Targeted cuts to Ryan White programs could raise HIV incidence by 8-17% in 30 US states and the District of Columbia.

Using an HIV transmission model in 30 states and Washington DC, we simulated ending Ryan White services from Parts C and D and the Ending the HIV Epidemic and Minority AIDS initiatives in February 2026. We projected 23 883 additional infections by 2030 (95% credible interval 2812-53 813) - a 17.6% (2-39.5%) excess. A 'conservative' estimate of suppression losses projected 8.1% (4.4-12.3%) more infections. Ryan White services are critical to preventing US HIV transmission.