Staff Reporter
Uncertainty in Washington is straining critical HIV prevention and treatment services in L.A., raising fears of increased transmission rates and patient neglect.
Story Highlights
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Massive Funding Reductions: $3.4 million federal cut hits public media and public health programs in Los Angeles.
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HIV Care in Crisis: Medical Care Coordination (MCC) teams face staff shortages, heavier workloads, and growing patient concerns.
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Policy Shifts: Changes in federal HIV/AIDS grant distribution and Trump-era budget cuts destabilize programs.
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Community Impact: Missed HIV treatments may increase viral loads and HIV transmission risk across L.A. County.
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Public Health Warning: Experts fear decades of progress in HIV prevention could be undone.
A Day in the Life of a Nurse Fighting HIV
Mike Kirakosyan spends his workdays in the trenches of the health care system, navigating an overwhelming maze of patient needs and medical protocols. As a care manager in an HIV care program, his role stretches far beyond simple nursing duties.
He schedules patient appointments for critical medications, coordinates with doctors, assists with complex medical forms, and reviews lab results with anxious patients. His goal is crystal clear:
“We want every patient’s HIV viral load to be undetectable,” Kirakosyan explains. “If we can achieve that, we prevent transmission across Los Angeles and beyond.”
For years, this mission has driven the Medical Care Coordination (MCC) program at the Los Angeles LGBT Center — a program that has been praised for reducing HIV transmission rates and improving the quality of life for thousands of patients. But now, that mission faces its biggest threat yet.
A Success Story Under Siege
The MCC program has been a cornerstone of HIV prevention in Los Angeles County since 2013. Its model is simple yet effective: each team includes a care manager like Kirakosyan, a licensed vocational nurse, and a medical social worker. Together, they provide wraparound services, from medication management to housing and transportation support.
But these services rely on consistent funding from federal programs such as the Ryan White HIV/AIDS Program and support from the Health Resources and Services Administration (HRSA). That stability has been shattered.
Funding Uncertainty and Policy Changes
In January, the U.S. Department of Health and Human Services disrupted its longstanding practice of issuing a single annual HIV/AIDS prevention grant. Instead, the agency began sending “episodic partial notices”, leaving county officials unsure how much funding they would receive for the entire year.
The instability didn’t stop there. Pandemic recovery funds ran dry, and Trump administration budget cuts to the Centers for Disease Control and Prevention and HRSA deepened the crisis. HRSA, which distributed over $12 billion in community health grants last year, also lost 700 employees between February and June — crippling its ability to process funding requests.
County officials responded by cutting costs. Thirty-eight contract positions were eliminated, and 36 full-time employees were reassigned. Ultimately, the county slashed HIV care contracts by 30%, calling the move “fiscally prudent.”
Impact on the Ground: Fewer Teams, More Patients
At the start of this year, the LGBT Center’s MCC program had six full teams. Today, it has only four. Each team manages nearly 1,000 HIV-positive patients, many of whom require high-acuity care.
“It’s a lot of patients, a lot of calls, a lot of messages,” says Kirakosyan. “Our teams work hard, but with fewer people, things are falling through the cracks.”
The result? Longer delays in scheduling, reduced ability to follow up with patients, and increasing emotional stress on staff members. Some workers have already left, fearing more cuts are coming.
Kirakosyan admits he worries he could be next. But his greater concern is for his patients:
“The whole point of our program is to help people navigate this broken health care system,” he says. “Now that safety net is fraying.”
Missed Medications, Rising Risks
One alarming sign of strain is the growing number of patients missing doses of injectable HIV medication — a treatment administered every two months.
“If patients miss their injection, they often have to start the entire program over,” Kirakosyan explains. “That means more people will be out there with an active viral load.”
This scenario, he warns, increases the risk of community transmission.
“Having sex is about to get a lot more dangerous than it is right now,” he says. “And patients are scared. They’re asking what’s going to happen, and we don’t have good answers.”
The Larger Public Health Concern
The Los Angeles LGBT Center is already grappling with additional financial pressures, including federal Medicaid cuts and California’s budget crisis. “They can’t just make up the money we’re losing,” Kirakosyan says.
Public health experts warn the implications extend beyond individual patients. If HIV care programs in Los Angeles collapse, decades of progress in prevention could be lost, and infection rates could rise dramatically.
“Patients will fall through the cracks, retention will suffer, and new infections will increase,” says a county health official.
What’s at Stake
Programs like MCC are vital because undetectable viral loads prevent HIV transmission. But maintaining undetectability requires consistent care, frequent monitoring, and strong patient-provider relationships.
Without funding, those relationships — and the progress they represent — are in jeopardy.
The fight against HIV in Los Angeles has long been considered a public health success story, driven by comprehensive care models and strong community programs. But as federal funding cuts and policy changes threaten HIV care programs in Los Angeles, that progress hangs in the balance.
The strain on the Medical Care Coordination program is already evident: staff reductions, missed treatments, and rising patient anxiety. If these trends continue, experts warn that HIV transmission rates could climb, undoing years of progress in prevention and treatment.
Ensuring that HIV patients maintain undetectable viral loads isn’t just about individual health — it’s about safeguarding entire communities. Without immediate solutions to stabilize funding and restore critical resources, the city risks sliding backward in the fight against HIV, with consequences that could extend far beyond Los Angeles County.
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