For a growing number of patients, going to a clinic now means risking detention by Immigration and Customs Enforcement. For people with HIV, that prospect can carry serious consequences. Providers are watching stable patients disappear from care, and they know what comes next: missed doses, viral rebound, resistance and the unraveling of treatment that took years to get right.
One Latino community leader described exactly this during one of 20 interviews we conducted in late 2025 with community leaders, advocates and HIV researchers who had attended the White House’s ¡Adelante! Summit in 2024, with a full report published in the VOCES LATINAS field guide, available at voceslatinasguide.org. (1)
This leader lost a friend to advanced HIV, a friend who was afraid to seek care because he was undocumented. Many of the people we interviewed told similar stories. They described how fear of immigration enforcement, shifting health policies and unstable funding are reshaping how Latinas/os with HIV reach care, putting decades of progress at risk.
Community fear is widespread
The people we interviewed described many forms of fear. One participant explained that migrant farmworkers were hiding in fields for hours when immigration agents approached: “People in the fields hear ICE is five minutes away, and their only option is to stay buried in the dirt, for hours …”
“It’s not just undocumented immigrants who are afraid,” another leader explained. “Permanent residents and U.S. citizens are afraid to go out because of the indiscriminate raids.”
Because of the fear created by these raids, one leader said no-show rates for medical, mental health and substance-use appointments had risen from 15%-19% to nearly 50%.
These fears are not unfounded. Investigations by ProPublica have documented more than 170 U.S. citizens held by immigration authorities (2), while reporting from The Guardian has described farmworkers who felt “hunted” during immigration raids. (3)
Detention disrupts HIV care
Participants also raised concerns about what happens when patients are detained by ICE.
Today, people with HIV can live long and healthy lives when they take their medication as prescribed. But as one participant asked, when patients are “moved from place to place and don’t know if they’ll receive their medications on time, what does that do to them?”
Another leader recalled two patients who were receiving long-acting antiretroviral therapy and were suddenly detained, forcing the care team to scramble for alternatives because those medications were unavailable at the detention facility. Compared with correctional systems, immigration detention facilities have different health care infrastructure and regulations, if any at all.
In February 2026, an oversight inspection of the nation’s largest ICE detention facility documented 49 violations of detention standards, including delays of up to 14 business days in responding to detainees’ medical concerns. (4) Similarly, a 2024 human rights investigation found that 13 of 17 people with HIV who were detained reported medical neglect in custody. (5) People, regardless of where they come from or their HIV status, deserve compassion and respect for their humanity.
Policy shifts and funding cuts threaten care
Leaders warned that federal funding cuts and policies targeting LGBTQ+ and Latina/o communities are harming community-based organizations and federally qualified health centers. These programs are the primary entry points to care for many Latina/o communities, and they are being forced to adapt to shrinking federal budgets and an expected cut of more than $1 trillion in federal Medicaid spending over the next decade. Medicaid covers roughly 40% of nonelderly adults with HIV and is a major source of revenue for the FQHCs that serve them. (6)
Meanwhile, executive orders rescinded prior policies supporting LGBTQ+ health equity, forcing clinics to adjust services while working to preserve dignity and care. These changes place added pressure on already strained safety-net clinics. (6-8)
Research instability threatens progress
Several people we interviewed described losing research funding.
“Our funded research base has been reduced by several million dollars,” one investigator said. “Many grants related to sexual and gender minorities or communities of color were cut.”
In 2025, the National Institutes of Health terminated more than 230 HIV-related grants, totaling roughly $1.8 billion. (9) Although some were later restored through legal challenges, several researchers said they have altered project language or removed references to marginalized communities to secure funding.
Provider distress and moral injury
The emotional toll on community health leaders and clinicians, often described as moral injury, is heavy.
“I haven’t been coping,” one leader told us. “I focus on supporting those who are more vulnerable … but there are so many things to process.”
