Texas HIV medication program stable for now, but funding concerns on the horizon

After an initial delay, the Texas HIV Medication Program Advisory Committee met June 3. The committee advises state health officials on policies, medication formulary decisions and program goals for the Texas HIV Medication Program, which provides HIV-related medications and support services to eligible Texans. Steven Vargas, a member of the committee, posted his thoughts afterward on social media, with additional comments that he shared with Positively Aware, and agreed to have them republished for this First Person essay.

.FIRST PERSON. COMMENTARY

I spent most of June 3 participating in the Texas HIV Medication Program Advisory Committee meeting in Austin. As a long-term survivor of HIV and someone who has served on various governmental advisory bodies for more than 20 years, I see this work as one of the most important ways I can help ensure that people living with HIV fully benefit from the advances our community has fought for over the last 45 years.

Like many states, Texas is anticipating potential budget shortfalls. However, people living with HIV in Texas can have a strong degree of confidence that access to care and medications will remain stable for at least the next six months, with no expected changes resulting from state-level requirements or program adjustments. Beginning in January 2027, the 90th Texas Legislature will convene, and future funding decisions will depend on the actions it takes. Thanks in part to fierce advocacy from people living with HIV, we expect the program to remain stable through at least June 2027 and, hopefully, through the next budget cycle.

As I do in every meeting, whether online or in person, I make a point of increasing the visibility of our friends and family of trans experience by including my pronouns alongside my name on screen or on my meeting placard. Visibility matters, especially in spaces where decisions affecting people's lives are being made. And those of us not of trans experience need to step up for this beleaguered and beloved community.

As one of the founding members of the Texas Strike Force, I was deeply encouraged to see several Strike Force members attend the June 3 meeting and provide public comment, and that many others submitted written testimony. Several emphasized the importance of transparency, and I believe the meeting demonstrated a significant commitment to that principle.

And I’ll take a moment to brag about the Texas Strike Force.

Every community member living with HIV who serves on this advisory body is a member of the Texas Strike Force. At the national level, during AIDSWatch in Washington, D.C., you can count on at least one, and often both, of Texas’s state coordinators being Strike Force members as well.

This is not accidental. It is intentional.

Our goal has always been to ensure that the voices of people living with HIV are present wherever decisions are made about our care. We work from the outside, organizing communities, raising awareness about potential threats and opportunities and advocating against policies that could harm us. At the same time, we work from the inside through official advisory bodies and decision-making structures where those critical policies are shaped. Both roles are necessary, and both are powerful.

On this 45th anniversary of the first reports of what would later become known as AIDS, and on the heels of HIV Long-Term Survivors Awareness Day on June 5, I am proud to report that people living with HIV in Texas continue to take the Denver Principles seriously. We are not simply asking for meaningful involvement; we are living it every day, in real time, and in real life. 

Having six months of certainty that the program will remain unchanged is certainly welcome news. It’s a bit like knowing we won’t be hit by a hurricane over the next six months: a relief, but one that comes with the understanding that circumstances can always change.

This feels like a temporary reprieve from what could happen once the 90th Texas Legislature is sworn in next January. That said, the Texas Strike Force is already hard at work identifying and supporting potential HIV champions among both new and returning candidates for the Texas House. Moments of relief are often temporary. Still, I’ll gladly take the reassurance of knowing we’re stable for at least the next six months and potentially through June 2027.

Beyond that, much will depend on the priorities of the next legislative session and the influence advocates will have with newly elected representatives. The future could look very different. A big part of this effort was to help clear the air so that people living with HIV do not have to feel the strain, at least for now, that many people with HIV are experiencing across the country in their respective states regarding their AIDS Drug Assistance Programs (ADAPs).

At our meeting, the Department of State Health Services (DSHS) stated in its budget projections that the Texas HIV Medication Program is expected to begin experiencing a budget shortfall in fiscal year 2027. To help maintain solvency for as long as possible, the department is currently drawing down its pharmacy inventory reserves.

Without program changes and additional appropriations, that shortfall is expected to continue. That’s why many of us are concerned about what could happen once the legislature convenes in January. The good news is that DSHS has committed to no changes to the program over the next six months.

Additional funding will likely be needed by June 2027. DSHS indicated it will ask the legislature for $29.4 million to address the projected shortfall and to maintain at least a two-month pharmacy inventory.

DSHS’s own projections show the shortfall growing to an additional $41.8 million by the end of FY 2028. Given rising medication costs and increasing program demand, and if the goal is truly to maintain a minimum two-month inventory, I believe we should request approximately $71.2 million to meet the projected need.

Even then, I shared that a two-month inventory may not be sufficient. From my perspective, maintaining at least a three-month medication supply would better protect people living with HIV in Texas, particularly during hurricane season or other emergencies that could disrupt access to medications or require sudden relocation. We already encourage individuals to keep up to three months of medication on hand whenever possible.

For that reason, I recommended that DSHS calculate the cost of maintaining a three-month pharmacy inventory and request funding at that level. That would provide greater stability for the program and more security for the Texans with HIV who depend on it.

Steven Vargas is a Houston-based HIV advocate and long-term survivor who has spent more than three decades advancing HIV policy, care access and community engagement at local, state and national levels. Diagnosed in 1995, he has served in leadership roles with the Houston EMA Ryan White Planning Council, the Latino HIV Task Force, the Texas HIV Medication Program Advisory Committee and the National HIV and Aging Advocacy Network, and has contributed to federal HIV treatment-guideline development and numerous community-led advocacy initiatives.