People living with HIV don’t know when their next refills will come for lifesaving medication, more than a year after the Virginia Department of Health cut funding to HIV clinics serving people who can’t afford healthcare.
Many clients of Virginia clinics that lost such funding are weeks away from running out of antiretroviral medication, some providers said. And nonprofit providers around the state said lawmakers’ efforts to restore some funding to clinics won’t be enough to make up losses.
The problem started under former Virginia Health Commissioner Karen Shelton, when VDH cut two-thirds of its funding to HIV safety net clinics last year. The cuts made up for a costly accounting error by VDH that led to a nearly $17 million dip in annual rebates paid to the department by the HIV drug manufacturer Gilead in 2024.
The drug company mistakenly overpaid the rebates to VDH for years, due to faulty data collection by the department.
VDH still owes Gilead an additional $16.7 million, to be paid over roughly four years, according to an agreement reached in June.
The decision to shrink HIV clinic funding preserved essential HIV care, such as the state’s medication assistance program. But the cuts greatly limited access to that care, and the new state budget will only backfill the clinic funding by $13.2 million over two years.
Amid the fallout, connecting clients to the state’s HIV medication assistance program has been a feat, said Karen Legato, CEO of the Health Brigade nonprofit clinic in Richmond.
“Health Brigade has experienced a rapid uptick in clients; these clients had been served by another organization that lost (most of their HIV) funding,” Legato said.
“These clients are requesting rapid recertification appointments because their (HIV medication assistance) is expiring and they are on their last script.”
After three clinics in the Richmond area stopped providing HIV case management services — including the combined Richmond-Henrico health department — the Health Brigade and other clinics are taking on more clients. Legato said the cuts also mean she has fewer staff to do the extra work.
“Health Brigade is now having to refer some to the other (HIV safety net) providers in the area, and crossing our fingers that they will get their recertifications done before they run out of medication,” she said.
Last year, 14 out of 27 clinics and other organizations throughout the state were forced to end case management services that connect clients to medication and food assistance, housing and other supports that keep people on HIV medication consistently. Case loads ballooned for the remaining clinics.
The organizations form the backbone of the federal Ryan White HIV/AIDS fund administered by states, which pays for health care, wraparound services and medications for people who struggle to afford treatment, said Stacie Walls, CEO of the LGBT Life Center in Norfolk.
“Most people never see the moment someone decides not to refill a prescription because money is tight, misses an appointment because transportation is out of reach, or hesitates to ask for help because they don’t know where to turn,” Walls wrote in a statement, “(But) for many Virginians living with HIV, those decisions are shaped by the systems of care that support them.”
Root of the problem
Drug rebates from Gilead and other companies have historically been one of the largest sources of funding for HIV safety net care in the U.S., as federal funding for the Ryan White program has remained nearly flat for more than a decade. VDH’s mistake cut those rebates by close to half for Virginia.
In June, VDH agreed to pay back Gilead $16.7 million in rebates it still owes for overpayments the company made from 2021 to 2023, the company told WHRO.
In those years, VDH received roughly $32 million in rebate revenue, which dropped to nearly $17 million in 2024 after VDH corrected its accounting.
“For many years, we were able to carry over rebate dollars that had not been expended from one year to the next,” said Laurie Forlano, VDH’s lead epidemiologist.
“We unintentionally received some rebate payments in those prior grant years, which falsely elevated the amount we received,” Forlano said.
The rebates from the drug company are generated when Virginia covers insurance payments for medication for people who can’t afford HIV care but don’t qualify for Medicaid.
VDH is making quarterly payments to Gilead in the amount of $1.25 million, or 50% of the total rebate repayment owed to Gilead each quarter. The repayments will be made by deducting from the rebates Gilead will continue to regularly pay.
“Gilead and VDH agreed that repayment terms should support the (HIV medication assistance) program’s continued operation,” Gilead wrote.
Fixes come up short
State legislators voted on a budget amendment on June 22 to only backfill $13.2 million of the HIV care cuts over two years, less than the nearly $20 million shifted from clinics.
Healthcare providers and advocates said the funding is a positive step, but hoped that an $18 million Senate proposal would have gone through.
“It does not replace what has been lost in funding, staff, capacity or health care access for people who need it most,” Walls said. “This is an important step, but it is not enough to end the HIV epidemic in Virginia.
Legato agreed more funding is needed, but added that the budget amendment shows that the state is taking a more active role in HIV care. The Ryan White program has been primarily funded by the U.S. Health and Human Services, rebates, local dollars and other grants.
“I’m glad a commitment was made to fund Ryan White (program funds for health organizations) or the first time ever in the state budget,” Legato said. “I think this speaks to the advocacy that has been going on across the state, and our legislators heard and responded to the critical need.”
Earlier this year, President Donald Trump axed federal funding for HIV prevention, surveillance and research. With the cuts by VDH, the loss of prevention funding means there were fewer resources for HIV testing and health counseling in Virginia.
Legato said she worries about what the Trump administration’s policies could mean for future funding for healthcare for people living with the virus.
“We can’t control the past and I’m not confident that the federal government will continue to fund the states for Ryan White (clinics) for much longer into the future,” Legato said.
“My focus is on now and how the statewide Ryan White program can leverage these (state) funds to stabilize a system that meets the most pressing gaps clients are experiencing in HIV prevention and treatment.”