Moral injury is distinct from burnout. It occurs when clinicians are prevented from providing adequate care by systemic constraints, when law, funding or policy forces them to act against the values that brought them to the work. In a survey of 1,126 physicians, 57% reported moderate or severe distress from working in systems that failed to treat vulnerable patients with dignity and respect. (10) Leaders worry the current climate will deepen this distress and burnout among those serving Latina/o patients.
The disparities behind the strain
These pressures are landing on communities already carrying a disproportionate share of the epidemic. CDC surveillance data released in May 2026 show that in 2024, Hispanic/Latino people accounted for about one-third (34%) of new HIV diagnoses nationally despite making up roughly 19% of the U.S. population.
Among males older than 24 whose HIV was attributed to male-to-male sexual contact, Hispanic/Latino men accounted for the largest share, at 40% of diagnoses. (11) As one community-based leader put it, Latinos remain the group whose diagnoses are rising while others fall. That was the starting point, before the policy and funding shifts of 2025.
Where we go from here
Despite these challenges, leaders shared concrete strategies and remained cautiously hopeful. Their recommendations, detailed in the VOCES LATINAS field guide (1), included:
- Bringing care to where people are, through telehealth, mobile testing, home visits and transportation support, and making the clinic itself feel safe through private intake, trauma-informed staff and protocols for enforcement activity near clinic sites
- Leveraging trusted messengers, including promotors, community health workers and peer navigators who come from the communities they serve
- Diversifying funding away from federal dependence toward philanthropic and private sources, while building legal preparedness for organizations themselves
- Continuing to educate and raise our voices through advocacy, no matter how big or small, like community members praying outside Atlanta's ICE field office (see photo)
- Refusing the isolation that leaders described as deliberate, through regular peer-to-peer contact, convening and intentional solidarity rather than competition among organizations serving the same communities
As infectious diseases and HIV providers know, the treatments exist. What is missing is trust and stability. Rebuilding trust, sustaining vital research and supporting the communities that need it most are essential to protect decades of progress against HIV. (1)
Photo: “No matter how small the gathering...”: Community members pray the rosary outside the Fulton County ICE facility in Atlanta; photo by Carlos S. Saldana, MD
References
- Saldana CS, Serrano PA, Mena LA, et al. VOCES LATINAS: A Practical Field Guide for Clinicians, Community Leaders, Researchers, and Advocates. Emory University; 2026. Accessed May 30, 2026.
- Foy N, Maney F. More than 170 U.S. citizens have been held by immigration agents. October 16, 2025. Accessed May 30, 2026.
- Sainato M. U.S. undocumented farm workers feel ‘hunted like animals’ amid Trump’s immigration raids. The Guardian. July 14, 2025. Accessed May 30, 2026.
- U.S. Immigration and Customs Enforcement, Office of Detention Oversight. Compliance Inspection: El Paso Camp East Montana, El Paso, TX, February 10–12, 2026. 2026. Accessed May 30, 2026.
- Immigration Equality, National Immigrant Justice Center, Human Rights First. No Human Being Should Be Held There: The Mistreatment of LGBTQ and HIV-Positive People in U.S. Federal Immigration Jails. June 2024. Accessed May 30, 2026.
- Dawson L, Kates J. Medicaid and People With HIV. KFF; 2025. Accessed May 30, 2026.
- Ives-Rublee M, Musheno K. The Truth About the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare. Center for American Progress; July 3, 2025. Accessed May 30, 2026.
- Dawson L, Kates J. Overview of President Trump’s Executive Actions Impacting LGBTQ+ Health. KFF; February 25, 2026. Accessed May 30, 2026.
- Basilio H. Trump team guts AIDS-eradication programme and slashes HIV research grants. Nature. March 31, 2025. doi:10.1038/d41586-025-00969-5
- Physicians for a National Health Program. Moral Injury in Medicine. March 17, 2026. Accessed May 30, 2026.
- Centers for Disease Control and Prevention. HIV Diagnoses, Deaths, and Prevalence: 2026 Update. National HIV Surveillance System. May 18, 2026. Accessed May 30, 2026.
