This past Friday, I was asked point blank: “What would happen if we don’t have funding for your Ryan White Part B program in April?”

It was framed as a hypothetical. For our organization, it is not.

As Executive Director of Health Brigade, I have led through uncertainty before. We are one of Richmond’s longstanding providers of HIV prevention and care, and the need for our services has always exceeded available resources. But in May 2025, Virginia cut $20 million in Ryan White Part B (RWB) funding at the state level. For Health Brigade, that meant a 75% reduction in funding for services proven to keep people with HIV healthy, in care, and preventing transmission.

Ryan White Part B supports case management, mental health care, transportation, housing assistance, and other wraparound services for low-income Virginians living with HIV. When that funding disappears, the safety net that keeps people in care disappears with it.

The RWB cut did not happen in isolation. Over the past two years, our Comprehensive Harm Reduction Program lost 33% of its state funding, our HIV Testing Program lost 70%, and $850,000 in federal funding for critical maintenance on our 1952 facility was eliminated in Congress’s budget reconciliation bill.

The math became impossible.

Nearly overnight, we were forced to operate with drastically fewer resources as demand grew. We implemented a hiring freeze, reduced services, and even put our building up for sale. Still, a 75% funding cut is devastating.

We were one of just 14 organizations in Virginia to receive any RWB funding this year—down from 33 community-based organizations previously supported. Our neighbors at Capital Area Health Network and CrossOver Healthcare Ministry received nothing, forcing program shutdowns, layoffs, and agency expenses that should have been reimbursed.

We were told to connect displaced clients from shuttered programs with funded organizations. But when programs close, people do not transfer seamlessly across town. They disappear.

For people living with HIV, Ryan White is not extra. It is the difference between stability and survival mode—the structure that keeps the ground from falling out.

Janet, a 63-year-old woman who has lived with HIV for 40 years, worried about losing access to her medication. She knows what happens if there is a gap: missing doses can cause resistance and limit future treatment options. When she asks me, “What if I can’t get what I need? What if this is the thing that finally pushes me under?” I do not have an easy answer. She is aging with HIV and managing other chronic conditions. She is also worried about potential Medicaid cuts. For her, uncertainty is life and death.

Branson, a 55-year-old man living with HIV, returned home from incarceration with nothing. Without housing, he sleeps outside. Each day, he trades his safety for a place to stay while navigating probation requirements that can feel designed for failure. Managing HIV treatment under those conditions is a daily act of endurance.

Many of our community members live at the intersection of HIV, poverty, addiction, housing instability, and stigma. Funding cuts do not create those struggles, but they intensify them and increase the likelihood that people fall out of care.

The emotional toll extends to providers. One of our two remaining RWB case managers told me, “What hurts most is not just what’s being taken away, but the silence that follows. The ones who disappear because the system lost them, or decided they were expendable.”

We can only ask for so much resilience. Many will not remain healthy without access to the services that make treatment possible.

At Health Brigade, we will continue to hold the line. Private donations and emergency funding have helped, but they replace only a fraction of what was lost. A safety net this essential cannot depend on temporary charity, hiring freezes, and building sales.

The $20 million reduction in Ryan White Part B funding shocked providers across the Commonwealth. The consequences unfold every day in exam rooms, in housing courts, and in the quiet absence of patients who never make it back into care.

As members of the General Assembly consider amendments to the state budget, they face a clear choice: restore stability to Virginia’s HIV care system or allow further erosion of the infrastructure that keeps thousands of Virginians healthy.

Fully restoring funding will not undo months of instability overnight. But correcting the drastic reduction in Ryan White Part B support is a necessary first step.

Let’s get it right.