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Mike Kirakosyan spends his\u00a0days working in the deep weeds of the health care system. He messages patients that it\u2019s time to schedule their next visit for medications. He juggles calls and emails with providers to coordinate delivery of care. He helps patients fill out often complex medical forms, walks them through lab results, genially chases down those who\u2019ve been away from the doctor for too long.<\/p>\n
Kirakosyan, 33, does these things with a single goal in mind: to make sure the patients\u2019 HIV viral loads become and remain undetectable, so low that the people cannot transmit the virus to others in the L.A. area \u2014 or beyond.<\/p>\n
\u201cThis is very much a public health program as well as a patient care program,\u201d says Kirakosyan, a registered nurse. \u201cMaking sure that patients are staying healthy, staying undetectable, reduces the rates of transmission in the community.\u201d<\/p>\n
It is not a one-person job. Kirakosyan works as part of the Medical Care Coordination team at the Los Angeles LGBT Center, one of several such MCC programs in the area administered through the Los Angeles County Department of Public Health. The MCC program has long been recognized for helping decrease infection rates<\/a> in L.A. County, increasing quality-of-life years for those living with HIV and remaining cost efficient in the process.<\/p>\n In other words, it\u2019s a success story. It is also facing the most severe strain it has been under since its inception in 2013. The Trump administration\u2019s gutting of federal funding is compromising the county\u2019s ability to run the program at its current scale, leaving the team understaffed and desperately trying to handle ever-greater work loads. Kirakosyan worries for his fellow workers and for himself \u2014 but mostly, he worries for his patients.<\/p>\n \u201cThese policy changes are murder. I don\u2019t know how else to describe it,\u201d Kirakosyan said. \u201cPatients are going to fall through the cracks. It\u2019s been really discouraging \u2014 heartbreaking.\u201d<\/p>\n Each Medical Care Coordination team consists of a care manager (Kirakosyan\u2019s job), a medical social worker and a licensed vocational nurse. In addition, MCC programs employ retention specialists to help keep patients enrolled.<\/p>\n To Kirakosyan, the team concept works beautifully \u2014 and busily. At the L.A. LGBT Center, the MCC program started this year with six such teams of workers, with each team responsible for roughly 1,000 HIV patients.<\/p>\n \u201cObviously, not all of our patients are high acuity (with severe medical issues),\u201d Kirakosyan said. \u201cBut it\u2019s a lot of patients, a lot of messages and calls. Our teams work so well together that it all somehow works.\u201d<\/p>\n But that was before a series of budget shocks rocked the system. In January, the U.S. Department of Health and Human Services abruptly stopped its practice of announcing a key AIDS\/HIV prevention grant award to the county in a single annual sum. Instead, federal officials began issuing what county officials called \u201cepisodic partial notices\u201d of funding through the Ryan White HIV\/AIDS program \u2014 leaving administrators in the county\u2019s Public Health Division of HIV and STD Programs unsure what a year\u2019s worth of funding would ultimately be.<\/p>\n That chaos was compounded by the end of temporary funding increases from an HIV-directed initiative<\/a>. That program is administered through the federal Centers for Disease Control and Prevention, a target for severe budget and staffing reductions by Trump\u2019s administration. One-time post-pandemic recovery funds from L.A. County were also depleted.<\/p>\n Then came a second shock: Trump was proposing to eliminate the federal Health Resources and Services Administration, a little known agency<\/a> that nevertheless awarded more than $12 billion<\/a> in grants in 2024 to support community health centers and programs, including HIV\/AIDS treatment and prevention.<\/p>\n Critically, the HRSA\u2019s workers help manage the myriad projects that fund such endeavors. KFF Health News reported that more than 700 of the agency\u2019s 2,700 employees had left or been fired between February and June. Such a loss of workforce meant the agency would struggle to handle funding requests or distribute money in a timely manner.<\/p>\n In an email, the Los Angeles County Department of Public Health told Capital & Main that it cut staff in its HIV and STD program in response to the budget uncertainty, eliminating 38 contract workers and reassigning 36 full-time employees elsewhere. Ultimately, county officials decided to reduce HIV care and treatment contracts by 30%, which the email described as \u201cfiscally prudent.\u201d<\/p>\n The fallout was swift. The Los Angeles LGBT Center eliminated one of its MCC teams in late spring, meaning that roughly 1,000 patients would have to be absorbed by the remaining five. In August, a second team was eliminated.<\/p>\n Now, Kirakosyan says, those in the Medical Care Coordination program are taking on dramatically heavier numbers of patients and seeing increased workloads. They\u2019re also looking over their shoulders. \u201cI see myself next on the chopping block,\u201d Kirakosyan said. Some of his co-workers, sensing the same, have begun looking for other jobs.<\/p>\n His primary concern, though, remains his patients \u2014 the ones with whom he already works on a regular basis, but also new patients coming his way as the result of the LBGT Center\u2019s reduction in staff.<\/p>\n \u201cThe whole point of our program is that there are people who have a really hard time navigating our diseased health care system,\u201d Kirakosyan said. \u201cWe help with all that. We also have a medical social worker on every care team, and they provide wraparound services \u2014 assisting with housing, food, transportation, things like that. That\u2019s the kind of work that is going to be extremely difficult to pick up the slack for.\u201d<\/p>\n As a result, he says, patients are going to go underserved. Their absences from treatment plans will get noticed later than they should. Retention of patients is likely to suffer. And importantly, Kirakosyan says, his and his co-workers\u2019 ability to develop rapport with the patients is going to become strained by the sheer demands of time.<\/p>\n The Los Angeles LGBT Center is under fire from every direction when it comes to funding, including federal Medicaid cuts and California\u2019s own budget crisis. \u201cThey can\u2019t just make up the funding that we are losing for MCC,\u201d Kirakosyan said. So the program loses funding, and people.<\/p>\n \u201cThere\u2019s an injectible HIV medicine that we have a lot of patients on,\u201d the nurse said. \u201cIt\u2019s generally given every two months. And lately I\u2019ve noticed that patients have been falling through the cracks. We try to reach out to every patient when it\u2019s time to schedule their next injection, but with fewer people to make calls, patients are falling through. They\u2019re missing their injections, and some have to start over with the entire program.<\/p>\n \u201cThat means that more people will be out there with an active viral load,\u201d Kirakosyan added. \u201cIt raises the risk of transmissions within the community. Having sex is about to get a lot more dangerous than it is right now, and a lot of our patients are scared about what\u2019s going to happen in the future. It\u2019s hard to even know what to tell them.\u201d<\/p>\n Copyright 2025 Capital & Main<\/p>\n","protected":false},"excerpt":{"rendered":"Keep up with LAist. If you’re enjoying this article, you’ll love our daily newsletter, The LA Report. 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