV—or class-specific, such as medications used to treat mental health issues and epilepsy, in which cases prescriptions are not subject to step-therapy requirements that would require patients to try other medications prior to being prescribed the one they actually need.

Photo Source: MedicareFAQ

Why Adding Medications to Treat HIV to the PDL is a Bad Idea

When a class of medications is exempted from inclusion on a PDL, medications in that class cannot be subject to prior authorization (PA) requirements, patients are able to access the medications that work best to treat their specific strain of HIV, and patients are not forced to endure delays or administrative red tape that might prevent them from accessing and taking the medications they need to stay alive.

In its budget adjustment document, Connecticut has made a craven attempt to justify including HIV medications on the PDL by suggesting—incorrectly—that medical advances in HIV therapies merit this change:

Now, over two decades later, there have been significant advances in the treatment of HIV and, in recognition of this, the Governor is proposing to lift the current restrictions and include antiretroviral medications on the preferred drug list. This will not only allow the state to receive supplemental rebates on these drugs, but it will also allow for better management of these medications as their inclusion on the preferred drug list will help to ensure practitioners are aligning with clinical criteria and best practices (OPM, 2026).

Not only is this assumption wildly incorrect, but it also amounts to medical malpractice by the State of Connecticut. And all so the state can reap drug rebates to offset expenditures.

Advancements in the quality, tolerability, and efficacy of HIV treatment regimens do not mean that every patient’s HIV can be treated with the same medication.

HIV—a retrovirus that uses reverse transcriptase enzymes to turn its ribonucleic acid (RNA) into deoxyribonucleic acid (DNA), making itself compatible with a person’s own DNA—evolves extremely rapidly, exhibiting the highest recorded biological mutation rate of any organism currently known to science. This is largely due to the reverse transcriptase process, which is prone to errors during viral replication (Andrews & Rowland-Jones, 2017).

In lay terms, this means that medications used to inhibit the reverse transcriptase process—nucleoside reverse transcriptase inhibitors (NRTIs, such Truvada) and non-nucleoside reverse transcriptase inhibitors (NNRTIs, such as rilpivirine, used as part of the Cabenuva long-acting injectable regimen)—are vital for not only maintaining viral suppression, but for ensuring that the HIV virus, itself, is not given a chance to mutate.

What this means for patients is that, once they begin treatment for HIV, lapses in treatment can lead to the HIV virus mutating to create multidrug-resistant strains of the virus. Essentially, if patients suddenly stop taking a medication without replacing it with another NRTI or NNRTI, they risk developing a strain of HIV that is more difficult and more expensive to treat.

Photo Source: Medwave

What Can People Do to Prevent These Changes?

Under current Connecticut law, medications to treat HIV are exempt from inclusion on the PDL precisely because of the nature and rapid mutation of the HIV virus. Changing this drug class exemption literally places the lives of not only people currently living with HIV/AIDS at risk, but also those who might contract a multidrug-resistant strain of HIV from someone whose medications were delayed or no longer covered by Connecticut’s Medicaid program.

Alex Garbera, a long-term survivor of the HIV/AIDS epidemic and patient advocate residing in Connecticut, stated:

“Under current law, classes of antiretroviral drugs are exempt from prior authorization requirements and cannot be included on preferred drug lists. But what the Governor is proposing undermines that protection. PDLs, under the cloak of saving money, may be selecting drugs that are not based on patient needs but on the number of rebates received by the state from drug manufacturers. Sadly, prior authorization is far too common but still imposes an administrative burden on providers, can cause delays in obtaining needed medication, and could result in denial, subject to an appeal process. In my humble opinion, I would say keep the current law exactly as it is for HIV medications, given the complicated medical issues involved.”

