If I stopped taking the medication that suppresses my HIV, at first I’d feel fine. But over the next few months, my viral load would rise. In the first year or two, it might cause minor havoc (swollen glands, skin rashes). After a few years, it would become AIDS. Night sweats would likely drench my sheets. Wasting would make me look starved. Life-threatening infections, like PCP pneumonia, would become common. Within a decade of stopping meds, I might be dead.

When there were not any effective HIV drug regimens, this was a common trajectory. About 510,000 people died of AIDS in the U.S. between 1981 and 1996. In the late 1990s, a breakthrough “cocktail” of HIV meds became available. Since then, treatment options have become more abundant and easier to take, and in the United States, HIV-related mortality rates have plunged. There were some 43,000 deaths here in 1995. In 2023, there were slightly under 4,500.

But now there’s risk of a backslide. States across the country are considering cuts to a program that covers about a quarter of the roughly 1.2 million people in the U.S. living with HIV. Tens of thousands could soon lose access to medication.

The most extreme example is in Florida. Early this month, the state government drastically reduced access to its AIDS Drug Assistance Program, a long-standing federal initiative operated and partly funded by states that provides free or subsidized HIV meds and care. Claiming a $120 million budget shortfall, Florida chopped the annual income-eligibility cutoff for ADAP from about $64,000 (in line with many other states) to about $21,000. Half of the 32,000 Floridians who depend on ADAP would lose coverage.

Earlier this month, after HIV-activist lobbying, the Florida legislature passed a bill allocating $31 million to keep some of those 16,000 on their meds. Governor Ron DeSantis signed the bill into law last week, but the money lasts only through June. Fully funding ADAP past that would require Florida’s GOP-led legislature to find at least $120 million in the........

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