Most HIV-related programs in the United States rely on federal funding. This includes entitlement programs such as Medicare and Medicaid, both of which provide care and treatment to people with HIV, and discretionary programs, such as research at the National Institutes of Health (NIH), surveillance and disease prevention and control at the Centers for Disease Control and Prevention (CDC), the Ryan White Care Program and other medical workforce programs at the Health Resources Services Administration (HRSA), and many more.
Federal and state programs for HIV/AIDS have been chronically underfunded. This underfunding has real repercussions for the medical health and well-being of people infected with a potentially fatal disease.
The Centers for Disease Control and Prevention (CDC) estimate that there are 56,000 new HIV infections per year in the United States. The need for care, treatment, and other services for people living with HIV grows annually, but federal funding of HIV programs historically grows at a much slower rate.
Various estimates show that the public health sector as a whole, has seen a consistent 5% cut in funding each fiscal year, although this is spread across several federal agencies and dozens of programs.
In recent years, many HIV programs have even seen cuts to funding as budgetary concerns for the country have grown. These cuts have real world consequences for public health, the health system, and patients.
So-called “entitlement” programs are programs that are traditionally funded automatically as part of the U.S. budget and meet the needs of all who qualify for them. As an example, the Social Security, Medicare, Medicaid programs are all considered entitlement programs. Entitlement programs make up the largest portion of the U.S. budget.
Discretionary programs are those that Congress funds annually through the appropriations process. Congress retains complete discretion over the funding levels of discretionary programs, and even the parts of certain programs.
Non-defense discretionary programs (NDDs) are programs that are not related to the national defense or homeland security. NDD federal programs include public health, education, transportation programs, scientific research, public safety and law enforcement, job training, infrastructure, weather monitoring, environmental protection, food safety, natural resources, housing and social services, and international relations. These programs touch every American in every state and community across the nation.
For example, funding of research at NIH, provides (among other things) grant money to labs, and scientists across the U.S. researching medical and scientific questions, and developing life-saving innovations.
NDD spending equal only 17% of all federal spending and health funding makes up a total of less than 2%.
In recent years, federal officials have undertaken extensive efforts to decrease federal spending, trim the U.S. budget, and reduce the federal deficit. These efforts have profound implications for HIV programs.