If you have heard me speak - in a keynote, panel, workshop, or webinar - you have heard this story.
For years, I worked in corporate America.
I had employer-sponsored insurance. I had access. I could afford my copays. I could go to the doctor, get my labs, pick up my medication, and keep moving. I was living with HIV, but because I had coverage and the ability to pay what the system asked of me, I experienced HIV care as something I could manage.
That did not mean HIV was easy.
It meant I had a cushion.
It meant there were systems around me that made care possible. It meant I could survive the bureaucracy because the bureaucracy was not built to crush me every time I needed help.
For a long time, I thought I understood access.
Then I started working deeper in the community.
In 2016, I learned about ADAP - the AIDS Drug Assistance Program - not as an acronym in a policy document, but as a lifeline people were afraid of losing. I heard the fear around recertification. I heard what it meant to worry that one missed deadline, one missing document, one income change, one confusing notice, or one bureaucratic mistake could interrupt medication access.
But the lesson was bigger than ADAP.
ADAP was the doorway.
The system was the story.
What I began to understand was that HIV care does not depend on one program alone. It depends on an entire chain: employer insurance, Medicaid, Medicare, Ryan White, ADAP, public health departments, clinics, pharmacies, case managers, transportation, housing, privacy, trust, and the ability to move through bureaucracy without being punished for being poor, Black, queer, trans, rural, immigrant, aging, disabled, or living with HIV.
That was the moment I understood access is not one door.
It is a system.
And when politicians cut that system, people feel it in their bodies.
Access is more than having a card in your wallet.
A lot of people think health access means having insurance.
I used to understand it that way too.
Insurance mattered. It still matters. Having coverage helped me stay in care, afford medication, keep appointments, and manage my health. I will never pretend that did not matter.
But community taught me that coverage is only one part of access.
Access is whether you can afford the copay. Whether the clinic is open. Whether you can get there. Whether your paperwork is processed on time. Whether you can take off work without losing wages. Whether your case manager has time to help you. Whether your provider respects you. Whether you trust the system enough to walk through the door.
Access is also whether a public program is funded well enough to do what the public needs it to do.
That is why a cut is never just a cut. It breaks the chain between diagnosis, treatment, prevention, viral suppression, and the care that keeps people alive.
The safety net is not charity. It is infrastructure.
Ryan White, ADAP, Medicaid, public health clinics, STI programs, reproductive health services, gender-affirming care, transportation support, case management, housing assistance, and community-based organizations are often talked about like extras.
They are not extras.
They are infrastructure.
HRSA describes the Ryan White HIV/AIDS Program as a system that funds cities, counties, states, and community-based organizations to provide HIV care, treatment, and essential services to more than 600,000 people - more than half of people diagnosed with HIV in the United States. HRSA also reports that 91.4% of Ryan White clients receiving HIV medical care were virally suppressed in 2024.
That is what public systems can do when they are funded.
They keep people in care. They help people live longer and healthier lives. They help people reach viral suppression, which prevents transmission. They turn public dollars into public health.
ADAP is one part of that infrastructure. HRSA describes ADAP as part of Ryan White Part B, providing HIV medications and health services to low-income people with HIV. NASTAD’s 2026 ADAP report describes ADAP as a public health system performing at a high clinical level while navigating an increasingly fragile fiscal environment.
That word - fragile - matters.
Because the system does not only break when care disappears completely.
It breaks when people are made to worry that care might disappear. It breaks when recertification becomes a source of panic. It breaks when people do not know whether they will still be eligible next month. It breaks when public programs are forced to do more with less. It breaks when a person living with HIV has to ask, again and again, whether the medication that keeps them alive will still be there.
These issues are connected because people’s lives are connected.
One of the biggest mistakes in health policy is pretending that people live in separate categories.
HIV over here.
STIs over there.
Reproductive health in one room.
Gender-affirming care in another.
Medicaid in a budget hearing.
Transportation in a local planning meeting.
Housing somewhere else.
Privacy and surveillance treated like legal side issues.
But people do not live in policy silos.
