Ethan Suarez’s clinic has been on the frontlines of Central Florida’s HIV battle, offering free rapid tests at community events and health fairs so people can know their status.

But as President Donald Trump’s administration implements sweeping public health cuts, he’s watching in horror as such initiatives go on the budget chopping block. Their loss could have far-reaching consequences for Florida, one of the nation’s hotspots for new HIV infections , said Suarez, CEO of Pineapple Healthcare, a nonprofit clinic with offices in Orlando, Kissimmee and Lakeland.

“HIV affects everyone,” he said. “It is not a gay or straight disorder. … It is a silent disease almost until we’re into the very late stages. So with us not knowing, you’re actually going to cost the taxpayer.”

Democratic members of Florida’s congressional delegation are worried, too. They are asking the Trump administration to reinstate $2.5 billion in public health grants awarded to Florida, including about $42 million in HIV research grants. An Orlando Sentinel review found that about $1.7 billion of those terminated grants had already been spent, but hundreds of millions of dollars in outstanding funds are being clawed back by the federal government.

“These grants support vital public health initiatives, including childhood immunizations, infectious disease control, mental health programs, and HIV prevention and treatment,” Central Florida Reps. Maxwell Frost and Darren Soto wrote in the joint letter with six other representatives.

The federal government’s list of terminated grants include projects at Florida universities to increase the use of “pre-exposure prophylaxis” — that is a pill or shot that can drastically lower a person’s chance of contracting HIV — in Latino gay men and another to diagnose, treat, and prevent HIV infections in adolescents and young adults.

Twenty-three states and the District of Columbia sued in April to halt $11 billion in public health cuts, and a judge granted a preliminary injunction putting the brakes on those reductions. Florida was not among the states in the lawsuit, and it’s unclear what the status is of its terminated grants.

The U.S. Department of Health and Human Services acknowledged receipt of the letter from the congressional delegation but didn’t comment on the specific concerns. The Florida Department of Health did not respond to a request for comment on the status of its HIV prevention programs.

Suarez said he learned a few months ago that the state Health Department would no longer fund HIV testing supplies or condoms for his clinic starting July 1. Pineapple Healthcare was able to absorb the $20,000 expense to purchase the kits on its own, but Suarez said he fears others may not have the resources to pick up the tab and will need to charge patients.

Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, said he is alarmed by what he is seeing in Washington, from the termination of research grants to the elimination of 200 HIV prevention staffers at the Centers for Disease Control and Prevention.

A leaked budget document suggests even deeper cuts to HIV surveillance and prevention could be in the works, he said in an email. A budget blueprint released earlier this month by the White House keeps most existing HIV care and treatment programs intact, but it still would inflict “massive” cuts to public health programs, including prevention and disease surveillance efforts, according to Schmid’s group .

“People are just waiting for the next shoe to drop. … We are on shaky ground right now and very concerned,” Schmid said.

The federal government, he added, looks to be targeting research involving certain populations, such as Latino and Black gay men or transgender people.

Bakari Burns, CEO of Orange Blossom Family Health in Orlando, said his clinic received a letter from billionaire Elon Musk’s Department of Government Efficiency scrutinizing expenses related to a grant for HIV prevention in Black and Latino men. The funds arrived later than usual, which Burns said could cause problems for providers without sufficient reserves.

“A lot of these programs are in some of the underserved areas,” said Burns, an Orlando city commissioner. “Oftentimes, these are the only resources they have access to. I am concerned we will have less testing and that could potentially lead to an uptick in the number of new infections.”

During his first term, Trump vowed to end the HIV epidemic in the United States by 2030. The country seemed on the right track, posting a 12% decline nationally in new infections from 2018 to 2022, according to the CDC .

Lately, though, Trump has turned his attention to slashing government grant programs, particularly those seen as furthering diversity, equity and inclusion. White House officials say they are going after “unnecessary government contracts and grants that do not serve the national interest.”

Meanwhile, Florida has one of the highest rates of new HIV cases in the nation, and Orange County’s rate is even higher than the state’s, according to Aidsvu.org , which visualizes HIV’s impact using public health data.

More than 14,850 HIV-diagnosed people are living in the Orlando metro area, according to the group’s analysis of 2022 data, the latest available.

Suarez said HIV-related public health efforts are even more vital in a place that draws tourists from all over the United States and the world.

“We interact with these people when we’re out in the community, so not only are we affecting people in Orange County, we’re affecting people all across the world,” he said.