By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy
Did you know that Federal funding for the AIDS Drug Assistance Program (ADAP) accounted for just 29% of the 2024 national ADAP budget? Did you know that Congress has not appropriated any new money for the ADAP budget in over a decade?
It’s true!
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| Source: KFF |
According to the National Alliance of State and Territorial AIDS Directors (NASTAD), federal appropriations for ADAP account for a vanishingly small percentage of the national ADAP budget (NASTAD, 2026).
Since the establishment of the Ryan White HIV/AIDS Program in 1990, Congress has appropriated funds specifically to address the provision of medications to treat HIV/AIDS for patients who might otherwise be unable to afford them. But the spending power of those federal dollars has fallen significantly over the past twenty years.
In Fiscal Year 2004, federal appropriations accounted for 61%, state-level funding for 19%, and drug rebates for 12%.
Fast forward to 2024—the most recent year for which data are available—and that funding model is fundamentally different:
In FY2024, drug rebates accounted for 52%, federal funding for 29%, and state-level funding for just 4%.
According to a presentation delivered by NASTAD’s Tim Horn at ADAP Advocacy’s recent Health Fireside Chat in Pittsburgh, Pennsylvania, federal funding for the AIDS Drug Assistance Program has been stalled at ~$900 million annually for a program that costs $2.7 billion (Macsata & Hopkins, 2026).
And now, yet another crisis has landed itself in ADAP's proverbial lap. After 13 years, people living with HIV/AIDS in two states are once again being denied access to care and treatment because ADAP is running out of money. According to NASTAD’s ADAP Watch, Iowa and Utah have ADAP waiting lists.
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| Source: NASTAD |
How did we get here?
Put plainly, ADAP has been largely forgotten by federal and state legislators, in much the same way that many people seem to have forgotten that HIV/AIDS still exists. Unless someone is in front of them banging the drum that people are still being diagnosed and living with HIV/AIDS, it’s out of sight, out of mind.
In many ways, the reluctance of HIV advocacy organizations to actively and vocally push for increases to the ADAP earmark comes from a place of fear: fear that, by reminding legislators that HIV/AIDS exists, it places HIV funding at risk of further funding cuts.
And that fear isn’t without merit; since resuming office in January 2025, Donald Trump’s administration has actively worked to dismantle and defund HIV services at home and abroad.
In 2025, the Trump Administration:
- Issued a stop-work order that froze all programming and services for the President’s Emergency Plan for AIDS Relief (PEPFAR), which halted all work in the field, including the provision of antiretroviral therapy (ART);
- Issued a limited waiver for PEPFAR that allowed only ‘life-saving HIV services,” which excluded most HIV prevention services;
- Dissolved the USAID program that administered the PEPFAR program;
- Canceled funding for hundreds of programs that included HIV activities (KFF, 2026)
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| Source: STAT | Getty Images |
Beyond pulling the rug out from under PEPFAR, the Trump Administration has gone further by announcing it will not renew $46 million in funding for Community-Based Organizations (CBOs) to provide HIV testing, linkage to care, referrals to pre- and post-exposure drug treatment, and outbreak response (Cohen, 2026). Instead, those funds will be redirected to state and local health departments—an effort to control how the funds are used and who they reach, avoiding funding for “Diversity, Equity, and Inclusion.”
The President’s 2027 budget also proposed eliminating $800 million from the Centers for Disease Control and Prevention’s HIV prevention funding (Cohen, 2026). Additionally, it proposed the elimination of the Housing Opportunities for People with AIDS (HOPWA) program—which serves over 100,000 households annually (Bennett & Hannon, n.d.).
In context, those cuts, whether they’re actual or proposed, paint an even bleaker picture of the state of ADAPs at the federal level. Even though more clients are enrolling and healthcare costs are climbing, federal funding for ADAPs hasn't really grown over the past decade. This means ADAPs have the same purchasing power as they did in 1999, once inflation is accounted for. HIV advocacy needs to remind Congress of the inherent value of this program.
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] Bennett, R. & Hannon, B. (n.d.) Housing Opportunities for Persons with AIDS (HOPWA). National Low Income Housing Coalition. https://nlihc.org/sites/default/files/AG-2025/4-135_Housing-Opportunities-for-Persons-with-Aids-HOPWA.pdf
[2] Cohen, A. (2026, July 20). Trump administration puts kibosh on HIV prevention funding. Washington, DC: Roll Call: Policy. https://rollcall.com/2026/07/20/trump-administration-puts-kibosh-on-hiv-prevention-funding/
[3] KFF. (2026, August 06). The Trump Administration’s Foreign Aid Review: Status of PEPFAR. San Francisco, CA: KFF: Global Health Policy. https://www.kff.org/global-health-policy/the-trump-administrations-foreign-aid-review-status-of-pepfar/
[4] Macsata, B. M. & Hopkins, M. J. (2026, August 20). Fireside Chat Retreat in Pittsburgh, PA Tackles Emerging Crisis Facing AIDS Drug Assistance Programs. Washington, DC: ADAP Advocacy: ADAP Blog. https://adapadvocacyassociation.blogspot.com/2026/08/fireside-chat-retreat-in-pittsburgh-pa.html
[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
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