Florida’s HIV crisis demands an emergency response

More than 16,000 Floridians living with HIV are about to lose access to life-saving medication. The Florida Department of Health (DOH), once a leader in public health, has turned laggard. The result is a crisis unseen for decades.

The DOH recently announced sweeping changes to the AIDS Drug Assistance Program (ADAP) effective March 1, cutting income eligibility to 130% of the federal poverty level — about $21,000 a year, less than what a full-time minimum wage worker earns — with just 52 days’ notice and eliminating insurance premium assistance.

No public hearing was held, no public documentation was released, and no transition plan was provided. Despite requests dating back to 2024, DOH still refuses to show how it calculated the $120 million shortfall it claims.

Now, under the guise of “fiscal sustainability,” DOH’s tinkering with ADAP has created devastating uncertainty for thousands of vulnerable Floridians. At AIDS Healthcare Foundation’s Southern Bureau, we work with many of them. Patients are calling our offices in tears, unsure how they’ll afford their medications next month.

A patient in Southwest Florida asked us: “How long do I have to live without my meds?” That’s not a policy question. That’s a person wondering if they’ll survive the year.

These medications can cost $45,000 out of pocket per year. For someone earning $25,000, that’s not a gap; it’s a cliff. Providers tell us this feels like the 1990s all over again. To quote Florida Surgeon General Joseph Ladapo, “It’s a really, really serious issue.”

Here are the facts: More than 32,000 Floridians rely on ADAP, which provides FDA-approved medications to low-income people with HIV who have limited or no health insurance. ADAP funds also support treatment monitoring, helping those living with HIV stay on the medications that save lives and improve livelihoods. According to the latest estimates, about 50% of current patients fall between 130 and 400% of the federal poverty line, putting their ADAP access at risk.

DOH officials have blamed the $120 million budget deficit on federal funding cuts. But as David Poole, the former DOH administrator who helped run this very program, put it bluntly: “For them to point fingers at the feds is so unbelievably disingenuous.” The Ryan White grant that supports ADAP saw only a slight reduction in funding. Florida is the only state in the nation facing a funding hole of this magnitude. When pressed on why DOH failed to identify the deficit until after the budget deadline, Ladapo admitted he doesn’t fully understand how this happened.

Whatever the cause, DOH is trying to fix a program that is not broken. ADAP is an overwhelming success, achieving a 97% viral suppression rate among insurance clients — and when someone is virally suppressed, they cannot transmit HIV. This program protects everyone, not just those enrolled. When lifetime HIV treatment costs exceed $420,000, ADAP is quite literally a lifeline for personal finances and public health alike.

The DOH itself has acknowledged this. In 2023, the agency touted America’s “bold plan to end the HIV epidemic by the year 2030,” arguing that Florida must “take aggressive actions by scaling up key HIV prevention and treatment strategies.”

So why the retreat in 2026? At a time when Florida’s budget is increasing, not decreasing, there is no justification for crippling ADAP. Governor DeSantis’ “Floridians First” plan would boost current state spending by more than $2 billion. If that budget is putting Floridians first, HIV patients clearly aren’t part of the equation.

Florida’s congressional delegation is rightly pressuring the state government to pay attention. Last week, 15 organizations and more than 150 advocates gathered at the Florida Capitol to send a clear message to DOH officials and state policymakers: this is unacceptable.

There is only one path forward. The state government must declare a public health emergency and secure an emergency appropriation to close the $120 million gap. Senate Appropriations Committee on Health and Human Services Chair Jay Trumbull has said he expects the funding gap to be addressed this Session. We’re holding him to that. With cuts taking effect March 1 and the Legislative Session ending March 13, there is no time for half-measures.

The DOH has said Floridians have the right to “receive services needed to achieve or maintain a high quality of life if they have tested positive” and “obtain health care, free of stigma.” Now it’s time to honor that commitment.

Any threat to ADAP is a threat to thousands of Florida’s most vulnerable patients. This is an emergency, and it should be treated like one.

___

Esteban Wood serves as Director of Advocacy, Legislative Affairs, and Community Engagement at AIDS Healthcare Foundation’s Southern Bureau, based in Fort Lauderdale.