Popping up in some Pittsburgh neighborhoods are flyers with black-and-pink block print and an urgent message: "The AIDS crisis is not over. ADAP cuts are killing us.”

The flyers, referring to AIDS Drug Assistance Programs, are part of a larger campaign by the revitalized nonprofit Act Up Pittsburgh to raise awareness about state funding cuts — largely based on diminished federal grants — for programs that help people access medication to treat human immunodeficiency virus, or HIV, which can lead to AIDS.

There’s a misconception that the HIV/AIDS crisis is over or that it only impacts specific demographics, said Act Up members. But people are still being diagnosed with HIV, and, as those with the virus live longer, the need for the medication increases.

As advocates brace for increased demand, many local clinics say they are making do with smaller budgets but are starting to see the consequences.

“We are watching AIDS care in the U.S. and Pittsburgh go off a cliff very, very slowly,” said Luke Niebler, an Act Up member and Pittsburgh resident. “Pittsburgh is lucky in that it’s had really comprehensive and great HIV support. … We're seeing that being avoidably stretched thin to the point of breaking.

“It's watching something completely avoidable, something that had support, just slowly crumble in front of us.”

The Shapiro administration, in an email Thursday, pointed to a “dramatic decrease in available Ryan White HIV funds after the feds decided to cut federal funding for the program.”

Funding for the 2024-2025 fiscal year was $76.22 million; that dropped to $46.33 million for 2025-2026. The proposed state budget for 2026-2027 sees a slight rebound, at $48.35 million.

The AIDS Ryan White and HIV Care Program, housed within the federal Health Resources and Services Administration, encompasses ADAP.

The Health Resources and Services Administration did not respond to a request for comment about the funding cuts.

That Ryan White program started in 1987, in response to tens of thousands of deaths from the disease that year. In 1990, Congress passed a bill freeing up emergency funding for AIDS. Together these initiatives would become the Ryan White HIV/AIDS program, which gives states grant money to dole out as financial assistance for medication and treatment, as well as for services such as transportation to medical appointments and connections to housing.

By 2024, most HIV patients in the program were virally suppressed, according to HIV.gov; in other words, the virus was undetectable and therefore unable to spread. It’s estimated the service has averted 57,000 deaths.

Allegheny County reported 53 new HIV cases in 2025, according to the latest data. That’s a 31% decrease from the year before, when more than 4,000 people were living with HIV in the county and more than one in five contacted the virus through heterosexual contact.

Funding for the ADAP portion of the Ryan White program has remained flat since 2015. Advocates say that allotment has not accounted for rising demand and increased enrollment into the program.

In September, the Pennsylvania Department of Health announced changes to income-level eligibility in order for patients to receive certain assistance. Specifically, patients in Pennsylvania had been eligible for ADAP if they earned 500% above the poverty level, but that cap was decreased to 350%. The federal poverty level in Pennsylvania is $15,960 for a single individual, $21,640 for a household of two, and $33,000 for a family of four.

Because of the changes, about 1,600 Pennsylvanians will no longer get help funding their HIV meds, per NASTAD, a leading HIV and hepatitis nonprofit funded by the Centers for Disease Control and Prevention. HIV medications can cost up to $3,000 a month without insurance, said Sarah Miller, a nurse practitioner at the North Side-based Central Outreach Wellness Center.

In Pennsylvania, ADAP — known in the state at the Special Pharmaceutical Benefits Program — is only for patients who do not qualify for Medicaid.

In a September memo announcing the news, the state Department of Health cited “unprecedented enrollment” in the program and increasing costs of medication, and said it lowered the income limits “as a measure to sustain the long-term viability” of the program.

Pennsylvania is not the only state to make such changes. Florida changed its financial eligibility for ADAP from 400% of the poverty level to 130%, impacting an estimated 12,000 Floridians. Rhode Island, Kansas and Delaware also took this route.

“The Pennsylvania Department of Health remains committed to ensuring Pennsylvanians living with HIV have access to life-sustaining care, medications and support services,” said Neil Ruhland, the agency’s press secretary, in a statement to the Post-Gazette.

He noted that grant contracts have in the past been funded above the minimum earmarked by the federal government — DOH said it gives $25.5 million out of its own budget toward the program.

“We are proud of the thousands of Pennsylvanians we have been able to help and continue to serve through this vital program,” he said.

