Cuts to the Ryan White HIV/AIDS Program could mean thousands of additional HIV cases and declining health for people living with the virus. The program provides federal funding for primary care, antiretroviral treatment and support services for low-income people with HIV and is the main source of funds for state AIDS Drug Assistance Programs (ADAPs). Over half of people living with HIV in the United States received Ryan White services in 2024.

 

Budget cuts have already led some states to curtail HIV services and limit eligibility, and advocates fear waiting lists could return. A recent report from the National Association of State and Territorial AIDS Directors indicates that over 20 states have implemented or are considering ADAP cost-containment measures. Most notably, Florida lowered its ADAP income eligibility threshold, eliminated health insurance premium assistance and removed Biktarvy—the most widely used first-line antiretroviral regimen—from its formulary. The state legislature allocated $31 million in emergency bridge funding in March, but this is only a partial fix.

 

“Our communities deserve stable, complete access to care, treatment and coverage they need to live healthy lives,” says Carl Baloney Jr., president and CEO of AIDS United.

 

Over 90% of people who receive HIV medical care through the Ryan White Program have achieved viral suppression, which not only preserves their health but also prevents new infections, as those with an undetectable viral load do not transmit HIV via sex.

 

In a recent analysis, Melissa Schnure, PhD, of Johns Hopkins University School of Medicine, and colleagues used mathematical modeling to estimate the increase in new HIV infections if Ryan White services are ended permanently or interrupted until the end of the Trump administration.

 

If Ryan White services were to cease in 2026, the model projected an additional 117,431 new infections over the next five years, a 73% increase. Eight states could see new cases more than double. A temporary interruption of 2.5 years would result in 68,264 additional infections, a 43% rise.

 

“Projected increases in HIV infections due to disruptions of Ryan White services threaten the progress made in curtailing the U.S. HIV epidemic,” the researchers concluded.