Bay Area nonprofits that provide lifesaving services for people living with HIV/AIDS are fighting to secure sources of income at a time when public health faces devastating cuts to longstanding bipartisan programs.
Local public health experts warn that a reduction in HIV/AIDS prevention and treatment services would risk unraveling decades of progress made to end the HIV epidemic, potentially creating a preventable health crisis that would take generations to identify and resolve — or in simpler terms, start a new HIV/AIDS crisis.
“At a point where we know how to end this public health disaster, we have another challenge,” said California Sen. Scott Wiener, D-San Francisco, at the AIDS Walk SF Fundraiser in June. “We have another government that doesn’t care about us. It doesn’t care if people die. A government that is restricting access to health care, which is how you fuel HIV.”
Patients from around the region say that while legislators decide on whether or not to eliminate public health funding — in part stemming from the rejection of diversity, equity, and inclusion — the services that help keep people with HIV alive are at risk of disappearing.
The case of Tiffany Gordan demonstrates the importance of HIV services to vulnerable communities. She said she contracted the Human Immunodeficiency Virus (HIV) after being sexually assaulted by a man who threatened to kill her. She said her identity as a Black trans woman made it easy for this individual to take advantage of society’s lack of concern for people like her.
“He put a 12-gauge shotgun to my head at the gay club, where everybody outside saw him do it. No one called the police,” said Gordan. “I was alone.”
Gordan said her early adulthood had economic ups and downs in her life that made it hard for her to focus on her health. It was not until she was arrested in 1992 for shoplifting high-end goods and sent to the county jail that she finally had access to proper health care, and she received her HIV diagnosis.
At that time, in 2006, a doctor told her she had Autoimmune Deficiency Syndrome (AIDS) and had mere months to live. Her health quickly became her top priority.
Released from jail, she heard through her partner about the work of the Ward 86 clinic at San Francisco General Hospital and entrusted her care to the doctors and nurses there.
“(My partner) had HIV, and he was getting his services there. So, he was the one directing me to there. He gave me that hope, like, ‘You ain’t gotta worry. You’re gonna be all right, you’re not gonna die.’ Because I was really thinking I was gonna die,” said Gordan.
Now, 19 years later, Gordan says that the virus in her system has been suppressed — thanks to the care team at Ward 86. She said that without the team’s care model, not only in providing medical treatment but in connecting patients with resources for jobs, therapy, and housing, she would not have made it.
Reliant on federal funding
Most funding for the programs that Gordan and many HIV-positive people have used comes from the federal government.
The Ryan White HIV/AIDS CARE Act of 1990 was established by Congress to appropriate funds to health care programs that tackle HIV from a broad perspective. Over the decades, more programs from the departments of Health and Human Services and Housing and Urban Development have expanded services. In 2019, President Donald Trump himself announced a new program called Ending the HIV Epidemic in the U.S. (EHE) initiative that would continue fighting the disease through targeted programs.
Now, in an about-face, the second Trump Administration plans to cut over $2 billion in programming for federal HIV prevention services for fiscal year 2026, which begins in October of this year.
Of the estimated 1.1 million people estimated by the CDC to have HIV in the U.S., approximately 143,254 people, or 12%, live in California.
About 21% of Californians with HIV are estimated to live within the nine Bay Area counties. The state’s most recent HIV surveillance report, which was released in 2023, says the counties with the majority of new cases in the region are first Alameda, then San Francisco, and third Santa Clara. Over half of the new cases are within the Latino community, and that jumps to nearly 70% when combining other communities of color.
Cuts to Medicare and Medicaid, programs that have enabled greater access for citizens to receive HIV care, passed in the 2025 One Big Beautiful Bill Act, but the bill did not finalize the funding status of major safety net programs that have historically been the last options for those most vulnerable in the community.