For full Bill information, visit:

https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=HB05040&which_year=2026#

To locate your CT State Legislators, go to:

https://www.cga.ct.gov/asp/menu/cgafindleg.asp

To contact the CT Governor's office, visit:

https://portal.ct.gov/governor/contact-the-governor?language=en_US

The HIV Medicine Association (HIVMA) published an important fact sheet, outlining the potential harm done to HIV-positive patients by allowing prior authorization with HIV medicines, which would be allowed by states adding antivirals to PDLs. ADAP Advocacy will continue to monitor this situation, as well as monitor actions that may be taken in other states that place patients at risk.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Andrews, S. M. & Rowland-Jones, S. (2017). Recent advances in understanding HIV evolution. F1000Research, 6, 597. https://doi.org/10.12688/f1000research.10876.1

[2] Office of Policy and Management. (2026, February 04). FY 2027 recommended budget adjustments. Hartford, CT: State of Connecticut: Office of Policy and Management: Budget Document Home. https://portal.ct.gov/-/media/opm/budget/2027-midterm/governors-budget-2027-web-version-3-5-26.pdf?rev=8fedbe3df5384f6fa74c78846ec50017&hash=626EFF74CC89DC9E3949C627466B69D9

When Will 'Big' Enough Be Enough for Big Hospital Systems?

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Just four hospital systems control over 600 (~10%) of the 6,100 hospitals in the United States (Dyrda, 2026; American Hospital Association, 2026), and each of those four companies owns over 100 hospitals. There are 34 more private companies that own a combined 1,461+ additional hospitals, many if not most of which are regional systems.

Another report issued by Yale University in 2026 found that in 32 states, 50% or more of the hospitals are either highly concentrated in single areas or exist in a monopoly where one system is the only hospital provider available in a given state, including 19 states where two-thirds or more of the hospitals meet those criteria (Figure 1, Cooper et al., 2026).

Figure 1 - Share of hospitals that are in a highly concentrated market or are part of a monopoly, 2025

Photo Source: Owens, 2026

While hospital mergers can have positive outcomes, including financial and operational stability for the hospitals and the addition of new services at hospitals offered to patients after mergers, repeated evidence has demonstrated that hospital consolidation—the practice of hospital or healthcare systems purchasing existing hospitals and/or medical practices—creates more barriers to accessing healthcare services by:

• Reducing or eliminating competition, which strengthens the ability of large hospital systems to demand higher reimbursement rates, thereby increasing prices and introducing cost barriers
• Limiting the ability of patients to access healthcare services outside of those systems by locking them into provider networks through their public or commercial insurance providers (e.g., Medicaid, private, or employer-sponsored health insurance programs)
• Shuttering hospitals, clinics, and other providers that do not generate sufficient revenues for the hospital system to keep them in operation, thereby introducing distance, transportation, and cost barriers (Phillips, 2023).

In some cases, hospital systems, such as Bon Secours, will rake in 340B Drug Pricing Program rebate revenues from hospitals and practices serving lower-income neighborhoods, but choose to reinvest those dollars in more affluent communities where reimbursement rates are likely to be higher.

What Can Be Done?

Hospital consolidations, along with other types of business acquisitions, should fall under scrutiny by federal agencies whose remits include investigating, prosecuting, and breaking up sector monopolies. However, an analysis published in American Economic Review: Insights found that the Federal Trade Commission (FTC) took enforcement actions against just 13 of the 1,164 hospital mergers that occurred between 2002 and 2020, despite 238 of those transactions (20.4%) could have been flagged by the FTC using standard merger screening tools as being likely to increase prices by decreasing competition. Further examination of mergers that occurred between 2010 and 2015 found that 97 could have been flagged by the FTC as likely to increase prices by reducing competition. The FTC intervened in just 8 of these cases (Brot-Goldberg et al., 2024).

Photo Source: NPR | KUNR

It has long been speculated that both the FTC and the U.S. Department of Justice (DOJ) are not only susceptible to political interference in their activities by bad actors, but easily fall prey to those manipulations through the appointments of officials who lack qualifications, serve the whims of the sitting President, or fail to ensure that the agencies they lead remain independent of administration officials and/or corporate interests/lobbying.

