SPRINGFIELD — With cuts to HIV and AIDS programs looming from President Donald Trump’s administration, advocates are pressing Illinois lawmakers to fill a growing void or face a situation for which they say the state is unprepared.

It’s a “life or death situation,” Timothy Jackson, senior director of policy and advocacy at AIDS Foundation Chicago, said of those living with HIV or AIDS and the possibility of losing access to healthcare and medication.

“If you are a person living with HIV and you cannot secure your medications, it is going to progress to an AIDS diagnosis,” said Jackson, who was diagnosed with HIV 17 years ago. “And people are going to die.”

But with a tight state budget and many lawmakers reluctant to commit to new spending, advocates like Jackson realize it’s an uphill battle. Still, groups like AIDS Foundation Chicago are calling for a $6.5 million increase in the state’s HIV “lump sum” — a collection of grants and programs dedicated to HIV and AIDS testing, treatment, education and more — to minimize damage from federal funding cuts. The HIV lump sum of $25.56 million has not been increased since the 2021 budget.

“I know the state budget is tight, I know circumstances are really rough, but I’ve seen them definitely go above and beyond to put in money when the budget was tight,” said Aces Lira, director of public policy at Equality Illinois.

Gov. JB Pritzker’s provisional budget, released in February, proposed keeping funding for most HIV- and AIDS-related programs flat while eliminating a $500,000 grant for sexually transmitted infection screening and a $1 million grant for distributing PrEP — a highly effective medication that prevents HIV infection in HIV-negative people. Nevertheless, officials in the Democratic governor’s office blamed the Republican president’s administration.

“From gutting USAID, Medicaid, and research grants, Trump has made it clear he does not care about HIV prevention and treatment and is satisfied with erasing decades of progress,” the governor’s office said in a statement. “Illinois will continue to do everything in its power to support those in need through state-funded programs, but we are deeply concerned about the larger impacts of his cuts and the strain on our healthcare system.”

The federal cuts are hitting an already strained system. Nowhere is that more apparent than in the Ryan White AIDS Drug Assistance Program, which helps pay for or provides free HIV or AIDS medication to people who are 500% above the federal poverty level. Every state has its own ADAP, which is funded through a combination of state dollars, pharmaceutical drug rebates and the federal Ryan White program.

Nationally, about 25% of the 1.2 million Americans living with HIV rely on ADAP, according to the U.S. Department of Health and Human Services. Trump has proposed cutting roughly $250 million from the program.

Illinois’ ADAP was already under pressure before those proposed cuts. Between April 2024 and March 2025, the number of people the program served climbed nearly 18%, from 7,313 to 8,625, according to a Freedom of Information Act request shared with the Tribune by the AIDS Foundation. To manage rising costs in recent years, the Illinois Department of Public Health cut more than $3.5 million in grants supporting HIV community information events, testing and in-person training to help connect formerly incarcerated people with healthcare services, according to the records.

The caseload is only expected to grow. Between 194,000 and 415,000 Illinoisans are projected to lose Medicaid coverage under new work eligibility requirements and six-month redetermination provisions in the One Big Beautiful Bill, according to a report from the Robert Wood Johnson Foundation and the Urban Institute. People losing Medicaid who are living with HIV would likely shift to ADAP — and HIV-positive individuals rely on Medicaid at far higher rates than the general public: 40% compared with 15%, according to an analysis by the health policy nonprofit KFF.

IDPH spokesperson Jim Leach said the department expects between 3,000 and 5,000 Illinoisans with HIV to lose Medicaid and qualify for ADAP as a result.

“This will be closely monitored so that IDPH can evaluate ADAP’s capacity for future planning,” Leach said. “The increase in clients will present a challenge for ADAP’s capacity, especially if people losing coverage remain uninsured. IDPH is currently evaluating a number of potential strategies to ensure we are able to serve as many people as possible.”

Other states facing similar pressures have already begun scaling back their programs. Rhode Island lowered income eligibility from 500% to 400% of the federal poverty level for all new applicants in late October 2025. Pennsylvania dropped its threshold to 350% for new enrollees. Florida lawmakers earlier this week approved a decision to restore eligibility to 400% of the federal poverty level following earlier proposed cuts by the Florida Department of Health. When asked whether Illinois is considering similar measures, Leach did not rule them out.

The strain extends well beyond medication assistance. Advocates say flat funding in the face of federal budget cuts will also damage the state’s HIV and AIDS prevention and education efforts.

Nearly 1,600 people in Illinois were diagnosed with HIV or AIDS in 2025, and more than 42,000 Illinoisans were living with HIV or AIDS as of December 2025, according to IDPH data. New diagnoses fall disproportionately on Black and Latino residents. African Americans make up about 15% of the state’s population and Latinos about 19%, yet they account for 44% and 29% of HIV and AIDS diagnoses since 2018, respectively.

To address those disparities, the state’s African American HIV/AIDS Response Fund directs money to Black-led organizations for prevention, treatment, education and testing. Federal COVID-19 emergency funds once steered $15 million to the program, but that figure fell to $7.8 million in the current fiscal year.

Creola Kizart-Hampton, chair of the Black Leadership Advocacy Coalition for Healthcare Equity, said that without restored funding, the consequences will be generational.

“What it would mean if we don’t get more funding is that there will be more deaths in the Black community,” Kizart-Hampton said. “There will be more younger people who are dying because they don’t know they have it, and that means when we go generations out, there will be more and more that are passing the disease down that don’t know it.”

The federal picture has darkened considerably since Trump’s second term began.

His administration pulled an $18 million grant focused on HIV research in adolescents and young adults and eliminated another $600 million in grants for HIV and STD prevention and surveillance affecting Illinois and three other states. A federal judge has temporarily blocked the latter cuts amid an ongoing lawsuit between the states and the administration. Trump’s proposed 2027 budget would go further still, gutting more than $2 billion in funding for HIV education, prevention, housing and related programs — a sharp departure from his first term, when he pledged to eliminate the HIV epidemic by 2030.

U.S. Department of Health and Human Services spokesperson Andrew Nixon defended the cuts, saying the eliminated grants did not align with agency priorities.

“HHS is committed to ensuring Americans’ taxpayer dollars support gold-standard science that benefits all Americans,” Nixon said. “The Department is strengthening efforts to end the HIV epidemic by expanding access to prevention, treatment and care through investments in next-generation therapies, support for viral suppression programs, emergency preparedness efforts and public access to trusted HIV information and local services.”

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said the administration’s proposals would reverse decades of hard-won progress.

“No testing programs, no PrEP programs for HIV prevention, no education programs,” Schmid said. “We’re still looking for a vaccine, we’re looking for cures, we’re looking for longer-acting treatments, so you know that would all be delayed.”

Dr. Travis Gayles, chief executive director of Howard Brown Health, said the compounding effect of federal cuts and flat state funding creates conditions for a surge in new diagnoses in Illinois.

“We know that when folks don’t get tested, it decreases the opportunity for them to know their status, which again increases the risk of transmission in the community,” Gayles said. “You can start to see how the funding cuts, and again, even keeping funding flat, create a situation where we might see a significant increase in new cases, because we just simply don’t have the tools to be able to respond in a proactive manner.”