New York City is seeing an unsettling trend: new HIV infections are rising.

NYC was one of the earliest and hardest-hit cities of the HIV crisis. By the 1980s, thousands of New Yorkers were dying of HIV-related illnesses. Deaths peaked in the early 1990s, with ~7,500 New Yorkers lost each year in 1993 and 1994.

In the early years, government funding for HIV research was slow, in part because of stigma against the populations most affected, particularly gay men and people who inject drugs. In response to devastating losses, New York communities mobilized.

Activist groups like ACT UP and GMHC led protests and demonstrations demanding faster research, more funding, and equitable care. Their efforts reshaped public health policy and laid the groundwork for today’s HIV treatment and prevention. But looming federal cuts are now threatening to undo some of this progress.

New York has since been lauded for its continued efforts in the prevention and reduction of HIV. But even the best systems can’t withstand prolonged stress, and recent data show some cracks. Key questions include: Why now? And how do we protect years of progress?

What is HIV, and where do we stand with treatment and prevention?

HIV (human immunodeficiency virus) is a virus that attacks and destroys the infection-fighting CD4 cells of the immune system, making it harder for the body to fight off other infections and some cancers. Without treatment, HIV can gradually destroy the immune system and lead to AIDS (acquired immune deficiency syndrome), the most advanced stage of HIV infection.

While there’s no cure for HIV, we have effective treatments and medications that can prevent infection:

• Antiretroviral therapy (ART) reduces the amount of HIV in the body to levels that are essentially undetectable. When the virus is undetectable, it cannot be transmitted through sex (undetectable = untransmittable). ART allows people to live long, healthy lives, but timing matters. Starting ART early, before immune cells decline, leads to stronger immune recovery and longer life expectancy.

• Pre-exposure prophylaxis (PrEP) can be taken before sex, injection drug use, or other potential HIV exposures. It reduces the risk of infection from sex by about 99%, and infection from drug use by about 74%.
• Post-exposure prophylaxis (PEP) can be taken within 72 hours of potential exposure to reduce the risk of infection, but it’s less effective than PrEP.

These treatments and medications are truly remarkable for HIV prevention and treatment, but early testing, diagnosis, and access to care are essential.

Where we stand today

Thanks to breakthroughs in ART, new cases in New York dropped significantly after their peak in 1993. And since then, the downward trend in both new cases and deaths due to HIV has mostly continued.

But that has recently changed—in 2024, for the second year in a row, New York City HIV cases increased.

Why are infections rising again?

Even in a state with some of the strongest HIV prevention programs in the country, New York was not immune to the ripple effects of the Covid-19 pandemic.

The recent rise in HIV cases appears to be strongly tied to disruptions in prevention, testing, and care during the pandemic.

During the early stages of the pandemic in 2020, HIV testing plummeted across New York, and it still hadn’t returned to pre-pandemic levels by 2022.

Two-thirds of HIV testing clinics in NYC shut down in the early months of the pandemic.

Community outreach at bars, nightclubs, and other venues also stopped. At the city level, only one of the NYC Health Department’s eight sexual health clinics remained open throughout the pandemic. To try to fill the gaps, the city health department created a sexual health hotline and launched programs to mail STI and HIV test kits and prevention supplies to residents. These were important adaptations, but they weren’t enough to close the gaps.

New PrEP prescriptions and total PrEP prescriptions (including among those already taking it) also dropped substantially during the first 6 months of the pandemic. There were fewer clinic visits, prescription refills, and conversations between providers and patients about PrEP.

Behind these statistics are deeper, structural issues.

Housing instability, stigma, lack of adequate health insurance or employment, and unmet needs also continue to limit access to HIV services.

Among those newly diagnosed in 2024 and interviewed by the NYC Health Department, 48% reported a lack of health insurance, 37% reported housing insecurity, and 13% reported food and nutrition needs.

While the pandemic didn’t create these problems, it did make them worse. Those problems show up in the data about who is getting infected and where infection rates are increasing.

There were 1,791 people newly diagnosed with HIV in NYC in 2024, a 5.4% increase from 2023.

This follows a similar 6.9% rise the year before. In the rest of New York state, there were 734 new cases in 2024, no change from the year before.

HIV continues to reflect deep social and racial disparities:85% of new diagnoses were among Black and Latino New Yorkers, who make up only 50% of the city’s population.

• 42% lived in high- or very high-poverty zip codes at the time of diagnosis.
• 75% of new cases were among men, 20% among women, and 4% among transgender women. Less than 1% identified as transgender men or another gender identity.

But there are some bright spots, too. Screening is working better in some groups. Transgender women and youth ages 13–29 were more likely to be diagnosed during the earliest stage of infection, suggesting early detection is improving for these populations.

Access to care is also improving: 87% of people diagnosed with HIV in NYC are receiving care, and among those, 90% are virally suppressed.

Unfortunately, proposed federal funding cuts to HIV programs threaten to widen disparity gaps.

What federal HIV budget cuts mean for New York

Proposed federal budget cuts for FY2026 could damage key programs in New York, especially in communities facing the highest risk.

These programs are on the line:

• CDC HIV Prevention Program: The House bill proposes eliminating all $755.6 million in federal funding, including over $41 million for NYC. These funds support HIV surveillance, testing, and outreach. Without it, our ability to track and contain HIV will be weakened.
• Ending the HIV Epidemic (EHE) initiative: Congress could eliminate the entire $220 million budget for EHE. NYC is a priority site, and these funds currently support PrEP access, mobile testing, and same-day care.
• Ryan White HIV/AIDS Program: The bill proposes a $525 million cut, including the elimination of programs that fund HIV care in community health centers, provider training, and support services for women, infants, children, and youth. Thousands of New Yorkers rely on Ryan White for care, housing, and case management.
• Medicaid: Proposed changes would cut nearly $1 trillion from Medicaid over 10 years. In New York, almost half of all people with HIV depend on Medicaid.

Taken together, these cuts don’t just reduce funding,

they remove the infrastructure that supports our entire HIV response. Right now, these programs are temporarily funded at last year’s levels under a short-term continuing resolution (which ended the government shutdown), but Congress will have to vote on the full FY2026 budget in the coming months, putting them back on the chopping block. If enacted, New York could backslide on decades of progress, increasing disparities and seeing a resurgence of preventable infections.

Bottom line

New York has made incredible progress in the fight against HIV, but that progress is not guaranteed. Rising infection rates, persistent disparities, and looming federal funding cuts put us at risk of sliding backwards. Continued investment in testing, early access to ART, and prevention are essential to keep moving forward.

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health expert. This newsletter exists to translate complex public health data into actionable insights, empowering New Yorkers to make informed and evidence-based health decisions.