This essentially leaves individual states to pursue antitrust charges against these mergers. Again, these state entities are as susceptible to administrative and business-interest interventions aimed at preventing enforcement. The sad reality is these Big Hospital Systems will continue to expand, and patient access and choice will continue to deteriorate.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] American Hospital Association. (2026). Fast Facts on U.S. Hospitals, 2026. Chicago, IL: American Hospital Association: Statistics. https://www.aha.org/statistics/fast-facts-us-hospitals

[2] Brot-Goldberg, Z., Cooper, Z., Craig, S., & Klarnet, L. (2024, December). Is There Too Little Antitrust Enforcement in the US Hospital Sector? American Economic Review: Insights, 6(4), 526-542. https://tobin.yale.edu/sites/default/files/2024-02/Hospital_Merger_Heterogeneity_manuscript.pdf

[3] Cooper, Z., Harris, A., & Hill, M. (2026, March 09). A Ranking of All 50 States by Hospital Consolidation. New Haven, CT: Yale University: Health Care Affordability Lab: Commentary. https://www.healthcareaffordabilitylab.org/commentary-press-release-posts/a-ranking-of-all-50-states-by-hospital-consolidation

[4] Dyrda, L. (2026, February 25). 100 of the largest hospitals and health systems in the US: 2026. Chicago, IL: Becker’s Hospital Review: Rankings and Rating. https://www.beckershospitalreview.com/rankings-and-ratings/100-of-the-largest-hospitals-and-health-systems-in-the-us-2026/

[5] Owens, C. (2026, March 09). The states where hospitals are most concentrated. Arlington, VA: Axios: Health. https://www.axios.com/2026/03/09/hospital-concentration-states-health-costs

[6] Phillips, A. (2023, November 15). The consequences of U.S. hospital consolidation on local economies, healthcare providers, and patients. Washington, DC: Competition. Washington Center for Equitable Growth. https://equitablegrowth.org/research-paper/the-consequences-of-u-s-hospital-consolidation-on-local-economies-healthcare-providers-and-patients/

A Recent Milestone in HIV Treatment: The 10th Patient

By: Jonathan Sosa, Guest Blog Contributor, ADAP Advocacy

Recently, a Norwegian man became the 10th person ever to be cured of HIV. It represents another step forward in understanding how long-term remission can be achieved for those living with HIV. The news also still offers hope for people living with HIV/AIDS (PLWHA) that a cure is possible, while also offering some good news for the HIV community–which has been battered by a presidential administration gutting long-established and proven safety-net programs that have served as the backbone of the nation’s care continuum for them.

Photo Source: Live Science | Dr_Microbe via Getty Images

The 63-year-old Norwegian patient received a stem cell transplant from his brother, who carries a rare genetic mutation known as CCR5-delta 32. This mutation prevents HIV from entering immune cells, effectively blocking the virus from spreading within the body. 

Following the transplant, the patient discontinued antiretroviral therapy (ART) and has shown no detectable viral load (Glassman-Hughes, 2026; Gometz, 2026). While cases like this are rare, they prove that eliminating HIV from the body is possible nonetheless. 

Limits of this treatment approach 

Despite the significance of this case, there are limitations that prevent it from being a universal solution for curing HIV/AIDS. 

First, stem cell transplants are complex, high-risk procedures usually done on patients who have cancer. In other words, these are not common procedures (or even the safest options) for most PLWHA. 

Second, the 10th man cured from HIV/AIDS has a brother with a natural mutation that creates a natural resistance to it. However, there are not many donors that may have this CCR5 mutation, which limits the ability to scale this approach to others living with HIV/AIDS. Due to limitations like these, researchers are not viewing this case as a universal solution but as insight into how the disease can be cured in more people moving forward. 

Photo Source: WowRx

Why HIV/AIDS funding matters 

The HIV community has expressed concern with feeling under attack, since policies regarding funding are being called into question, and in some cases gutted or eliminated as proposed in the Trump Administration’s Fiscal Year 2027 budget blueprint. This uncertainty makes continued scientific progress even more important. It shows why HIV funding matters. 

