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HIV Incidence Could Rise by 73% in 30 States if Ryan White Ends: A Simulation Study, Abstract
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CROI 2026 Feb 22-25 Denver
PROGRAM ABSTRACT
Background: The Ryan White HIV/AIDS Program provides comprehensive services for >50% of the 1.2 million people with HIV (PWH) in the US and often functions as a “payer of last resort” for those who would otherwise be unable to access care. Using a mathematical HIV transmission model, we sought to estimate the increase in HIV infections in 30 states if Ryan White services were interrupted or discontinued.
Methods: We applied the Johns Hopkins Epidemiological and Economic Model, a dynamic, compartmental model of HIV transmission, in 30 states in which 99% of people diagnosed with HIV in the US reside. We represented the Ryan White program by simulating the proportion of people with HIV in each state receiving Ryan White AIDS Drug Assistance (Ryan White Part B), Outpatient Health services (Parts A-D), or Support services (Parts A-D). To quantify the impact of interruption or discontinuation of services, we simulated a loss of viral suppression in each category if services were to permanently end or return after a delay of 2.5 years, and projected the resulting increase in new HIV infections from 2026 to 2031.
Results: Assuming Ryan White services continue, we projected 160,206 new HIV infections (95% credible interval 153,564 to 167,325) from 2026-2031 across all 30 states. Cessation of Ryan White services in 2026 was projected to result in 117,349 additional infections (30,845 to 213,182) from 2026-2031-73% (19% to 132%) more than if Ryan White were continued. A temporary interruption of 2.5 years resulted in 68,183 (18,152 to 123,024) additional infections. Excess infections varied across states, from a 42% increase (8 to 86%) in Indiana to 147% (29 to 311%) in Colorado. In eight states-Colorado, South Carolina, Missouri, Tennessee, Kentucky, Alabama, Illinois, and Wisconsin-the projected number of infections would more than double due to program cessation. Across all states combined, infections increased most among adults <35 years and men who have sex with men, without large differences by race.
Conclusions: Projected increases in HIV infections due to disruptions of Ryan White services threaten the progress made in curtailing the US HIV epidemic, illustrating the critical role Ryan White plays in preventing HIV transmission. Though not examined in this analysis, additional proposed funding cuts-such as those to Medicaid or HIV prevention services-may lead to higher HIV incidence than estimated here.
Figure: State-Level Relative Excess HIV Infections from 2026-2031 If Ryan White Programs are Stopped or Interrupted. Boxplots display the projected percentage increase in new HIV infections under two scenarios compared to no service interruption. Medicaid non-expansion states are labeled in orange text; expansion states are labeled in purple text.
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