Philadelphia offers many resources for people living with the human immunodeficiency virus, or HIV, including testing, medical assistance and treatment. Organizations like Philadelphia FIGHT complement this by providing education and care to those battling the disease.
“People who come to our program will not only rebuild their lives, but they will flourish with new life,” said Teresa Sullivan, director of HIV prevention and education at the organization.
One of Philadelphia FIGHT’s greatest resources is the TEACH project.
The eight-week course educates people living with HIV about mental health, living with the diagnosis (which, if left untreated, can become AIDS or lead to cancer or heart disease, among other things) and the resources available. The program also includes graduation for participants and alumni who connect after graduation.
“You may have received this diagnosis in prison,” Sullivan said. “You may have heard this diagnosis, but you never learned why you needed to get treatment and how important it was to lower the level of the virus in the community and how to go on with your life and thrive instead of just living your life.”
Project TEACH has helped thousands of Philadelphians over the past 20-plus years, but recent funding cuts threaten it and other similar programs. Additionally, state and federal cuts could enhance the cost of prescription drugs and HIV support services.
“This is not going backwards,” she said. “This is a dismantling of our program.”
Nationwide, provincial and local cuts
The cuts made by the Philadelphia Department of Public Health follow several other funding cuts.
The Pennsylvania Department of Health recently changed some of the income requirements for HIV assistance.
The Special Pharmaceutical Benefits Program (SPBP) provides approved HIV medications to low-income Pennsylvanians who are uninsured or have restricted health care. IN recent noteBye. DOH said it would lower income limits due to increased enrollment and rising drug costs.
In an email, the Department of Pa. reported that over the past two years, “drug costs for SPBP have increased by $67 million.”
Additionally, the state also changed eligibility requirements and spending guidelines for Ryan White Part B grantees. The program provides states with federal funds to support people with HIV who have restricted resources. In the memo, DOH emphasized that when issuing reduced allocations, grantees should focus on “essential” services such as mental health services, emergency financial assistance and housing.
For Aaron Richterman, a physician and assistant professor of infectious diseases and health policy at the University of Pennsylvania, the impact of these changes on his patients will likely be higher costs and a “multiplier of poor outcomes.”
“I’ve been practicing in Philadelphia for five years,” he said. “And for the first time since I’ve been here, I’m seeing people with HIV, and I don’t really know how I’m going to get them HIV medicine.”
Federal cuts could also result in the removal of more services. The recent government shutdown was fueled by a conflict between Democrats and Republicans over providing tax breaks under the Affordable Care Act. Democrats argue that without these credits, health care costs for many Americans will skyrocket. Democrats have also tried to negotiate more health care coverage, such as support services for people infected with HIV.
The final budget and allocation of services will depend on ongoing negotiations and it is possible that this may result in a reduction in HIV support services.
HIV tends to disproportionately affect low-income and indigent communities, Richterman explained, adding that limiting eligibility for other social protection programs, such as SNAP food assistance, could compound the negative effects for people struggling with HIV.
“SNAP is not an HIV program or a health program, but SNAP improves the lives of people with HIV,” he said. “In some of my work, I have shown that expanding SNAP eligibility leads to declines in state-level HIV rates. So these kinds of programs, which can alleviate issues like poverty, give people more space to engage in care.”
He said people often forgo health care when other basic needs are not addressed.
“When someone doesn’t have enough to eat or doesn’t have stable housing, taking a pill every day isn’t necessarily on the agenda,” he said.
Increased risk
Richterman said HIV infection rates in Philadelphia and across the country have remained somewhat steady over the past few years.
According to AHEAD, an interactive government dashboard that measures HIV infection rates, The number of people diagnosed with HIV per 100,000 in Philadelphia has declined since 2017. Preliminary data for 2024 shows a decline to 303 per 100,000.
Richterman said removing funding could impact that progress.
“A small loss of control over an infection like HIV can have consequences,” he said. “One infection can turn into another, then it can turn into another, and in the absence of resources, there can be this kind of cascading impact.”
This is particularly significant for HIV because people on treatment have undetectable levels of the virus, significantly reducing transmission of the virus. However, Richterman said, the concept is not well understood and people often feel stigma associated with a positive diagnosis.
“Every week in my clinic I meet people who don’t fully understand it and don’t believe it,” he said. “So there’s still a lot of work to be done to make sure people understand how successful they can be and why it can be the least of their lives if we can get them effective care.”
Richterman said that’s why educational resources are so significant – because they reduce stigma in communities and enable more people to seek treatment.
Sullivan said Project TEACH’s educational efforts would be devastated by funding cuts.
“These cuts will result in an 80% reduction in program staff, and some of those staff are people living with HIV,” she said. “There will be a 70% reduction in TEACH classes and diplomas.”
Project TEACH also aims to maintain an “active alumni network” enabling people living with HIV to connect, reconnect and meet monthly to learn about living with the disease.
“It’s another way to keep people engaged and connected to the community, and the cost will be reduced by 82%,” Sullivan said.
“Even if you don’t know someone who is living with HIV, it is a condition that needs to be addressed because the stigma associated with it still persists and we still see people not surviving,” she said. “There’s a reason we call our city the City of Brotherly Love, right?”
Richterman said lack of treatment could result in a “wide spectrum of consequences” beyond AIDS.
“There are many cancers that can develop,” he said. “For untreated HIV-positive women, they can have a very high risk of cervical cancer. We see a very high risk of lymphomas and blood cancers if people are not treated. As the virus progresses, we also see the risk of other inflammatory conditions such as kidney disease, heart disease, things like that.”
For now, Sullivan said the organization is doing everything it can to apply the resources it has been allocated. But he hopes the demanding work Project TEACH has been doing in the community for decades “will not be erased” by these cuts.
“We don’t want to go back to the beginnings of the epidemic,” she said. “We want to move into a future where we can see the HIV epidemic in the lifetimes of people living with HIV and our supporters and allies.”