Despite pressures on HIV advocacy and proposed funding cuts, there is still promising news, like the cure for the 'Oslo patient'. Each new case is evidence that a cure to HIV is possible. Prior to this case, several other HIV patients who underwent comparable transplants had achieved long-term remission from the infection (Lanese, 2026).

Continued progress in HIV treatment is driven by ongoing research efforts to find a cure. According to the National Institutes of Health, current strategies include gene-editing techniques designed to replicate the CCR5 mutation, immune-based therapies targeting hidden viral reservoirs, and approaches aimed at activating and eliminating latent viral reservoirs within the body (National Institutes of Health, 2026). 

These research efforts reinforce why continued investment in HIV research remains essential for providing accessible care. Although challenges remain, progress is being made, and cases like these prove why research and investment into HIV care should be supported.

Disclaimer: All of the funders of the ADAP Advocacy Association are publicly available online at https://www.adapadvocacy.org/support.html. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Lanese, Nicoletta. (2026, April 13). Oslo patient likely cured of HIV after getting stem cell transplant from his brother who is genetically resistant to the virus. Live Science. https://www.livescience.com/health/hiv/oslo-patient-likely-cured-of-hiv-after-getting-stem-cell-transplant-from-his-brother-who-is-genetically-resistant-to-the-virus

[2] National Institutes of Health. (2025, April 15). Research toward an HIV cure: Research priorities overview. NIH Office of AIDS Research. https://www.oar.nih.gov/hiv-policy-and-research/research-priorities-overview/research-toward-hiv-cure

[3] Glassman-Hughes, Emma. (2026, April 14). Norwegian man is 10th person cured of HIV thanks to his brother. New York Post. https://nypost.com/2026/04/14/health/norwegian-man-is-10th-person-cured-of-hiv-thanks-to-his-brother/

[4] Gometz, Emma (2026, April 13). Person functionally cured of HIV after bone marrow transplant from sibling. Scientific American. https://www.scientificamerican.com/article/person-functionally-cured-of-hiv-after-bone-marrow-transplant-from-sibling/

Lies, Damned Lies, and 340B Matters Lies

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The 340B reform denialists, in chorus, obfuscate the truth: namely, that the 340B Drug Pricing Program is doing "just fine" and needs no changes, no matter how big or small. In a recent social media post, an organization that professes to care about patients, “340B Matters”, posted the following on X:

Welcome to Friday Pharma Lies, a series debunking the drug industry’s falsehoods about the 340B Program.

Lie: 340B discounts are supposed to be passed along to patients.

Truth: Congress created 340B “to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.” Accordingly, covered entities use 340B to fund safety net healthcare services they otherwise could not afford to offer. Many covered entities use 340B discounts to connect patients with discounted drugs, but there is no requirement for them to do so (Figure 1; 340B Matters, 2026).

Figure 1 – 340B Matters Social Media Post

Photo Source: 340B Matters

This post, while technically accurate, is arguably one of the most craven positions one can take on the sprawling, virtually unregulated funding mechanism we call the 340B Program.

Moreover, it is a position being taken by an “org” that is almost entirely devoid of information about who they are.

When looking into the history of 340B Matters, what ADAP Advocacy was able to find was the following:

