By Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM
World AIDS Day always sparks considerable reflection on my part. I have been involved with the populations most impacted by AIDS since long before the initial day of remembrance in 1989. I shared that story and its impact in last year’s World AIDS Day blog.
The past few World AIDS Days have found me more optimistic than in the past. I loved watching the evolution of prevention and treatment. The 41 million people living with HIV infection around the world finally had a reason to celebrate. People were living longer and having more healthy years than ever before. Proactive and consistent treatment led to a near-normal life expectancy for the majority of patients (Hayes, 2023). Amid the 1.3 million people who acquired HIV in 2024, mortality rates were profoundly less than in prior years. Global mortality for HIV-related deaths was 630,000 (World Health Organization, 2025) and a 26% reduction from the 820,000 lives lost in 2023 (UNAIDS, 2024).
Funding for research was abundant and well into the billions. This influx of dollars meant the development of increasingly affordable and accessible life-sustaining drugs. Promising research from Melbourne, Australia, reported the first true cure for the disease (Lay, 2025). What could possibly go wrong with this level of momentum?
Funding Changes Negate Attaining Expected Benchmarks
Unfortunately, 2025 brought a dramatic reversal in the progress detailed heretofore. The global target for 2025 was set: to reduce new HIV infections to under 370,000 annually. It was also hoped that AIDS-related deaths would not surpass more than 250,000 lives lost per year. However, neither of these data points are likely to be met.
Case managers value knowing the rationale behind a failure to meet expected benchmarks. The causes are related to several moving parts, though stem from massive US domestic and international funding shifts.
Domestic funding changes
Macro-level funding issues have been a constant news item with meso and micro-level consequences.
Domestic Funding
Major funding and support for the following programs has been eliminated or decreased:
- The Domestic HIV/AIDS Prevention and Research Program, previously funded at $755.6 million, has been eliminated.
- The Ryan White HIV/AIDS Program (previously funded at $2.6 billion with reductions as high as $525 million)
- The Children, Youth, Women, and Families Program (Part D) and AIDS Education and Training Programs (Part F) (recommended budget cuts at 50% of the current $880 million)
- The National Institutes of Health (NIH) will cease support for its coveted Federal HIV clinical guidelines by June 2026 (Collins, 2025).
Organizations that rely on federal funds are also dealing with ongoing furloughs and layoffs of case managers, community health workers, and front-line practitioners.
International funding
Some 61% of the deaths from HIV-related causes in 2024 occurred in African countries. These regions were most impacted by the loss of critical funding and staffing out of the US (amfAR, 2025), including:
- Funding cuts to the US President’s Emergency Plan for AIDS Relief (PEPFAR)
- Ending of foreign assistance by closure of the United States Agency for International Development (USAID)
- Other proposed cuts to:
- The Global HIV/AIDS Program (a loss of $128.9 million), and
- Global TB Program (a loss $11.7 million).
The recent Federal government shutdown during the last quarter of 2025 further hampered public health’s infrastructure. High-risk populations served by state and local facilities, programs, and clinics have been forced to go without life-sustaining care and treatment. Massive supply-chain issues have led to problems with the transport and distribution of medication, resulting in treatment interruptions for those most in need. Delays and cancellations in HIV testing and administration of prevention programs (e.g., PrEP access) put others at increased risk of transmission with mental health intervention also limited.
The 2026 Crystal Ball
What will the future bring? Break out that crystal ball, case managers! I strive to be optimistic in how I end any publication or presentation. However, I am also research-driven and rely on data to inform my actions. And let’s face it: the data isn’t promising.
Concerning rates for new HIV infections are appearing across Eastern Europe, Latin America, and Africa (Buchbinder & Liu, 2025). While these increases are outside of the US, the epidemiological concern is valid. Readers are reminded that many public health emergencies have their origins in other countries, from Ebola to HIV and COVID, among others (Moss et al., 2025). A 2025 simulation has already predicted how terminating critical services has the potential to increase new HIV infections by almost 50% over the next five years (Foster et al., 2025). Other models predict some 6 million new HIV infections and 4 million AIDS-related deaths by 2029 without the prior rate of financial and industry support (Buchbinder & Liu, 2025).
Frontline professionals can expect to face ongoing challenges in working around the words to access grants and services for their populations. Many of the identified groups appearing in executive orders and other administrative requirements are those most traditionally impacted by HIV: distinct ethnic groups, members of the LGBTQIA+ community, persons of color, women, and others. Efforts to reduce stigma and discrimination against these affected individuals are being undone.
So, what does this mean for case managers? Advocacy remains a prime directive of case management. The populations we care for rely on our workforce for needed intervention. Here are several strategic actions to engage in:
- Contact local and federal legislators to inform them of the direct impact of these budget directives on your patients and populations, and
- Advocate for needed action.
- Engage with your professional associations and their public policy efforts
- Stay up to date with CMSA’s DEIB Core Committee and Public Policy Committee on current happenings.
Let my 2026 World AIDS Day blog reflect a more optimistic picture.
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Bio: Dr. Ellen Fink-Samnick is an award-winning industry entrepreneur whose focus is on professional case management, health equity, interprofessional ethics, quality, and trauma-informed leadership. She is a content-developer, professional speaker, author, and educator who serves as a faculty member, academic advisor, and the IRB coordinator for the Doctoral of Behavioral program at Cummings Graduate Institute of Behavioral Health Studies. Dr. Fink-Samnick is a member of the PMCJ editorial board and serves as editor of the journal’s HeartBeat of Case Management department. She also serves in national leadership and consultant roles across the industry, including as current Chair for CMSA’s DEIB Core Committee.