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Projected Increase in HIV Incidence in 11 States if Ryan White Ends: A Simulation Study
Melissa Schnure1, Ryan Forster1, Joyce L Jones1
1At the time of the study, Melissa Schnure, Joyce L. Jones, Kelly A. Gebo, Maunank Shah, and Anthony T. Fojo were with the Johns Hopkins University School of Medicine, Baltimore, MD. Ryan Forster, Catherine R. Lesko, Keri N. Althoff, David W. Dowdy, and Parastu Kasaie are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. D. Scott Batey is with the Tulane School of Social Work, New Orleans, LA. Isolde Butler is with Crescent Care, New Orleans, LA. At the time of this study, Dafina Ward was with the Southern AIDS Coalition, Birmingham, AL. Karen Musgrove is with Birmingham AIDS Outreach, Birmingham, AL. Mamta K. Jain is with UT Southwestern Medical Center, Dallas, TX.
None:
Objectives. To estimate the increase in HIV infections in 11 US states if Ryan White services are interrupted or ended. Methods. We applied a population-level model of HIV transmission to 11 states. We represented the proportion of people with HIV receiving Ryan White AIDS drug assistance, outpatient health services, or support services, and simulated a loss of suppression in each category if services permanently end or return after delays of 1.5 or 3.5 years. Results. Cessation of Ryan White services in 2025 was projected to result in 69 695 additional infections from 2025 to 2030 (95% credible interval [CrI] = 18 943, 123 628), 68% more (95% CrI = 18%, 118%) than if Ryan White were continued. Temporary interruptions of 1.5 and 3.5 years resulted in 26 951 (95% CrI = 7341, 47 534) and 53 594 (95% CrI = 14 645, 94 860) additional infections, respectively. Excess infections varied across states, from a 45% increase in Texas to 126% in Missouri. Conclusions. Projected increases in HIV infections because of 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. (Am J Public Health. 2026;116(5):732-735. https://doi.org/10.2105/AJPH.2025.308409).
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