The Virginia Department of Health is drafting its new five-year plan for tackling the HIV epidemic in the state in the face of multi-million dollar funding cuts for HIV care.
Due to a billing mistake by VDH, Virginia lost roughly 50% of one of its largest sources of funding for HIV care — rebates from its HIV drug purchases — in 2024.
VDH met earlier this month with healthcare providers, people living with HIV and others concerned about HIV care in Virginia for input on the plan, which would guide HIV treatment and prevention efforts in Virginia from 2027 through 2031. Everyone who spoke at the meeting feared that service cuts could set back wins against the HIV epidemic in Virginia.
Virginia’s HIV health safety net has also been crippled by federal cuts to HIV prevention and Medicaid alongside rising insurance and drug costs. The cuts forced VDH to provide only the most critical care, which has been devastating for patients and healthcare providers.
VDH may further cut HIV care. Virginia is on a national watch list of states considering limiting payment assistance for people who struggle to afford HIV medication, and shortening the list of medications available to these people.
Sammie Hubbard is a peer counselor and health worker with Minority AIDS Support Services. His days are spent making stops across Hampton Roads in his van administering hepatitis and HIV rapid tests.
MASS and other non-profit HIV clinics don’t charge uninsured people for treatment or testing, which Hubbard fears further funding cuts would end. Stopping these services could be particularly harmful for youth, he said.
“What happens if we lose our money? We close,” Hubbard said, “What happens to our LGBT youth … who been rejected, and family told them there would be nothing when they get 18?”
Hubbard, now 35, said he knows how it feels to lack familial and financial support as a gay, Black teen and how it can impact health outcomes. He struggles with recurrent drug addiction and previously had a Hepatitis C diagnosis.
“Trust me, I was the one, I grew up in the church,” he said, “So, if we don’t fix this [funding] problem, [HIV] is going to be an even bigger problem.”
At the meeting earlier this month, a Virginia woman living with HIV who identified herself as Tiffany told VDH officials Virginia’s new five-year plan for fighting the virus should also consider the health needs of people who are older.
“We need to make sure we are planning for people aging with HIV even more because we didn’t think we’d be here [alive] and we are,” she said.
“I don’t know if the [healthcare] facilities will be ready for us because we have so many comorbidities that may be related to HIV medications [or] the virus.”
Goals made, goal missed
VDH officials said objectives for the five-year plan include reducing racial and geographic disparities in HIV transmission and management, and improving care for all people living with HIV. The plan will lay out methods for closing gaps in care, and its strategies change as needed, said Ashley Yocum, an HIV services planner for VDH.
“It’s not a plan that sits on the shelf and gathers dust for five years — it is a living plan,” Yocum said, “It’s hard, sometimes, to predict what’s going to happen in five years.”
HIV care providers told VDH the plan should consider looming issues such as the potential impact of the housing crisis on the growing need for financial assistance for HIV drugs, as well as specialist physician shortages in Southwest Virginia.
“It wouldn’t take too much of a shift in the economy for people who aren’t really taking advantage of [HIV medication assistance] right now, to suddenly be at the door,” said Mark Baker, who is on a state HIV care advisory committee.
State health departments are required to draft these plans, called HIV Integrated Services plans, to receive HIV care funding from the Health and Human Resources Administration.
The new plan is due to HRSA at the end of June, VDH officials said. But Virginia is behind on all of the goals in the current five-year plan that started in 2021, including reducing new HIV infections and improving viral suppression, which prevents people with HIV from spreading the virus.
Experts said the fight against HIV has become even harder since VDH cut funding to HIV clinics that provide care for low income people by $20 million last year and reduced other HIV services. The cuts allowed VDH to prioritize providing medications to people with low incomes living with HIV, VDH officials said, though it also led to the reduction of preventative care and the closing of some clinics.
Hubbard told WHRO that education and health outreach by MASS and other HIV clinics is needed to stop the spread of HIV and Hepatitis C.
He said that before he worked for MASS, he didn’t know that PrEP — HIV prevention medications — could be taken as a shot every six months, instead of as a daily pill. He also didn’t know how to get his insurance to cover the injections.
“That’s how we’re going to stop the virus — education, outreach — and luckily, I work for a company [MASS] that’s doing it now.”
Funding woes loom large
VDH cut clinic funding when its rebates earned on purchases of HIV medication dropped by nearly $15 million in 2024. The rebate losses came after an error in claims paperwork filed by VDH resulted in Gilead, the leading manufacturer of HIV medication, overpaying rebates to VDH from 2021 to 2023, the company said.
Stacie Walls, the CEO of the LGBT Life Center in Norfolk, asked VDH officials at that meeting what they would do to ensure they won’t have to cut funding again.
“The challenges are the same across the board in that all the funding … has been cut,” she said. “What would be the next step to ensure that’s not going to be the result of the next plan that is developed?”
Allison Green, Virginia’s senior adviser for the Ryan White program that helps fund medications for those with HIV and low-incomes, declined to answer questions about funding losses during the public meeting and advised Walls to email her questions afterward.
In a statement earlier this month, Cameron Webb, Virginia’s newly appointed health commissioner, said that VDH would spend the next month finalizing the details of a repayment plan with Gilead and correcting claims filing processes. From now through 2027, VDH will provide quarterly updates on its funding for HIV care, Webb wrote.
“We are accountable — not because something went wrong before I arrived — but because Virginia’s health department must earn and keep the public’s trust,” Webb wrote.
The Virginia House and Senate have both advanced amendments to partially restore the HIV funding. But Green said that VDH, and healthcare and other service providers may have to rely more heavily on community support.
“[The five-year plan] may focus on community building and trying to identify additional community resources,” Green said. “How we can still work towards those goals that we know that we want to achieve and still make progress.”