Ruhland agreed that available federal funding hasn’t kept pace with increases in program enrollment, medication prices and other program costs, necessitating the income eligibility changes.

The health department, he said, is “working closely with providers to connect clients to alternative supports, including housing resources and other available pharmaceutical assistance.”

Antiretroviral medications for HIV suppress the virus in the body, keeping the immune system functioning and the virus at undetectable levels. If HIV-positive people stop taking their medications, they’re at risk of a compromised immune system and additional infections, and they can transmit the virus again through sexual contact.

Patients can also develop resistance to medications if they stop taking them, as the virus mutates inside the body without being suppressed and renders a previously successful treatment ineffective.

“We have seen that happen with people who stop their meds and go back on,” said Miller.

Clinics including Central Outreach Wellness Center, which has a telehealth-based HIV service, are ratcheting up existing services to better reach those who are vulnerable.

For Damian Roman, a nurse practitioner at Central Outreach, seeing the barriers to care early in his career motivated him to help with the program. He worked in AIDS hospice in Seattle in the early 2000s, he said, and saw patients frequently get infections from having a suppressed immune system.

“It was awful, and I didn’t even see the worst of it,” he said.

Much of his job was managing infection and disease; now, due to the success of HIV medication, his job involves connecting people to resources, visiting, and running blood lab tests.

“People losing access to medications is something we haven’t seen for a long time, but I’m scared of that coming back,” he said.

There’s some evidence that’s already occurring, as a result of the income eligibility changes.

Several members of Act Up Pittsburgh who were previously eligible for ADAP funding — many Act Up members are living with HIV themselves — are no longer eligible, said Quincy Nolan, a Pittsburgh resident and Act Up member.

“Right now, we are really on a shoestring trying to keep everyone having access to care, but people are scared,” Nolan said.

Miller hasn’t seen as many patients lose financial assistance for medication as she has for transportation to clinics and housing programs that help people with HIV and AIDS.

Losing transportation means skipping vital lab work to test levels of the virus in the blood and missed prescriptions. If patients can’t pay for their medication and lose their housing, their hierarchy of needs changes, said Roman, who is also an Act Up member.

“If you destabilize the basic needs of people living with HIV, it makes it really hard for them to adhere to their medication routine,” he said.

With March marking Act Up’s 39th anniversary, Pittsburgh members began the flyer campaign, convening on the streets of East Liberty to speak about renewed challenges and how to support those with HIV and AIDS.

“Here we are fighting a similar fight, facing a new landscape and new challenges,” said Nolan.

HIV-related funding and research have seen instability at the federal level as well, worrying health care workers that the problem may worsen. Proposed cuts in the 2026 budget were blocked by Congress, but the 2027 U.S. budget lays out an additional $1.6 billion in cuts to HIV programs, according to the Kaiser Family Foundation.

A study by Harvard and Johns Hopkins researchers, published around the time Congress maintained 2026 funding, found that if future cuts were to bear out, states would see tens of thousands of new HIV infections within five years.

And the federal Big Beautiful Bill Act, signed last July, also includes changes to Medicaid work requirements, which is expected to decrease eligibility for the insurance and further increase demand for ADAP statewide. Four in 10 Medicaid recipients in 2018 were HIV positive, according to KFF. President Donald Trump’s reasoning for these cuts was to eliminate fraud and what he views as excessive spending.

Drug manufacturers have financial assistance programs for their medications, though those without insurance face out-of-pocket costs for such needs as lab work.

Act Up Pittsburgh said it is also collaborating with Allegheny County Council members, asking them to add a line item to the 2026–2027 budget to reserve health department funds for residents who have lost access to HIV care.

Their goal is to focus on the power they do have and not try to solve the whole problem at once, said Nolan and Niebler.

“Let's be quite honest, Donald Trump is not meeting with Act Up Pittsburgh,” said Niebler. “Quincy and I do not have a number to call to get in touch with him.”

But they have access to members of county council, the health department and the state legislature.

“There are things we can do at the county level that can protect these vulnerable populations,” he said. “Those are the levers that we can push and the people that we can talk to.”

County Board of Health members have been supportive of their efforts and eager to collaborate, said Niebler, but bureaucracy makes progress sluggish during a time of urgency, and the groups are still in “very early talks.”

With Allegheny County officials already steeling for significant budget cuts in order to stabilize finances, it’s unclear where money for such supports might come from.

Iulia Vann, board member and director of the county health department, did not respond to a request for comment.

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