CA-11 HIV Programs and Funding.

Ryan White HIV/AIDS Program

Ryan White is a federal HIV safety-net program for low-income, uninsured, and underinsured people living with HIV. It funds medical care, medication, case management, dental services, workforce training, transportation, housing support, and other services.

The program served 601,853 clients in 2024 and achieved 91.4% viral suppression among clients receiving HIV medical care, compared with about 67% among all people diagnosed with HIV nationally. A Johns Hopkins study projected that ending Ryan White alone would cause 75,000 additional HIV infections by 2030, a 49% increase.

How the program is structured

• Part A: High-burden metro areas, including San Francisco.
• Part B: State grants and the AIDS Drug Assistance Program, which helps cover HIV medications.
• Parts C and D: Community clinics, early intervention, and family-centered care for women, infants, children, and youth.
• Part F: Provider training, dental care, the Minority AIDS Initiative, and special projects.

Final FY2026 legislation largely preserved Ryan White funding, although an earlier House version proposed a 20% cut targeting Parts C, D, and F. The final legislation cut the Minority HIV/AIDS Fund by $4 million. The proposed FY2027 budget would eliminate Part F, affecting provider training, dental programs, the Minority AIDS Initiative, and HIV innovation projects.

AIDS Drug Assistance Program

The AIDS Drug Assistance Program is authorized under Part B of Ryan White. It provides FDA-approved medications to low-income people with HIV who have limited or no health insurance. Funding is distributed to states through formula grants based on the number of people diagnosed with HIV/AIDS.

States can use the money for direct drug purchases or insurance cost-sharing programs. The program is a payer of last resort and covers only medications and services that cannot be paid for through other sources. Before the Affordable Care Act, chronic waitlists were common; marketplace subsidies and Medicaid expansion largely eliminated them. Cuts to those programs could increase demand for ADAP and bring those waitlists back.

PrEP Assistance Program

California’s PrEP Assistance Program serves HIV-negative Californians at risk of HIV, covering co-pays, lab work, and clinical visits associated with PrEP that are not covered by manufacturer assistance programs or other insurance. PrEP is not eligible for Ryan White funding by statute, so participating states use state funds.

Housing Opportunities for Persons with AIDS

HOPWA is the only federal housing program specifically for people living with HIV. Housing stability helps people remain in care and adhere to medication; studies consistently find that stably housed people with HIV reach viral suppression at substantially higher rates than people who are unhoused or unstably housed.

The Department of Housing and Urban Development administers HOPWA. Ninety percent of its funding goes to eligible cities and states through formula grants based on local HIV/AIDS case counts, with the remaining 10% awarded competitively. Grantees can provide tenant-based rental assistance, project-based rental assistance, permanent housing placement support, and wraparound services.

The proposed FY2027 budget would eliminate HOPWA by consolidating it into the Emergency Solutions Grant program. Congress has previously rejected proposed consolidations or cuts to HOPWA.

Ending the HIV Epidemic

The Ending the HIV Epidemic Initiative is a cross-agency federal effort launched in 2019 with a goal of reducing new U.S. HIV infections by 75% by 2025 and 90% by 2030. It funds surveillance, testing, linkage to care, PrEP navigation, outbreak response, and health-department capacity across 57 priority jurisdictions—including San Francisco—that collectively account for more than half of new HIV diagnoses.

Funding flows through the Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institutes of Health, and Indian Health Service. New HIV diagnoses in EHE jurisdictions declined 21% between 2017 and 2022, faster than the 12% national decline over a comparable period.

Congress has passed a 78% cut in HIV funding and a 40% reduction in overall CDC funds compared with FY2026. Proposed FY2027 cuts would further reduce CDC HIV-prevention funding and move some EHE-related functions into the proposed Administration for a Healthy America, with less clear HIV-specific protection.

San Francisco context

San Francisco reported 146 new HIV diagnoses in 2024, up from 140 in 2023. Latinx residents represented 37% of new diagnoses. Black and African American residents represented 29%, with cases rising from 26 to 40 year over year. HIV prevalence among Black queer men was 48.8%, compared with 24.4% among queer men overall.

About 75% of San Francisco residents living with diagnosed HIV are age 50 or older, making long-term survivor care a major local issue.

Notable San Francisco programs

Common HIV treatments

In the United States, HIV treatment is usually described in terms of preferred initial antiretroviral therapy and alternative or salvage regimens if the first treatment fails because of resistance, intolerance, side effects, or adherence issues. Effective treatment suppresses HIV to undetectable levels in the blood, protecting the health of the person living with HIV and eliminating sexual transmission risk—the principle known as Undetectable = Untransmittable, or U=U.

• Biktarvy: Bictegravir, emtricitabine, and tenofovir alafenamide from Gilead Sciences. The dominant U.S. HIV drug and a single daily pill.
• Dovato: Dolutegravir and lamivudine from ViiV Healthcare. A two-drug, single daily pill and the leading doublet alternative to traditional three-drug regimens.

Two companies dominate the U.S. market for modern HIV treatment: Gilead Sciences and ViiV Healthcare. Janssen plays a secondary role and partners on Cabenuva. Generic options have begun emerging for some older components, but most first-line regimens remain on-patent and expensive.