By the end of June, health care providers in Maryland will lose nearly three-quarters of the funding they use to find and treat thousands of people with HIV.

Advocates and providers say they had been warned there would be less money by the Maryland Department of Health, but were stunned at the size of the drop — from about $17.9 million this fiscal year to $5.3 million the next. The deep cuts are less than three months away.

Without the money, they say there could be a public health catastrophe.

“We need to make sure people stay on their medications,” said Lynda Dee, executive director for AIDS Action Maryland, which provides advocacy and services for those with HIV.

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“We risk losing a lot of ground.”

The money comes from the federal Ryan White program, which pays for treatment for those with HIV after other sources, including insurance, are exhausted.

Funding continues for medications crucial for treating HIV and preventing spread. HIV, which stands for human immunodeficiency virus, attacks the immune system and makes it harder for the body to fight infections. There’s no cure, and without treatment it can progress to AIDS, which can be life-threatening.

Advocates say stigma and fear keep people from being tested or seeking treatment, and when they do, it’s not as easy as sending them home with a prescription.

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The programs that help find and test people are among those facing the funding cliff. So are the ones that help support people so they stay on their medications — things like outreach and education, nutrition counseling, and substance use and mental health treatment.

Those programs are largely funded through rebates the state collects from drug manufacturers during negotiations for HIV drugs.

Federal law long allowed the state to collect that money, but until 2016, a quirk in state law didn’t allow it to be spent. It pooled into a much bigger pot of money to be doled out in recent years, according to Chase Cook, a spokesman for the state health department.

The reserve fund taps out this year, meaning the state can spend only what rebate money continues to come in. Cook said officials have been working to ensure providers are aware.

“We have worked closely with providers for years to prepare them for this change,” he said.

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Advocates say they want state health officials to consider ways to continue funding programs until they can find other sources so HIV rates continue to drop, or at least don’t rise.

Cook said the state remains committed to a goal of ending the HIV epidemic and fewer than 80 new diagnoses a year.

Maryland reported 751 new HIV infections among people age 13 or older in 2022 and an estimated 31,600 are living with HIV, with 3,200 undiagnosed, in the latest state data available. Maryland has the 12th-highest rate of infection nationally.

Many of the programs slated for cuts are tailored to groups who are more likely to be estranged from the health care system. Programs for the LGBTQ community, for example, make sure people see providers who understand what puts them at risk and don’t make them feel judged. Transgender patients are called by their preferred names.

“People used to fall between the cracks of the system,” said Jasmine Pope, a community advocate. “We know the system did not work for a lot of people, which is why we have these programs.”

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More than a dozen advocates and health care providers from Johns Hopkins Medicine, the University of Maryland Medical System, LifeBridge Health and AIDS Action Maryland sent a letter to the state health department earlier this month warning that HIV could spread and sicken people faster if the programs disappear.

“This critical funding situation threatens to decimate services across the entire scope of our state’s HIV health care safety-net and destroy many years of progress, increasing HIV prevalence as well as morbidity and mortality,” says the letter.

Cuts ranged among the programs, including $593,000 at the Johns Hopkins AIDS Psychiatry Service for approximately 900 patients and $800,000 at Chase Brexton Health Care for health care providers, therapists and case managers for about 3,000 patients.

Blair Adams, a spokeswoman for the city health department, said in a statement officials there were “actively preparing” for the reduction in funds “by prioritizing care according to client needs” in the metropolitan area that includes Baltimore and Anne Arundel, Baltimore, Carroll, Harford, Howard and Queen Anne’s counties.

About 10,000 people receive publicly funded HIV-related services in the region each year, according to the health department. Those are patients whose insurance won’t cover all the care they need and can’t afford to pay for it themselves.

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A Baltimore mother of two said she is among those with HIV who relies on Ryan White programs for care she can’t afford. She said her husband, from whom she was separated, had HIV and later died. Her 8-year-old son, who tested negative for HIV as a baby, became sick and tested positive last year.

The mother, who did not want to be named to protect her son’s privacy, has used mental health care, nutrition counseling and other case management services through the Ryan White program, her doctor confirmed.

“When I was first diagnosed it was scary, but I thought I wanted to be there for them,” she said about her son and her other child. “There is a huge mental health element. A lot of people won’t even go get tested because they can’t handle it. Then they get sick.”

She described a bumpy road, but said she now has a job and health insurance, and her children are healthy.

“I feel they need to keep funding programs,” she said. “Not everyone is getting help. They’re out there doing things. That’s how this spreads.”

A Baltimore man who has been HIV positive for nearly 23 years said he’s turned to Ryan White programs at times when he needed help paying medication copays, getting dental services and dealing with emergencies.

The man, who did not want to be named because not everyone in his life knows about his diagnosis, had serious complications and had “horrible” side effects. He’s needed to try new medications. Without help navigating the system, he said he and others might not get sufficient care.

“Leaving folks to fend for themselves for services is not OK,” he said. “People who are thriving with HIV will be devastated.”