A Black gay man living with HIV may also be dealing with housing instability, medical debt, transportation barriers, aging, stigma, and insurance paperwork.
A Black trans woman may need gender-affirming care, HIV prevention or treatment, STI testing, mental health support, safe housing, and a provider who does not make her explain her humanity before offering care.
A rural person living with HIV may have insurance but still live hours from a clinic.
An immigrant may qualify for care but avoid it because they fear what information will be shared, who will see it, or how it could be used.
An older adult aging with HIV may need HIV care, Medicare navigation, Medicaid supports, long-term care, transportation, and protection from isolation.
A person who uses drugs may need harm reduction, HIV testing, hepatitis C care, wound care, housing support, and a clinic that does not treat them like a problem to be managed instead of a person to be cared for.
When one part of the system is cut, the harm does not stay in that lane.
It spreads.
Medicaid cuts are HIV cuts. Public health cuts are STI cuts. Clinic cuts are reproductive health cuts. Transportation cuts are appointment cuts. Research cuts are future-treatment cuts. LGBTQ+ health cuts are community survival cuts. And Ryan White or ADAP cuts are not just program cuts.
They are treatment cuts.
Seven Days in June is a chance to make the invisible visible.
Seven Days in June: Health Is Primary is a national week of action scheduled for June 1-7, 2026. The campaign describes itself as a decentralized, nonpartisan, grassroots-driven effort to focus attention on how health funding cuts, policy changes, and regulatory changes will affect local communities and economies.
That is exactly what this moment requires.
Because people need to see what cuts do before the damage becomes normalized.
Too often, the harm starts quietly.
Not always with one dramatic announcement. Sometimes with forms, delays, denials, underfunding, fear, and silence.
A clinic reduces hours. A case manager leaves and is not replaced. A state adds paperwork. A pharmacy benefit changes. A transportation program disappears. A public health department loses staff. A provider stops offering care because the politics have become too hostile.
Then a person misses one appointment, then another. A person falls out of care. A person becomes detectable again. A person gets sick in a way that could have been prevented.
That is how systems fail people.
Seven Days in June gives advocates a chance to interrupt that silence. It gives us a chance to say that health is not a niche issue. It gives us a chance to show the public what public health looks like in real life. It gives us a chance to connect the dots before people are forced to live the consequences.
Health care is an LGBTQ+ issue, an HIV issue, and a racial justice issue.
Equality Federation has said clearly that cuts to health care funding, research, and programs will lead to worse health outcomes and will be devastating for LGBTQ+ communities, who already experience discrimination, poverty, and worse health outcomes.
That is not separate from HIV.
It is part of the same fight.
Black LGBTQ+ people do not experience health policy as an abstract debate. We experience it in our bodies and in clinic safety. We experience it in whether providers listen, whether insurance covers what we need, whether our data is respected, and whether public systems see us as people or problems.
And for people living with HIV, these systems are not theoretical.
They are the difference between staying in care and falling out of care, between being undetectable and being placed at risk. They are the difference between life and death.
One Nation, Overcharged names another part of this same reality: people are being overcharged for the health care they need, from copays and deductibles to prescriptions, lab tests, and emergency care. The campaign argues that the health care system should put people first and work for everyone.
For people living with HIV, “people first” cannot be a slogan.
It has to mean treatment without terror. Coverage without traps. Care without humiliation. Public programs funded like lifelines, because that is what they are.
Let me be plain.
I do not see this timing as innocent.
I see it as political strategy.
Delay the deepest harm until after the midterms, then let communities absorb the damage.
That is my advocacy interpretation.
And I am not saying it softly.
There is evidence for why advocates are alarmed. KFF reported that Medicaid issues in 2026 are likely to intersect with broader health care coverage and affordability debates leading up to the November 2026 midterm elections. KFF also reported that the 2025 reconciliation law made historic cuts to federal Medicaid financing, estimated at $911 billion over ten years, with work requirements beginning January 1, 2027, for many Medicaid expansion enrollees.
