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).
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| 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.
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| 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elimination of the Housing Opportunities for Persons With HIV/AIDS (HOPWA) program, referring to the program as “…outdated by focusing on housing low-income, homeless, and at-risk HIV-positive individuals, as the prognosis and medical care for HIV have significantly improved since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.
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| 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/
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