Equality Arlington Urges County to Protect Access to HIV and STI Public Health Services
Dear Mr. Karantonis and Mr. Schwartz,
Over the past year, we have seen a federal assault on public health services and funding that seeks to erase the progress we’ve made in addressing public health priorities for our community, including reducing the incidence of HIV and sexually transmitted infections (STI), increasing access to pre-exposure prophylaxis (PrEP) for the prevention of HIV, and ensuring equitable access to gender affirming care. The strain on safety net systems in Arlington will likely only increase over the next several years as federal policies impacting individual market coverage and Medicaid are expected to result in 310,000 Virginians losing coverage over the next decade.
We believe that the county has an important role to play in shoring up the public health and healthcare safety nets in Arlington to ensure that Arlington residents maintain access to lifesaving services. We urge the county to implement the following measures:
Ensure that HIV treatment and prevention services remain affordable and accessible in Arlington
As more Arlingtonians are expected to need access to safety net services, Arlington’s Public Health Division must ensure application and eligibility processes are simple, fair, and do not result in denials of care due to red tape
Affordable and Accessible HIV treatment and prevention services in Arlington
Arlington HIV prevention and treatment providers – including NovaSalud, the only clinic serving Arlington County focused exclusively on provision of STI services – provide essential HIV care, treatment, and prevention services to thousands of Arlington residents each year. However, state and federal funding cuts threaten the ability of these providers to continue to provide access to these services, particularly for low-income uninsured and under-insured individuals. Earlier this year, the Virginia Department of Health made significant cuts to the portion of federal Ryan White HIV/AIDS Program (RWHAP) it allocates to HIV providers, including to RWHAP providers serving Arlington. NovaSalud alone experienced a $500,000 funding cut to their RWHAP serving Arlington residents. These cuts are due to state accounting errors and do not take into account any proposed federal cuts to state and local HIV providers. The White House FY2026 Budget Request proposed a $1.5 billion (35 percent) reduction in funding for HIV programs compared to FY2025 levels, and the House proposed budget largely followed the White House cuts. Congress is currently debating final FY26 appropriation levels for public health programs. Safety net providers who rely on state and federal grant funding to keep their doors open cannot absorb additional cuts without cutting services and access. We urge the County Board to ensure HIV prevention and treatment providers, like NovaSalud, have the necessary funding to continue their lifesaving work as cuts at the state and federal level put our community increasingly at risk.
Additionally, Arlington County’s Public Health Division provides access to critical HIV and STI services, providing a safety net for access for low-income individuals who don’t have other coverage sources. As mentioned above, the federal funding landscape for governmental public health is very much at risk of significant appropriations cuts for FY2026 and beyond. This is despite the emerging data on the cost-effectiveness of HIV prevention, including PrEP, at reducing new HIV infections and a $500,000 estimated lifetime cost of HIV. The potential access challenges for receipt of PrEP is particularly concerning given the continued access gaps among communities who could most benefit from the intervention, including among Black and Latino gay men. Generic forms of the PrEP medication are now available for $1 per pill and health departments around the country are implementing new and innovative programs to increase access and uptake. Now is not the time to take the foot of the gas when it comes to increasing access to PrEP. We urge the County Board to invest in making PrEP available to those most in need through Arlington’s Public Health Division.
Streamlined Public Health Division application and eligibility processes
Burdensome eligibility processes, including unnecessary paperwork, directly impact access to services. This is why public health programs have made a concerted effort to streamline eligibility processes to ensure that individuals receiving services meet program criteria, while reducing client documentation burden. Arlington County’s Public Health Division provides critical access to STI and other communicable disease prevention and treatment services, but the eligibility criteria for these services is opaque and not spelled out in public materials. For instance, services are provided to low-income individuals based on a sliding scale, but the income criteria are not published, nor are the documents that individuals need to bring with them to prove they are income-eligible for sliding scale services.
This means that individuals may find themselves at Arlington’s STI Clinic in need of services, but if they do not have the appropriate documentation (a mix of pay stubs, tax returns, ID, and utility bills) on their person, they have the choice of delaying or forgoing care or proceeding with care under the condition they could be charged hundreds of dollars for the service if they don’t ultimately meet the public health eligibility criteria for reduced fee services. Nor is there a straightforward way for individuals to demonstrate they currently have no income, something that is important in a county experiencing surging unemployment as a direct result of reckless federal cuts to the federal workforce. Other public health departments – such as Baltimore City Health Department’s sexual health clinics – have a much more transparent and streamlined way to collect information from consumers that Arlington could consider adopting. It is also important for Arlington’s Public Health Division to invest in making the clinic more accessible – implementing online appointment scheduling and continuing their new marketing campaigns to reach at-risk populations throughout the county. We urge the County Manager to prioritize removing barriers to accessing critical public health services including maximizing transparency, reducing paperwork burdens, and exploring making access to the STI Clinic free for all patients.
We are happy to discuss improving public health services further and look forward to working with you to ensure that Arlington is a place where LGBTQ+ residents can thrive.
Sincerely,
Kellen MacBeth, President
Samantha Perez, Vice President
Sacha Brenac, Treasurer
Hans Bauman, Board Member
Whytni Kernodle, Board Member
Arne Nelson, Board Member
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