Axios reported that the real effects of Trump’s tax and spending bill likely would not be felt until after ballots were cast, and summarized the delayed implementation of major Medicaid and ACA changes as backloaded.
So yes, I read the timing politically.
I read it as MAGA understanding exactly how devastating these cuts will be once people feel them in their bodies, their clinics, their pharmacies, their insurance notices, and their families.
But people living with HIV cannot afford delayed honesty.
Neither can people on Medicaid, people depending on ADAP, people using Ryan White services, people trying to stay housed, insured, virally suppressed, and alive.
These are not just cuts.
Cuts kill.
A cut is never just a line item.
A cut is never just a line item. It can mean skipped labs because the clinic is farther away, rationed medication because approval feels uncertain, case managers carrying twice the workload with half the resources, and rural patients choosing between gas money and groceries. It can mean Black trans women avoiding clinics where care has too often come with humiliation, older adults aging with HIV getting lost between HIV care, Medicaid, Medicare, housing, transportation, and long-term care, immigrant families avoiding services because they fear surveillance, young people testing late because outreach workers have disappeared, and people who were undetectable becoming detectable again - not because they stopped caring, but because the system stopped caring for them.
That is why I refuse to talk about health care cuts as if they are only numbers.
Budgets are moral documents.
Eligibility rules are moral documents.
Recertification systems are moral documents.
Copays are moral documents.
Transportation policies are moral documents.
And when those documents are written in ways that make survival harder, we have a responsibility to say so.
The call to action is local, public, and urgent.
Between now and June 1, we should be organizing.
We should be asking local organizations, clinics, faith communities, HIV service providers, LGBTQ+ groups, reproductive justice advocates, disability advocates, labor partners, and public health workers to name what cuts will mean where they live.
From June 1 to June 7, we should be visible.
Seven Days in June calls for local action because local communities will feel these cuts locally: in hospitals, clinics, pharmacies, health departments, families, and economies.
So hold the town hall. Write the op-ed. Host the forum. Bring the AIDS Memorial Quilt into public view.
Ask elected officials direct questions.
Will you protect Medicaid? Will you protect Ryan White? Will you protect ADAP? Will you protect public health infrastructure? Will you protect STI testing? Will you protect reproductive health access? Will you protect gender-affirming care? Will you protect transportation support? Will you protect community clinics? Will you protect the people whose lives depend on these systems?
Do not let them hide behind language.
Ask them who will lose care. Ask them who will lose medication. Ask them who will lose transportation. Ask them who will lose coverage. Ask them who will die.
I know what access gave me. That is why I fight for it.
I know the difference between managing HIV with support and managing HIV while afraid.
I know what it means to have insurance, to afford copays, and to move through the system with enough protection to survive it.
And I know what I heard in 2016 when community taught me the truth: access is not guaranteed just because treatment exists.
That truth changed my life.
It made me an advocate.
And now, as a Black gay man living with HIV for 30 years, as Co-Chair of the USPLHIV Caucus, and as CEO of Unity Arc Advocacy, I am asking people to stop treating health care cuts as distant political noise.
They are not distant. They are coming through the clinic door, the pharmacy counter, the Medicaid notice, the ADAP recertification packet, and the lives of people who have already survived too much.
We do not have the luxury of waiting until the harm is undeniable.
By then, people will already be missing care. People will already be rationing medication. People will already be afraid. Some people will already be gone.
So during Seven Days in June, let us be clear.
Health is primary.
Access is survival.
And cuts kill.
Sources and reporting notes
This draft uses my personal reflection about working in corporate America with employer-sponsored insurance, learning about ADAP and recertification fears through community work in 2016, and entering advocacy as a result.
Core sources reviewed include:
Seven Days in June: Health Is Primary
HRSA Ryan White HIV/AIDS Program
HRSA ADAP Overview
NASTAD 2026 National Ryan White HIV/AIDS Program Part B ADAP Monitoring Project Annual Report
KFF, “Medicaid: What to Watch in 2026”
Axios reporting on delayed health-policy effects after the midterms
Equality Federation, “Health Care Is an LGBTQ+ Issue”
One Nation, Overcharged