In Southwest Virginia, just one organization still receives federal funding that helps marginalized and low-income HIV patients access basic needs like housing and food — supports that are critical for helping people stay on top of virus-suppressing medications.
An April reduction in funding meant that Virginia saw a 67% decrease in grant money for programs that help HIV patients, dropping from $29 million to $9.7 million in one year.
The Ryan White HIV/AIDS Program is a federal fund, implemented by Congress in 1990, to help patients access important services and medications and to help educate the public on the disease. The available funding is split up into several parts, and Part B, which supports programs like housing assistance and dental care for low-income individuals, is no longer available in Virginia except to a handful of providers.
The Council of Community Services in Roanoke is now the sole Part B recipient in Southwest Virginia, but it’s managing a 50% reduction in funding. Last year, it received $2 million in Part B funding and just $1 million in 2025. At the same time, the nonprofit expects to take on about 400 additional HIV patients who can no longer receive services in surrounding areas.
The Council of Community Services had used its Ryan White funds to provide low-cost medications, dental care, housing assistance, transportation, mental health support and copay assistance.
All of that has been cut.
“Getting people to engage has been more of a struggle since we’ve lost some of our services and it’s just disheartening. We can say that we’re there for them as much as we want, but when we’re limited in our scope of what we can do, it makes things really difficult for us,” said Keenan McNamara, lead medical case manager for the council.
The drop in funding has been steep
The fund is named for Ryan White, a young Indiana boy who was diagnosed with AIDS in 1984 after a blood transfusion, according to the Health Resources and Services Administration. His family faced AIDS-related discrimination, but their advocacy helped educate the public about the disease. White died at age 18, and shortly after, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act.
Cuts to the program came abruptly in April, said Todd Rothrock, the council’s director of health services. Though federal funding was already appropriated to the Ryan White Program in 2025, the Trump administration proposed sweeping cuts, dropping the program’s overall funding by about $525 million, or 20%, according to the HIV + HEP Policy Institute.
Part B programming is the largest component of the Ryan White fund and is administered by states through their health departments. In Virginia, the health department also relies on voluntary rebates from pharmaceutical companies to keep costs down on the life-saving medications needed to control HIV. However, this year, fewer rebates were available, according to the department’s website.
Combined with the decrease in federal dollars, the drop in funding has been steep. The state stopped grants for wraparound services so that it could focus its resources on keeping medications affordable.
At the end of last year, Virginia received more than $29 million to distribute to 27 local programs. This year, the amount fell to $9.7 million for just 14 recipients — a 67% decrease, according to a presentation by the Joint Commission on Health Care.
With that funding, more than 1,200 clients in Southwest Virginia received services in 2023 and about 1,400 in 2024. Only three providers in the region were funded to serve this population.
Southwest Virginia has lost $3.5 million since the cuts and lost two providers: Carilion Clinic in Roanoke and the Community Access Network in Lynchburg. [Disclosure: Carilion is one of our donors, but donors have no say in news decisions; see our policy.] The result has been a sharp reduction in support services, case management and staff.
Carilion Clinic also lost funding that the hospital used to offset the cost of care for HIV patients, said spokesperson Hannah Curtis. The hospital has shifted that responsibility to its financial assistance office. The hospital continues to access federal grants for early intervention, primary care and testing.
Medication adherence is critical for HIV patients
The Council for Community Services works with a highly transient population, facing significant barriers to health care, transportation, housing and nutrition. Each of these factors directly affects a person’s ability to adhere to the strict medication regimen needed to suppress the HIV virus, McNamara said.
HIV patients are typically advised to see a doctor every six months for lab work and medication assessments. For most clients at the clinic, treatment involves taking a daily pill. But when patients experience gaps in medication, the virus can mutate, rendering the drugs ineffective, according to Rothrock.
People who must focus on meeting basic needs like housing and food are less likely to consistently follow the medication regimens needed to manage HIV, Rothrock said. He warned that without the Part B support, more drug-resistant strains are likely to spread.
“You’re looking at a mutated virus that is being spread in the community. That can, in time, create more drug resistance,” Rothrock said.
Researchers at Johns Hopkins Medicine surveyed clinic administrators around the country to estimate the number of clients who would lose viral suppression medications if all services related to the Ryan White Program stopped. They found that if the program were completely eliminated, HIV infections in the U.S. would increase by 49% by 2030.
Last year, the Council of Community Services served about 600 individuals across its offices in Marion, Danville and Roanoke. The Danville office is largely supported by the Ryan White funds that were cut.
“There’s not a lot of access to care in Danville, which is why we funded that clinic in the first place. We’ve really had to focus our response to that area because it’s super important to hold up that Danville clinic,” Rothrock said.
Lynchburg provider lost $1.2 million
Community Access Network in Lynchburg lost all of its Part B funding from the state health department, $1.2 million, for HIV wraparound services, according to Christina Delzingaro, chief executive officer for the organization.
The organization is a nonprofit health center treating patients regardless of insurance status or income. It also receives enhanced Medicaid and Medicare payments. It offers things like behavioral health, pediatrics and women’s health services.
Until this year, Community Access Network relied on two Ryan White–related grants to serve about 400 HIV-positive patients annually. When the state announced the funding cuts, Delzingaro had just 10 days to notify 12 staff members and patients. She laid off seven case managers, two nurses, one dentist and two dental assistants.
The funding covered the cost of dental services, benefiting all patients, not just those with HIV. Currently, no dental services are offered, but the organization is looking for alternative funding sources in order to restart dental care.
“It’s demoralizing to have that money pulled away. … It gives me concern about the future of health care when we’ve taken this big step back,” Delzingaro said.
From success to scarcity
Rothrock said that efforts to restore funding now need to shift to the state level. In the meantime, safety-net organizations like his will have to lean more heavily on community support. However, he is conscious of the fact that all safety-net providers and health systems are also in need of state and community support.
He added that many foundations have focused their resources elsewhere, in part because the federal government had long sustained Ryan White programs, which until now had been highly successful in addressing the needs of people with HIV.
In 2023, 90.6% of people receiving medical care through the overall Ryan White program achieved viral suppression. This far exceeds the national average of about 65% among all people diagnosed with HIV, according to HRSA.
A KFF analysis shows that clients supported by Ryan White services are significantly more likely to maintain sustained viral suppression than people not in the program.
“We really have to get in the mindset of working from a place of scarcity because it has been a situation where the services were funded and everything was great. Now it’s like, what do we do to raise money?” Rothrock said.
Staff writer Emma Malinak contributed information to this report.