Community-based orgs pivot services as federal HIV prevention funding shifts to states

By Skye Crawford

Just three days before shutting down, PowerHouse 2.0 in Charlotte tested and identified someone newly positive with HIV.

The organization had been around for 16 years, offering free HIV screenings and prevention services for Black men in the community who have sex with men. (HIV is the virus that causes AIDS and other sexually transmitted infections.) It shut down at the end of September after the CDC redirected HIV prevention funds to state and local health departments. 

“To just be able to end the funding stream, it does not mean that the work needs to be ended,” said Ra’Shawn Flournoy, CEO at Quality Comprehensive Health Care, the parent organization of the PowerHouse program.

In July, the Trump administration directed the CDC to not renew its five-year grant that has invested almost $240 million in HIV prevention directly through 96 community-based organizations across the country since 2021.

“I think that sometimes the administration does not understand the lives that are truly attached to these resources and really the consequences when it comes to losing support,” Flournoy said.

By the end of 2025, 1,327 North Carolina residents had been newly diagnosed with HIV. Between January and March of 2026, another 338 people were diagnosed. Once an infection that inevitably progressed to AIDS and death, HIV can now be managed as a chronic disease — but only if the person receives treatment. 

Though it once supported community groups directly, now the CDC has changed its policy. The federal agency started offering supplemental funding to states that are current recipients of the High-Impact HIV Prevention and Surveillance Programs for Health Departments award. States that apply and receive supplemental funding are encouraged, but not required, to spend at least 10 percent of the money they get on community-based organizations. 

Carl Schmid, executive director of the Washington, D.C.-based HIV and Hepatitis Policy Institute, said the change in funding is a “real disruption” in the HIV prevention infrastructure. Some states, he predicts, will take portions of their supplemental funding with no guarantee it will go to community groups. 

“It’s a mix of what’s happening, but we do know that some programs are ending, people are being laid off and this work is not being conducted as it was before,” Schmid said.

The N.C. Department of Health and Human Services told NC Health News that it received $1,785,603 in supplemental funding last month, and that 30 percent of that amount is going to support community-based organizations. The agency said that’s happening through funding the N.C. State Laboratory of Public Health to support community groups’ HIV/STI testing, providing them with social marketing materials and rapid test kits to continue providing needed services.

Additionally, the state budget passed this July allocates just over $135,000 to HIV prevention and community planning, with funds coming from the federal Preventive Health and Health Services Block Grant. NCDHHS told NC Health News that this money is going toward supporting Duke Partners in Caring HIV testing clinics in Durham and Wilmington and HIV prevention activities at local health departments.

Change in direction

The policy change undoes an initiative the CDC took in 2020, when the federal agency first announced it would partner with and fund local community groups, emphasizing the advantage these organizations have to “complement and extend the reach of HIV prevention efforts implemented by state and local health departments.”

“Because of their accessibility, history, and credibility in the community, [community based organizations] are recognized and remain important partners in providing comprehensive high-impact HIV prevention services,” the announcement read.

“A lot of times, people are uncomfortable going into the health department,” Flournoy said. “It’s already deemed as the place that you go for STDs or HIV.”

The numbers prove him right. Between 2012 and 2017, the rate of newly diagnosed HIV cases was three times higher at CDC-funded community-based organizations than at CDC-funded health departments nationwide.

“With PowerHouse, it was in a discreet location, so people were able to easily access it,” Flournoy said. “It was right on the bus line. We had traditional and untraditional testing hours, and we were able to even meet people where they are with our mobile outreach unit.”

Flournoy also said that local health departments can get overwhelmed and send people to community offices to get tested.

PowerHouse retained much of its outreach team at Quality Comprehensive Health Care, and the organization is offering comprehensive health screenings that still include HIV testing, according to Flournoy. He emphasized that even though PowerHouse is closed, members of the community can still see staff who have been there for them in the past at Quality Comprehensive Health Care.

“We’re still out in the community, and we’re just looking at trying to find innovative approaches and ways to continue to sustain funding because unfortunately we’ve had very little communication with our state and local health department with access and resources,” Flournoy said.

Flournoy said the organization does not have a clear understanding of the status of funding but was told by state health officials that it could apply for funding sometime next spring.

A challenge with history

Although PowerHouse was the only North Carolina HIV prevention group to directly receive CDC funding, other groups that provide community resources, testing and connection to care have been navigating recent and previous funding changes. 

In 2025, other federal funding cuts caused SEEDS of Healing based in Castle Hayne, an unincorporated area near Wilmington, to reduce employees and hours, and led Positive Wellness Alliance in Forsyth County to close.

Emilia Ismail, executive deputy of the statewide organization El Centro Hispano, said her organization has not experienced an impact on its education programming, but they are noticing changes in their ability to connect community members to testing resources.

“It’s not that there has been a direct cut to the funding sources that support our HIV education programming, but because other partner organizations and agencies that we rely on for that work have had cuts, then we have limited access to those resources,” Ismail said.

Adriana Adams, CEO at Triad Health Project in Guilford County, said her organization and North Carolina AIDS Action Network have collaborated for years, but recent federal decisions pushed them to make their partnership more official.

“Knowing the writing on the wall and what was kind of happening internally because we were connected, [we] knew that there were some things that were gonna come down the line and it may not be possible for [their] organization to continue,” Adams said.

Now, NC AIDS Action Network operates under Triad Health Project’s organizational umbrella and focuses on policy advocacy.

Matt Martin was the associate director at NC AIDS Action Network and was its only full-time employee for about a year due to a consistent loss of community funds, which Martin said were already limited.

“When federal funding or state funding gets cut, it usually means that there’s not a lot of community funding to go around either,” Adams said. “Truth be told, there hasn’t been a lot of prevention funding in our state for HIV for years. We’ve been getting the same small grant from the state anyway.”

Adams said Triad Health Project conducts 60 percent to 70 percent of the testing in Guilford County for sexually transmitted infections.

“We have the tools to make people who are living with HIV live very long, healthy, happy lives, but the systems that are put in place for them to navigate are so hard to navigate, especially when cuts are coming from every single level,” Martin said.

With more need for funding across the board, Martin and Adams are working to change policy, with Martin continuing advocacy at the state legislature.

In 2021, Martin worked alongside Sen. Jim Burgin (R-Angier) on a piece of legislation that would allow pharmacists to administer post-exposure prophylaxis (PrEP), a medication that people at risk for contracting HIV can take to prevent infection from sex or injection drug use.

“I think we do have a fair number of folks on both sides of the aisle who will understand the importance of our work and really try and show up for us as best we can,” Martin said.

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