Fighting the HIV/AIDS Epidemic and Supporting People Living with HIV/AIDS

We now face a make-or-break moment for the middle class and those trying to reach it. After decades of eroding middle-class security as those at the very top saw their incomes rise as never before and after a historic recession that plunged our economy into a crisis from which we are still fighting to recover, it is time to construct an economy that is built to last. The President’s 2013 Budget is built around the idea that our country does best when everyone gets a fair shot, does their fair share, and plays by the same rules. We must transform our economy from one focused on speculating, spending, and borrowing to one constructed on the solid foundation of educating, innovating, and building. That begins with putting the Nation on a path to living within our means – by cutting wasteful spending, asking all Americans to shoulder their fair share, and making tough choices on some things we cannot afford, while keeping the investments we need to grow the economy and create jobs. The Budget targets scarce federal resources to the areas critical to growing the economy and restoring middle-class security: education and skills for American workers, innovation and manufacturing, clean energy, and infrastructure. The Budget is a blueprint for how we can rebuild an economy where hard work pays off and responsibility is rewarded.

It also renews the President’s commitment to ending the AIDS pandemic. To address HIV/AIDS in the U.S. and around the world, the 2013 Budget will:

Support HIV/AIDS Research. While we have made great strides in understanding the AIDS virus and in devising ways to combat it, there is still more work to be done. Developing safe, effective vaccines for HIV/AIDS is a challenge that will require significant advances in basic research to both better understand the virus and to develop new vaccine strategies. The Budget provides $3.1 billion for intramural and extramural HIV/AIDS-related research supported by the National Institutes of Health.

Support the National HIV/AIDS Strategy (NHAS) and Expand Investments in Prevention, Care, and Research. The Budget expands access to HIV/AIDS prevention and care activities and supports the goals of the National HIV/AIDS Strategy: reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities. The Budget prioritizes HIV/AIDS resources within high-burden communities and among high-risk groups, including gay and bisexual men, Black Americans, Latino Americans and substance users. Compared to 2012, the Budget increases domestic discretionary HIV/AIDS funding at HHS by $120 million and Veterans Affairs (VA) HIV/AIDS funding by $74 million. Overall, total U.S. Government-wide spending on HIV/AIDS increases by $800 million in 2013.

Fund Cross-Cutting Innovative Efforts for Care and Prevention. To take advantage of potential synergies across Department of Health and Human Services (HHS) agencies, the Budget authorizes HHS to transfer 1 percent of HHS domestic HIV program funding (approximately $60 million) to support cross-cutting collaborations in areas such as increasing linkages to care and developing effective combinations of prevention interventions.

Expand the Ryan White HIV/AIDS Program. The Budget includes an increase of $75 million for care and treatment through the Ryan White HIV/AIDS Program. The Budget includes $1 billion for AIDS drug assistance programs, an increase of $67 million above 2012 levels to expand access to life saving HIV-related medications for uninsured and underinsured people living with HIV/AIDS. Based on current projections, this increase in funding for ADAP, combined with sufficient state contributions, will eliminate ADAP waiting lists in 2013. The Budget also increases funding for the Ryan White Part C program by $15 million to expand access to critical early intervention and primary care services for the most vulnerable populations living with HIV/AIDS. To address the disproportionate impact of HIV/AIDS on communities of color, there is an $8 million increase in funding above 2012 for Ryan White Minority AIDS Initiative activities, totaling $169 million in 2013.

Increase Funding for HIV/AIDS Prevention and Service Integration. The President’s Budget includes an increase of $30 million for the Centers for Disease Control and Prevention (CDC) to reduce the number of new HIV infections, reduce behaviors associated with HIV transmission and acquisition, and increase the number of infected individuals who are aware of their infection. The FY 2013 Budget also continues to build a strong network of HIV prevention programs nationwide by providing technical and financial support to 67 health departments through the new HIV prevention flagship health department cooperative agreement. These health departments will provide 2 million HIV tests annually, improve linkage to care and prevention, and expand surveillance activities. The FY 2013 Budget also enhances flexibility by allowing CDC and States to transfer up to 10 percent of resources across all CDC HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases (STDs), and Tuberculosis (TB) activities for program coordination and service integration activities.

Support Housing Assistance for People Living with HIV/AIDS. The President’s Budget requests $330 million for the Department of Housing and Urban Development’s Housing Opportunities for Persons with AIDS (HOPWA) program, to address housing needs among people living with HIV/AIDS and their families. The program is designed to provide States and localities with the resources to create comprehensive strategies for providing housing assistance that gives patients the stability needed for effective treatment. However, the current formula for distributing HOPWA funds does not reflect the current nature of the epidemic. To modernize the HOPWA program, the Administration is proposing an updated formula based on the number of people living with HIV and adjusted for an area’s fair market rent and poverty rates, focusing HOPWA on the areas with the most need. The proposal will also include several changes that will allow better targeting of HOPWA resources and more flexibility for grantees to provide the most cost-effective, timely interventions. These changes, which will be proposed in separate legislation, will improve the Nation’s response to the specialized housing needs of HIV/AIDS patients.

Fight the Stigma of HIV/AIDS. To strengthen civil rights enforcement against racial, ethnic, sexual orientation, religious, gender, and gender identity discrimination, the Budget includes a 6 percent increase in funding to the Department of Justice’s Civil Rights Division. This investment will not only help the Division handle enforcement of civil rights protections for people living with HIV/AIDS, but align with a key action steps for reducing HIV-related disparities, reducing stigma and discrimination against people living with HIV.

Support the President’s Ambitious Goals for to Address Global AIDS. On World AIDS Day 2011, the President announced ambitious new targets for the prevention and treatment of HIV/AIDS that will bring us closer to the goal of an AIDS-free generation. Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the Budget supports focused investments on proven methods to prevent new HIV infections, including supporting voluntary medical male circumcision, preventing mother-to-child transmission, expanding access to condoms, and providing antiretroviral treatment (ART) for 6 million patients. These expanded targets are possible in a constrained budget environment due to the strong programmatic foundation that the U.S. has built under Presidents Bush and Obama, and relentless work to bring down costs and find efficiencies. The per-patient cost to the U.S. of providing anti-retroviral treatment has fallen by over 50 percent since 2008 because PEPFAR has invested carefully, tailoring prevention to countries’ urgent needs, using generic drugs, shipping more efficiently, and linking PEPFAR to other needed health services. The Budget fully funds the balance of the Administration’s historic three-year, $4 billion pledge to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, in recognition of this multilateral partner’s key role in global health and its progress in instituting reform.