Also at risk are such programs as the Minority HIV/AIDS Fund, CDC HIV Prevention programs, the Ending the HIV Epidemic initiative, and Ryan White HIV/AIDS Program Part F, all which specifically work to prevent the spread of the virus before people are in need of treatment. The administration has justified the proposed cuts by saying the programs “use taxpayers funds to nonprofits that are not aligned with several administration policies.”
On July 1, California announced it would backfill HIV programs with a $75 million fund in its 2025-26 budget, and the city of San Francisco made similar promises, organizations that receive the majority of their assistance from the federal government fear local funds would not be enough.
And on July 31, the Senate Appropriations Committee rejected the large-scale changes the Trump administration had proposed for these programs, signaling a possible stay in current funding levels.
But the actions did little to allay the fears at local centers, given all of the uncertainties surrounding the budget process. And anxiety levels rose again on Sept. 1, when the House of Representatives’ Appropriations committee passed its own funding bill that would not only fulfill the Trump Administration requests but would cut additional funds from more programs.
Congress has until the end of September to come to a consensus on how to allocate funds for public health and have a final vote before the start of the new fiscal year on Oct. 1.
Budget fight puts programs in peril
Ward 86 director Doctor Monica Gandhi said that, while the fight against HIV in the Bay Area has been progressively more successful, the region is now at risk of seeing the decades of work to combat the epidemic come undone.
“All these community organizations are needed. We are not actually a system of care that someone can come to just one place,” said Gandhi. “We really do need that community support for people living with HIV, it’s such a complex disease, and so yes, we absolutely need our community partners and people living with HIV and advocates to help us help people with HIV thrive.”
Having community partners that help patients tackle problems with their health, housing, and income are extremely important, according to Gandhi, because HIV can affect every aspect of someone’s life.
“Think about HIV as almost a social disease as well as an infection in the body. It requires this kind of care, of housing support, food support, and of all the things that come along with HIV,” said Gandhi.
Other counties face similar challenges.
At the Solano Pride Center, for example, Executive Director Will McGarvey said they rely heavily on the funds from the Solano County Public Health department and operate on small margins.
He said another organization, the Solano AIDS Coalition, had to stop providing HIV prevention and treatment services because there was not enough funding to sustain its operations. According to McGarvey, the Pride Center’s ability to continue operating depends entirely on the timetable money is distributed.
“We don’t know how we will keep staffing if the funding is cut or challenged in court and takes a long time to get back to us,” said McGarvey. “Even with the California funds, it depends on how that funding gets distributed. Will it go to larger centers or to smaller ones like us?”
Contra Costa’s Rainbow Community Center said they are thankful for not having to immediately worry about funding for their operations but remain fearful of what the future has to offer.
“We have not felt (the funding cuts) yet, but it is something that we know is going to happen at some point, and it’s fearful,” said executive director Jorge “JC” Chamorro.
The Oakland LGBTQ Community Center has also been discussing the dire need for local and state governments to help in the case federal funds fall through. In July, they made requests to the Alameda County Board of Supervisors to give them a portion of funding to address homelessness, saying proposed cuts to the Housing Opportunities for People With AIDS (HOPWA) program could potentially leave HIV-positive people without a place to live.
Safety net isn’t a handout
Back in San Francisco, the housing assistance organization Maitri-Compassionate Care said they rely heavily on government funding for their operations. Their residents, who receive respite and hospice care as they fight HIV, often don’t have any other place to look for help, said Chief Executive Officer Michael Armentrout.
According to Armentrout, even with backfilled assistance from the city of San Francisco and state of California, without federal funding the region’s only center for end-of-life care for people with AIDS will have to shut down.
San Francisco resident Seville Christian, currently a patient in Ward 86, summed it up when talking about her own journey with HIV and using the services in the Bay Area. She said a safety net does not mean people are looking for a handout, they just need some help because the system has let far too many people through the cracks.
Christian said the constant relationship with her healthcare team has helped her pursue a degree in counseling for alcohol and drug addiction at a local college — her own attempt to help her community.
“We just want a hand so we can then give it to others,” said Christian. “We’ve come so far and for what, for us to turn around?”
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