Big Ideas: State Strategies to Sustain HIV Prevention, Care, and Treatment

The U.S. has spent more than four decades building one of the most effective HIV care systems in the world, and this has underpinned the progress the nation has made at curbing the impact of the HIV epidemic. That system is now under threat from a convergence of factors, including eroded funding amid inflation, rising costs, and growing demand for Ryan White HIV/AIDS Program (RWHAP) services, driven in significant part by policy changes enacted under the One Big Beautiful Bill Act (OBBBA) of 2025. As federal and state funding crises deepen, urgent and creative solutions are needed to ensure state-level advocates can respond effectively and protect continuity of care for people with and at risk for HIV. This requires a broad coalition approach that centers community voices to push for greater federal investment, while simultaneously advancing state-level action to codify protections for critical HIV prevention and treatment medications, modernize data-sharing frameworks and agreements, and safeguard the privacy and legal status of people with HIV.