More than 21,000 Texans living with HIV get their meds through the state-run Texas HIV Medication Program, which covers the cost of treatment for low-income individuals. But now that Texas faces a budget crisis, Houston Public Media reports, these people could lose access to lifesaving HIV treatment.

The COVID-19 pandemic has worsened the state’s financial situation. It has also forced more people living with HIV to rely on the Texas HIV Medication Program. “People who are losing their jobs,” Januari Fox, the policy director at PRISM Health of North Texas, told the media outlet, “they may have gone to a private doctor or had insurance. They no longer have that, and they’re looking for alternatives.”

Indeed, the HIV program has seen nearly a 30% spike in enrollment, to a total of about 21,000 people across the state. According to data from the Texas Department of State Health Services (DSHS), about 94,000 people were living with HIV in the state at the end of 2018.

Last month, DSHS officials asked state legislators for $103 million to keep the HIV program running until the end of fiscal year 2023.

Josh Mica, an HIV activist living with the virus, told Houston Public Media he’d likely stop taking daily antiretrovirals if he lost access through the HIV program. Currently, he is undetectable. Not only is this good news for his own health, but it also means he can’t transmit the virus sexually, a fact referred to as Undetectable Equals Untransmittable, or U=U. In that sense, providing treatment to people living with HIV is also prevention for the entire community.

One solution to the crisis in Texas, Houston Public Media points out, is for the state to expand Medicaid under the Affordable Care Act (ACA), or Obamacare. If Texas were to do this, federal funds available to Medicaid would cover treatment for low-income Texans.

Texas isn’t the only state facing financial cuts that might impact people living with HIV. New York advocates have urged the governor not to implement a 20% across-the-board withholding of funding for HIV programs and not to cut nearly $60 million from 340B safety net funds and pharmacy rebates. For more about the intersection of HIV and the coronavirus in the Empire state, see “How Will COVID-19 Impact New York’s Plan to End HIV? [VIDEO].”

In related news, President Joe Biden extended a special enrollment period for the ACA. People can now sign up for health insurance on until August 15. What’s more, several provisions in the recently signed stimulus law will help expand Medicaid and pay for the costs of insurance coverage through the ACA. For more details, see “Four Ways the $1.9 Trillion COVID-19 Relief Plan Boosts Obamacare.”

POZ March 2019 cover U=U Undetectable = Untransmitable

The March 2019 cover of POZ

To learn more about U=U, read “How Well Do U=U and PrEP Work? The CDC Updates Its Answers,” and check out the March 2019 POZ cover story “Understanding Undetectable Equals Untransmittable,” along with its companion feature “Viral Load Does Not Equal Value.”