The Potential Impact of Ending the Ryan White HIV/AIDS Program on HIV Incidence: A Simulation Study in 31 U.S. Cities
Forster R, Schnure M, Jones J, Lesko C, Batey DS, Butler I, Ward D, Musgrove K, Althoff KN, Jain MK, Gebo KA, Dowdy DW, Shah M, Kasaie P, Fojo AT
If the Ryan White HIV/AIDS Program ends permanently, we project 75,436 additional HIV infections by 2030—a 49% increase across 31 U.S. metropolitan areas.
The Ryan White Program is the nation's largest HIV-specific care program, serving as the payer of last resort for over 500,000 people annually. With effective treatment, people with HIV live normal lifespans and cannot transmit the virus.
See also: State-level analysis of 11 states (companion study)
Policy Scenarios Modeled
We simulated three funding disruption scenarios to understand how different policy outcomes would affect HIV transmission.
Brief Interruption
Funding gap followed by program restoration. Projected impact: +19% new infections by 2030.
Prolonged Interruption
Extended gap before services resume. Projected impact: +38% new infections by 2030.
Complete Cessation
Program ends with no recovery. Projected impact: +49% (75,436 excess infections). City-level range: 9% to 110%.
Metropolitan Areas Studied
City-specific epidemic models capturing local patterns in HIV prevalence, care engagement, and Ryan White service utilization.
Full Citation
Forster R, et al. The Potential Impact of Ending the Ryan White HIV/AIDS Program on HIV Incidence: A Simulation Study in 31 U.S. Cities. Ann Intern Med. 2025. doi:10.7326/ANNALS-25-01737
Research Funding
& Institutional Support
This research is supported by grants from the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, and the National Institute on Minority Health and Health Disparities.
Johns Hopkins Bloomberg School of Public Health
Computational Epidemiology Research Group
Advancing mathematical modeling for HIV prevention and control