1. 340B Matters is not, according to the federal government, a 501(c) non-profit organization. While this is not, in and of itself, illegal, the “.org” URL domain was originally intended for non-commercial ventures and organizations. As such, when a website is created using the “.org” extension, the safe assumption is that the website one is visiting is that of a non-profit or charitable organization. Instead, the website is owned by Han Kingler, a partner at the lobbying firm Black Diamond Strategies, who, according to the 340B Matters website’s privacy policy, serves as the Executive Director of the organization (340B Matters, 2016).
2. In addition to not being a registered non-profit, 340B Matters is “proudly sponsored” by The Craneware Group, a for-profit organization that specializes in “340B solutions”—a fanciful way of saying, “Maximizing 340B revenues for providers and increasing profits” (The Craneware Group, 2026). This, of course, runs counter to the 340B Matters tagline, “Patients Over Profits. The Craneware Group, while legally domiciled in Scotland, has a U.S. headquarters in Deerfield Beach, FL, part of the greater Boca Raton/Ft. Lauderdale area. The “solutions” they offer are software-based applications that focus on maximizing profits and decreasing overhead costs, including margins, revenues, and workforce.
3. 340B Matters obfuscates its ownership and operational team by creating a “Who We Are” page that provides the following explanation of the organization: “340B Matters seeks to protect this vital program for nonprofit healthcare facilities from those that would severely restrict access to the 340B program. We support patients over profits” (340B Matters, 2025). This page includes no information about who founded the organization, whether the organization has a Board of Directors, nor mentions any employees, contractors, or executive leadership. Nor does their website indicate that any healthcare providers or patient advocacy groups are affiliated with 340B Matters.

Essentially, what ADAP Advocacy found is that every aspect of the 340B Matters “organization” operates for one purpose:

To continue the unchecked growth of the 340B program. That explosive growth is concerning because it hasn't alleviated the medical debt crisis in this country, but also because it sets the stage for a program that is too big to fail.

Photo Source: ADAP Advocacy

Again, the aforementioned social media post is technically correct: there is no statutory obligation for 340B covered entities to provide discounted medications to the patients they purport to serve.

And this is just one of myriad problems with the 340B Program.

The program was designed to ensure that patients who could otherwise neither access nor afford healthcare services, particularly those living with HIV/AIDS, hemophilia, and Black Lung disease.

What it has become, however, is a revenue cash cow for unscrupulous hospitals, Federally-Qualified Health Centers, and other covered entities that, because of the fact that there are virtually no rules or enforcement mechanisms for the 340B Program itself, are able to get away with misappropriating 340B funds to support various endeavors that run counter to the statute’s intended purposes, including (but not limited to):

1. The inflation of executive compensation packages, as documented on 340bmap.org
2. The building, renovation, or upgrading of facilities in ways that do not improve access to healthcare services (e.g., adding water and other decorative features to existing hospitals)
3. The opening of new facilities or purchase of practices in higher-income areas that will generate greater revenue while simultaneously shuttering existing facilities and practices in lower-income areas
4. And not to mention, subsidizing a college football coach's salary, or funding electoral ballot initiatives, or purchasing private learjets

Photo Source: ADAP Advocacy

“Organizations” such as 340B Matters create content that is designed to make it seem that pharmaceutical companies and proponents of 340B reform are attempting to shut down healthcare facilities by taking away 340B revenues. They develop content like this to make it seem that only one side of the equation—the side of those who actually provide the 340B revenues to them in order to continue offering the medications through Medicare markets—are attempting to cut off your healthcare services just to make a profit.

What they consistently fail to mention is that, aside from AIDS Drug Assistance Programs and hemophilia clinics, 340B covered entities are not required to provide any transparency about the amount of their annual revenues the 340B Program accounts for, how those revenues are spent, or whether or not lower-income patients actually benefit from those revenues in any appreciable manner.

Disclaimer: All of the funders of the ADAP Advocacy Association are publicly available online at https://www.adapadvocacy.org/support.html. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] 340B Matters. (2016, June 01). Privacy policy. 340B Matters. https://340bmatters.org/Privacy-Policy/

[2] 340B Matters. (2025). Who we are. 340B Matters. https://340bmatters.org/who-are-we/

[3] 340B Matters. (2026, March 20). Welcome to Friday Pharma Lies, a series debunking the drug industry’s falsehoods about the 340B Program. Lie: 340B discounts are [Image attached] [Status update]. Facebook. https://www.facebook.com/share/v/1AwvuRMx8R/

[4] The Craneware Group. (2026). Our Story. Deerfield Beach, FL: The Craneware Group: