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

The Federal Budget

Having emerged from the worst recession in generations, the President has put forward a plan to rebuild our economy and win the future by out-innovating, out-educating, and out-building our global competitors and creating the jobs and industries of tomorrow. But we cannot rebuild our economy and win the future if we pass on a mountain of debt to our children and grandchildren. We must restore fiscal responsibility, and reform our government to make it more effective, efficient, and open to the American people. The President’s 2012 Budget is a responsible approach that puts the nation on a path to live within our means so we can invest in our future – by cutting wasteful spending and making tough choices on some things we cannot afford, while keeping the investments we need to grow the economy and create jobs. It targets scarce federal resources to the areas critical to winning the future: education, innovation, clean energy, and infrastructure. And it proposes to reform how Washington does business, putting more federal funding up for competition, cutting waste, and reorganizing government so that it better serves the American people.

To address HIV/AIDS in the U.S. and around the world, the Budget will:

Fund Cross-Cutting Innovative Efforts for Care and Prevention. To take advantage of potential synergies across the Department of Health and Human Services (HHS) agencies to implement the Strategy, 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. 

Increase 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. The Budget increases funding for intramural and extramural HIV/AIDS-related research supported by the National Institutes of Health by $74 million from the 2010 enacted level, for a total of nearly $3.2 billion in 2012.

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 2010, the Budget increases domestic discretionary HIV/AIDS funding at the Department of Health and Human Services (HHS) by $219 million and Veterans Affairs (VA) HIV/AIDS funding by $173 million, while maintaining HIV/AIDS funding levels at the Department of Justice (DOJ) and Department of Housing and Urban Development (HUD). Overall, total US Government-wide spending on HIV/AIDS increases from $26 billion to approximately $28 billion in 2012.

Expand the Ryan White HIV/AIDS Program. The Budget includes an increase of $88 million for care and treatment through the Ryan White HIV/AIDS Program.  Of the $2.4 billion total amount proposed for Ryan White, $679 million is for Ryan White Part A medical and support services in eligible metropolitan areas and transitional grant areas. The Budget also includes $940 million for AIDS drug assistance programs, an increase of $80 million above 2010 levels to support access to life saving HIV-related medications for approximately 13,000 additional people living with HIV/AIDS.  The Budget increases funding for the Ryan White Part C program by $5 million to maintain access to critical early intervention and primary care services for people living with HIV/AIDS. To address the disproportionate impact of HIV/AIDS on communities of color, there is a $15 million increase in funding above 2010 for Ryan White Minority AIDS Initiative activities, totaling $161 million in 2012.

Increase Funding for HIV/AIDS Prevention and Service Integration. The President’s Budget includes an increase of $58 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 increase includes $30 million from the Prevention and Public Health Fund.  The 2012 Budget for HIV Prevention includes four major highlights.  First, the Budget creates a new formula for funding allocations to health departments’ prevention programs, in alignment with the NHAS, to “ensure that Federal HIV prevention funding allocations go to the jurisdictions with the greatest need.”  Second, the Budget expands flexibility by allowing CDC and States to transfer up to 5 percent across all CDC HIV/AIDS, Viral Hepatitis, sexually transmitted diseases (STD), and tuberculosis (TB) activities for program coordination and service integration activities.  Third, the Budget redirects $51 million within CDC’s HIV/AIDS budget authority from less effective base activities to comprehensive and effective grants focusing on high-risk populations that align with interventions outlined in the NHAS.  Fourth, the Budget transfers HIV prevention programming for youth ($40 million) to the CDC’s National Center for HIV, STD, Viral Hepatitis and TB Prevention.  Priority investments in the Budget include $22 million for the Enhanced Comprehensive HIV Prevention program for metropolitan areas most affected by the HIV epidemic.

Support Housing Assistance for People Living with HIV/AIDS. The President’s Budget maintains funding at $335 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 and supportive services such as case management.  The Administration recognizes special needs among people living with HIV and AIDS, and HOPWA program benefits are one component of the President’s commitment to increasing permanent housing among low-income individuals and families, supporting short-term and transitional housing, and reducing the risk of homelessness. 

Fight the Stigma of HIV/AIDS. To strengthen civil rights enforcement against racial, ethnic, sexual orientation, religious, and gender discrimination, the Budget includes an 11 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.

Increase Support for Global AIDS Programs. Over the past two years, the President’s Emergency Plan for AIDS Relief (PEPFAR) has nearly doubled the number of people it supports to 3.2 million. This includes an increase in support to pregnant women allowing them to have a child free of HIV, which has resulted in an estimated 114,000 HIV-free births in 2010.  While achieving these results, the per-patient cost to the U.S. of providing anti-retroviral treatment has fallen by over 50 percent since 2008 because PEPFAR has investing carefully, tailoring prevention to countries’ urgent needs, using generic drugs, shipping more efficiently, and linking PEPFAR to other needed health services.