The potential unraveling of the Ryan White HIV/AIDS Program, the largest federally funded program dedicated to HIV care and support in the United States, could lead to a dramatic surge in new infections, according to recent modeling studies. Researchers warn that eliminating the program could result in a 73% increase in HIV cases by , reversing decades of progress in controlling the epidemic.
The findings, presented at the Conference on Retroviruses and Opportunistic Infections on , underscore the critical role Ryan White plays not only in providing care for those currently living with HIV but also in preventing new transmissions. “It’s crucial to point out that cutting Ryan White wouldn’t just mean abandoning hundreds of thousands of people currently living with HIV — it would also lead to a completely avoidable increase in HIV infections for years to come,” explained Melissa Schnure, PhD, a senior epidemiologist at the Johns Hopkins University School of Medicine.
Schnure and her team utilized a mathematical HIV transmission model to project the impact of either interrupting or discontinuing the program beginning in , across 30 states. The model estimated 117,349 additional HIV infections – a 73% increase – compared to continuing the program at its current level. The study highlighted the program’s success in maintaining high rates of viral suppression among people with HIV, a key factor in preventing transmission.
The Ryan White program was established in following the death of Ryan White, a 13-year-old diagnosed with AIDS after receiving a tainted blood transfusion in . His advocacy brought national attention to the HIV/AIDS crisis, and the CARE Act provides funding for primary medical care and essential support services for individuals living with the virus.
While Congress recently maintained the program’s funding for the current fiscal year, averting a proposed cut, the program’s future remains uncertain. As Schnure pointed out, Ryan White relies on annual budgetary approval, making it vulnerable to future cuts. This vulnerability is particularly concerning given recent changes in healthcare access.
Aadia Rana, MD, an infectious diseases professor at the University of Alabama at Birmingham, emphasized the potential strain on the program due to the expiration of enhanced Affordable Care Act (ACA) subsidies. “Many people living with HIV are insured through Obamacare… and will likely now be uninsured,” she stated. “This will result in more people needing care under the federal Ryan White/AIDS Drug Assistance Programs (ADAP). And if demand surges, we will stretch limited Ryan White/ADAP funds and potentially cause waitlists, reduced services or limited drug availability.”
The importance of continued funding extends beyond simply maintaining current care levels. Data from a study published in showed that patients involved in stable care through the Ryan White program had a 77% rate of viral suppression, significantly higher than the 28% rate observed in all HIV-infected adults.
Todd Fojo, MD, MHS, assistant professor of medicine at the Johns Hopkins University School of Medicine and senior author of the modeling study, underscored the broader implications of defunding Ryan White. “One of the things it shows is that, not only would cutting Ryan White be bad for Ryan White clients, but it would also be bad for the rest of us — we’d be looking at a lot more new HIV infections,” he said. He added that eliminating the program would jeopardize the health of his own patients, potentially leading to loss of viral suppression and, progression to AIDS.
“To my patients who get Ryan White services, it is absolutely critical to them controlling their HIV,” Fojo explained, emphasizing the program’s role in enabling him to provide comprehensive medical care. Schnure echoed this sentiment, stating, “To me, the Ryan White program represents our belief that access to lifesaving care should not depend on who you are or what you can afford. It reflects a commitment to protecting the health and dignity of people who are often the most vulnerable, and to affirming that their lives matter.”
Paul A. Volberding, MD, Chief Medical Editor of Infectious Disease News and Professor Emeritus of Medicine at the University of California, San Francisco, noted that successful HIV control in the U.S. Relies on continued viral suppression and access to prevention measures, both of which are heavily supported by the Ryan White program. He expressed hope that continued funding will allow the nation to maintain progress against the epidemic.
