This story was originally reported by Orion Rummler of The 19th.
The red van hands out food, water, clothes, first aid and free HIV tests. Locals recognize it across the Twin Cities: the van, nicknamed “Thrivey,” visits St. Paul on Mondays, drives up and down south Minneapolis on Wednesdays and Thursdays, then heads to north Minneapolis on Fridays. Tuesdays are restock days.
The van, and everything inside it, is funded by federal grant money that has been suddenly revoked. The Aliveness Project, the Minnesota nonprofit behind the van, is one of many HIV prevention groups across the country that face a financial cliff now that the government plans to reroute millions of dollars from groups like theirs to state health agencies.
But these groups say that nobody else can replicate what they do and who they reach: some of the most high-risk groups for contracting HIV, people who live outside of the formal health care system.
“They are going to fall through the cracks. That is the reality,” said Joe Franco, associate director of prevention and clinic operations at the Aliveness Project.
When high-risk populations fall through the cracks of HIV prevention, more people contract a fully preventable virus. More people need treatment. Health care costs rise.
And in this case, local services get taken away: to save money, the Aliveness Project plans to cut support groups and only put on two events a week, instead of five. That means fewer opportunities for people in the Twin Cities to get tested for HIV. They’ll also have to cut out the van.
“We’re already dealing with hard times,” said Matt Canada, HIV prevention lead at the Aliveness Project. “We just dealt with the whole ICE situation in February, which is still going on now … there’s a lot of individuals not getting their HIV medication, not getting their PrEP medication.”
This federal grant money is awarded on a five-year basis and disburses millions of dollars to groups like the Aliveness Project. Last week, the Office of Management and Budget (OMB), which serves the president and implements his agenda, told the Centers for Disease Control and Prevention (CDC) that these grants would not be renewed, as Roll Call first reported.
But so far, groups are still in the dark about what’s happening.
“There’s actually been no official communication from the CDC,” said Franco from the Aliveness Project. That hasn’t changed since The 19th first spoke with him last Wednesday. As far as the Aliveness Project knows, their grant money, which they had expected to receive after the last funding period ended on June 30, has already been handed over to the Minnesota Department of Health. The state health agency did not respond to a request for comment.
CDC employees told Government Executive that these changes will increase overhead for states and create gaps in federal oversight. One employee said that state health departments could still choose to subcontract these community organizations.
The CDC said in a statement that as the agency “streamlines HIV prevention funding through health departments, local decision-making will remain central to combating HIV, ensuring that local data inform local strategies and interventions.”
A three-month reprieve has been granted: the Aliveness Project, and many others, received a little over $110,000 to last them through the end of September, when funding will end for good. Unless something changes, no more grants will be issued.
This will make HIV cases go up, said Dr. Todd Fojo, associate professor of medicine at Johns Hopkins who provides primary care for people living with HIV. When nonprofits like the Aliveness Project test locals for HIV, they get more positive tests than health care providers because they’re reaching high-risk groups that are less likely to access healthcare or go to the doctor, he said. And once someone is diagnosed, they can start treatment that halts transmission of the virus.
“So if you pull out those tests, you’re pulling out the most efficient tests, the tests that are going to diagnose the most people with HIV,” Fojo said. If those people are in the dark about their HIV status, they won’t get treatment. The virus will spread.
Over 100 members of Congress are seeking answers from the OMB about the funding switch. By August 4, lawmakers want to know how many HIV prevention organizations will lose CDC funding and where those groups are located. Advocacy groups estimate that 96 groups will be impacted, based on how many were approved for these five-year grants in 2022. Roll Call, as well as advocacy groups, have identified the total grant amount being redirected from community groups as $46 million.
A clearer picture of the scope of the cuts can be found in public federal grant data.
The 19th took a look at all grants released by the CDC this year to fund HIV prevention activities for non-governmental organizations, and examined that data to find community groups who received the same $110,000 three-month grant extension that the Aliveness Project in Minneapolis did. These were cross-referenced with community grant recipients published on the CDC website in 2022.
The 19th found 89 organizations — local nonprofits and health clinics that accept patients without insurance — that received the same CDC funding extension as the Aliveness Project, although some of these groups also get funding from other branches of the Health and Human Services department. Only 64 of these impacted organizations are included in our map, to eliminate repetition in major cities like New York and Los Angeles.
Members of Congress say that funds for these community grants were already appropriated as part of this year’s budget for HIV prevention.
The problem is that congressional appropriation does not explicitly mandate funds for community organizations, said Jeremiah Johnson, executive director of PrEP4All and cofounder of the Save HIV Funding Campaign.
These groups have gotten federal grants for three decades. Congress didn’t have to spell this out before, he said. Apparently, now it does.
“Historically, there hasn’t been a need to get so specific in what is passed by Congress, because there was an understanding that the CDC would continue to fund in this way,” Johnson said. “That’s something that’s happening on multiple fronts with this administration.”
Congress has also fully funded the 988 hotline’s LGBTQ+ youth service and demanded that the Trump administration return it. But that suicide prevention lifeline for LGBTQ+ youth is still shut down, with the government saying it is working to reinstate it by the end of the year.
Advocacy groups are now asking Congress to make the appropriation language for next year’s budget more explicit by requiring that $60 million of the country’s HIV prevention efforts go towards community groups like the Aliveness Project. These groups are the front line of the country’s HIV prevention effort, they say.
In the past five years, the Aliveness Project used this federal money to administer over 6,000 HIV tests and connect thousands of HIV-negative Minnesotans to PrEP, a medication that protects people from contracting the virus in the first place.
This funding change exposes community-based HIV prevention groups to local politics in a new way, Johnson said: those who are willing to speak out against the cuts may be able to trust that their state health department will still be there for them. But other groups have to weigh if speaking out against the Trump administration will put their services at risk.
“It contributes to a climate of fear,” Johnson said.
These cuts also come amid broader concerns about the future of HIV prevention in the United States. The White House last year pushed to end all HIV prevention and surveillance at the CDC, and House Republicans still want deep cuts to the country’s HIV prevention infrastructure. So far, those sweeping cuts — which fly in the face of the first Trump administration’s promise to end the country’s HIV epidemic by 2030 — have been blocked.
More cuts to CDC funding would lead to an increase in HIV cases. At Johns Hopkins, Fojo and his colleagues mapped it out in a study published earlier this year: reducing CDC-funded testing anywhere from 25 percent to 75 percent would result in an increase of infections by 2 to 7 percent.
And the CDC funds much more than just tests. They just happen to be the most easily quantifiable part of the national HIV prevention response.
In Minnesota, the Aliveness Project has been around for 40 years and it isn’t going anywhere, Franco said. They plan to provide the same level of service, at least until the CDC grant money runs out in September.
“It is going to impact us, but it is not going to stop our work,” he said.