President’s Budget Proposes Key Investments in Ending the HIV Epidemic

The White House released its long anticipated President’s budget request (the first step in the Congressional appropriations process), prioritizing $6 trillion in spending aimed at economic recovery and expansion. Through the “American Jobs Plan” and the “American Families Plan,” the budget proposal calls for massive and historic investments, including in the country’s public health infrastructure and in the Department of Health and Human Services’ (HHS) many responsibilities. The White House has also committed to ending the HIV/AIDS epidemic and has requested significant funding to execute that goal.

Ending the HIV Epidemic (EHE)

The budget proposes an acceleration and strengthening of efforts to end the epidemic in the U.S. with a $670 million investment in programming to reduce new HIV cases, increase treatment, and expand the use of PrEP, while ensuring equitable access to services and supports. Of importance to Academy members, those dollars primarily will be focused on strategies that closely align with the communities where HIV transmission is the highest – and will continue to include prevention, diagnosis, and treatment interventions.

Centers for Disease Control and Prevention (CDC)

With these dollars, the CDC is committed to providing additional expertise, technology, and resources to the 57 EHE focus jurisdictions. The $275 million in funding for EHE (a $100 million increase) is estimated to result in approximately 14,000 new diagnoses, 12,000 people re-linked to health care, 13,000 people enrolled in PrEP services and treatment, and investigation of and response to 75-100 HIV clusters or outbreaks. The CDC has also prioritized health equity as being central to addressing the HIV epidemic, including utilizing innovative strategies to increase access to HIV prevention services, enhance community engagement, and combat stigma.

The budget also includes funding to address the disproportionate impact of HIV and hepatitis C infections in Tribal communities. However, while the amount requested for Indian Health Services’ Ending the Epidemic plan is significantly higher than in previous years ($27 million – a $22 million increase!), the amount requested for viral hepatitis within the (CDC) budget remains unchanged – a frustrating decision by the administration and disappointing news for providers working across issues.

Health Resources and Services Administration (HRSA)

Also important to Academy members is the budget proposal’s investment in HRSA. As a reminder, HRSA ensures equitable access to services and supports for low-income people with HIV through Health Centers as well as the Ryan White HIV/AIDS Program. This budget proposes $152 million for Health Centers (a $50 million increase), and $190 million in the Ryan White HIV/AIDS Program (an $85 million increase). Total Ryan White funds are proposed to increase by $131 million, but only across Part A, B, and C.

National Institutes of Health (NIH)

The budget proposal also includes $26 million for implementation research within the NIH, a $10 million increase. In particular, this funding will go to NIH-sponsored Centers for AIDS Research to support the initiative to end HIV/AIDS through evidence-based research on new strategies for the successful delivery of integrated prevention and treatment.

Housing and Urban Development (HUD)

One disappointing element of the President’s budget is in the Housing Opportunities for Persons With AIDS (HOPWA) program. This critical program is the only federal program that’s dedicating to the housing needs of people with HIV/AIDS, and expressly benefits those with low incomes and their families. We know this program is particularly important as the country moves toward economic recovery, with many folks still struggling with permanent, safe, and affordable housing. As such, the broader coalition of HIV-related provider groups and community organizations requested the administration boost HOPWA funding from $450 million to $600 million, a hefty increase that would actually make progress in the lives of so many. Unfortunately the President’s budget only proposes a $20 million increase, which is obviously a significant and disappointing difference from the community’s ask.