HIV and AIDS prevention and treatment have made lifesaving strides since Dallas County began fighting the crisis in 1986.
Now, local agencies and community action groups face questions about federal and state funding that could put those decades of progress at risk.
CAN Community Health shares space on Cedar Springs in Dallas with private practitioners who prevent, test, treat and counsel people living with HIV or AIDS.
Through cooperation and trust, the historic Oak Lawn neighborhood intentionally invested in fighting back the illness that first showed trends in male homosexual communities.
"It wasn't too long ago that we did have a very, very significant issue with HIV and AIDS and not only in Dallas, but across the world," said Dr. John Carlo, a former medical director of Dallas County Health and Human Services and the county's health authority from 2006-2010.
Now CEO of Prism Health North Texas, he was on the battle front in the mid-1980s.
"Many people really don't carry that memory further beyond that time where we were really, really struggling," he said.
Carlo said the epidemic’s forgotten fight is partly for good reason.
Health services did a good job stopping the spread, particularly with antiviral drug breakthroughs.
"Right around 1995, when the new protease inhibitor medications came out, we were literally pulling people out of the graves, we literally were putting people on treatment and within weeks, you could see a complete rebound of people that would have died within days, sometimes weeks before treatment," Carlo said.
Far from certain death at the virus's peak in the early 1990s, consistent treatment now offers a manageable life. But federal support for prevention and treatment has been put at risk — despite rising cases.
On the state’s top 10 of new HIV diagnoses in 2023, all four big North Texas counties made the list.
Collin, Dallas, Denton and Tarrant counties together recorded almost 34,000 known new HIV diagnoses that year, according to the Texas Department of Health and Human Services.
Holding or lowering infection rates requires consistent testing, lifelong medications and continuous follow-up visits, said Dr. Phillip Huang, Dallas County's Health and Human Services director.
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He says a new study shows the potential financial crisis from public health care cuts.
“One new case is estimated to cost like $420,000 in lifetime health care costs. So you prevent that one case — that one — and you've saved the community and the health care system a huge amount of money.
"For the number of new cases we had in 2022, it's like $382 million in Dallas County that those new cases are anticipated to cost in future health care costs," he said. "These numbers are a wake-up call. Prevention and early treatment aren’t just good medicine — they’re smart economics.”
Federal funding to states — then local disbursement — was delayed earlier this year.
Dallas County was notified in late May that it was prohibited from giving money to departments and organizations.
In July, after budget planning for next year had begun, local governments learned they would get money for HIV and AIDS case management after all.
By then it was too late.
Twenty five Dallas County Health and Human Services staff had been laid off, including disease data trackers.
Prism Health, like other government grant-funded organizations, furloughed staff, Carlo said.
"Community events and outreach, education, peer to peer programming, all of those things had to be disrupted and stopped, unscheduled, canceled, and this is one of those things that when we develop these programs, they're created with a great deal of trust," Carlo said. "we work with people that are naturally skeptical of any sort of intervention, especially issues that are as sensitive as HIV prevention. So it takes a lot to develop trust for the people that we serve."
Until 2022, Black communities in Dallas County consistently had the most new diagnosed HIV cases…slightly higher than cases among Latinos.
That year, for the first time since local records are available from 2014, cases among Latinos significantly surpassed all other races and ethnicities.
HIV and AIDS caregivers worry that numbers could begin spiking.
Organizations like the Ryan White program — which offers medical and social support services to people living with HIV — normally can be awarded five-year grants.
That money is now uncertain year to year.
Fear of violence or detainment is causing people who need care to avoid health and resource center visits.
Cuts to Medicaid and the affordable care act will only increase financial burdens — and limit access to health care, Huang said.
"Millions of people are going to die because they can't get on their HIV medications," he said. "And these are including children."
Twenty thousand staff members have been cut across federal agencies — almost enough to fill the city of Terrell.
Constant national crisis and chaos pulls attention in so many directions that people don’t realize what’s happened, Huang said.
"It's a destruction of these programs that support us at the state and local level," he said. "There's no staff there anymore."
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