Minnesota’s HIV service organizations juggle cuts and brace for more
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On a recent afternoon, the Aliveness Project in south Minneapolis was buzzing with people. The HIV services organization provides lunch, and members can meet with case managers and pick up prescriptions from the LGBTQ+ focused pharmacy.
Joe Watters lingered after lunch to chat with friends in the cafeteria. Watters is a member, and the president of the Aliveness Project’s membership organization.
“We’re not only providing food and nourishment, we’re providing a community for people who are feeling somewhat isolated and somewhat forgotten,” Watters said. “This is an opportunity for them to come here and to be part of something larger than themselves.”
Aliveness Project staff say building community is an essential part of their organization. It helps people stay connected to care and medication, all available in the same building; staying on medication keeps them from spreading the virus.
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Dylan Boyer is the director of development at the Aliveness Project.
“We saw the need for this model, for all of these services to be housed in one location,” Boyer said. “And this need is not something that was just created from our minds. This is what the community has told us that they needed to reduce the number of barriers to care.”
That one-stop-shop model relies largely on federal and state dollars, like most HIV services organizations across the state. But they’ve seen those funds shrink, and experts are worried that more federal cuts are on the way.
Tightening budgets
Decreases in federal and state funding hit HIV services organizations earlier this year; Minnesota’s Department of Human Services announced last year that it expected a shortfall of about $9 million in its HIV support budget.
Several organization leaders say they’ve avoided making big cuts to programs so far, but it’s put a strain on operations. The Aliveness Project has laid off some case managers. The University of Minnesota’s Youth and AIDS Project laid off several staffers; executive director Val Rubin-Rashaad said they went from a staff of 15 to just six this year.
Layoffs and changes at the Center for Disease Control have complicated the funding landscape, too.
The Minnesota Department of Health expected about $3 million in HIV prevention money on June 1, in a new round of funding for a grant awarded last year; the MDH didn’t receive it until the end of the month, according to a spokesperson. The spokesperson said the CDC did not give a reason for the delay.
That’s in line with a nationwide trend: health departments around the country say their expected CDC funds aren’t coming in on time.
“Unfortunately, the future of federal HIV funding remains unclear,” the MDH spokesperson said. “MDH is currently discussing plans for a range of potential outcomes as we monitor funding conversations at the federal level.”
Aliveness Project staff say they’ve also struggled to get answers from their contacts at the CDC regarding some of their other grants. The CDC has also issued letters ordering organizations to stop work with trans communities, which Aliveness Project staff say complicates their work.
“There’s a lot of unknowns, a lot of uncertainty,” said Aliveness Project executive director Matt Toburen. “What we are seeing is very, very troubling.”
Looking ahead, organizations say they’re worried about a budget proposal from President Donald Trump’s administration that would eliminate pieces of HIV funding, and move some funds from the CDC to an “Administration for a Healthy America,” a new agency proposed by Health Secretary Robert F. Kennedy Jr.
Mary McCarthy runs the Rural AIDS Action Network, which provides services in greater Minnesota. She said her organization has been able to keep up services and make cuts to overhead costs amid the cuts so far, but any more cuts will be harder to manage.
McCarthy is worried not just about HIV spending, but also proposed federal budget cuts to Medicaid and social services. She said those supports give clients needed stability; without it, they struggle to keep up with medication.
“I kind of picture it a little bit like Jenga,” McCarthy said. “You can move a piece … but eventually, if you move the wrong stuff too much, it's just going to all crumble.”
More clients, fewer services
The cuts and uncertainty follow closures of several HIV services organizations. Rainbow Health in Minneapolis shut down abruptly last summer, with no notice and little explanation. Months earlier, the African American AIDS Task Force (AAATF) closed.
Val Rubin-Rashaad said the Youth and AIDS Project is stretching to help make up for the loss of those organizations. The youth-focused organization used to refer many older clients to Rainbow Health and the AAATF; Rubin-Rashaad said they’re now keeping older patients in their organization longer, since there’s less options to refer them out.
“It was heartbreaking on a lot of levels — heartbreaking in the sense that the community has lost the only organization that focuses on African American folks in the Twin Cities,” Rubin-Rashaad said.
Those closures came amid ongoing HIV outbreaks. The MDH declared outbreaks in Hennepin and Ramsey Counties in 2020, and added the Duluth area to the list in 2021. Officials said many of the new cases were linked to encampments and injection drug use.
The outbreak is disproportionately impacting communities of color. The MDH reported 74 percent of new cases in Minnesota in 2024 were among people of color. Overall, diagnoses decreased from 2023, but increased in American Indian, Black African American, Black African-born and Hispanic populations.
Rubin-Rashaad is frustrated with the steady numbers of new cases — especially since experts know how to treat HIV. But treatment relies on the at-risk funding.
“I would like to be in a spot where we're not so reactive,” Rubin-Rashaad said. “Right now, we’re just putting out fires, and Minnesota should be situated in a space where we’re no longer putting out fires.”
State lawmakers offered some help this year. In the latest budget, the Legislature passed an increase of $3 million per year for HIV services, which advocates say is a welcome boost. But they’re still looking for new ways to bring in money, as the future of federal dollars remains uncertain.
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