Obama’s HIV Budget Shows Commitment to Domestic Programs

by Winnie McCroy

EDGE Editor

Tuesday March 18, 2014

President Barack Obama released his domestic budget for HIV prevention and treatment this month, and AIDS service organizations are mostly pleased with the distribution of funds to the Ryan White HIV/AIDS Program and his move to replace the cuts caused by sequestration.

"The budget President Obama outlined demonstrates his strong commitment to ending HIV by maintaining funding for prevention and lifesaving healthcare and medications for those who cannot afford it in the United States," said Deputy Executive Director Carl Schmid of The AIDS Institute. "We now urge Congress to show the same level of support as it considers federal spending priorities for the upcoming year."

Schmid was pleased that Obama and his Administration recognized the pivotal opportunity to end AIDS and the federal government's role in providing care and treatment to people with HIV/AIDS to keep them healthy and reduce new infections.

Under the President's budget, funding for the Ryan White HIV/AIDS Program would receive a $4 million increase for a total of $2.323 billion. The Ryan White HIV/AIDS Program provides medical care, drug treatment and support services to approximately 554,000 low-income, uninsured and underinsured individuals living with HIV.

But the budget proposes to eliminate dedicated funding for Part D of the Ryan White Program, which serves women, infants, children, and youth with HIV/AIDS. Perinatal infections are very low, but funding is still needed for children and youth. Under the President's proposal, Part D funding would be redirected to another part of the Ryan White Program that focuses on medical care.

"We are shocked the President would demolish the well-established system of care that has worked since 1988 in nearly eliminating perinatal infection and providing medical care and family-centered support for women, children and youth that helps ensure these populations remain in care and adherent to their medications," said Marylin Merida, President of The AIDS Institute and a Part D grantee in Florida. "We call upon the Congress to reject this proposal."

"While we are extremely disappointed in the proposal to eliminate Part D of the Ryan White Program and will ask Congress to oppose it, now it is up to the Congress to do its part and adequately fund critical public health programs, including those that prevent HIV and provide for care and treatment for people living with HIV. This includes implementing the ACA at both the federal and state levels," said AIDS Institute Executive Director Michael Ruppal.

Funding for the Ryan White AIDS Drug Assistance Program (ADAP) would be maintained at $900.3 million. In recent years, states have struggled to keep up with the growing number of low-income people needing lifesaving AIDS medications, and have had to establish waiting lists.

According to the National Alliance of State and Territorial AIDS Directors (NASTAD), enrollment in ADAP last year grew by 8 percent. Additionally, as some ADAP clients transition to the ACA's qualified health plans, ADAP dollars will increasingly be used to pay beneficiary premiums and assist in co-pays and other out-of-pocket expenses.

According to the CDC, only 37 percent of the 1.2 million people living with HIV in the U.S. are retained in HIV care, 33 percent have been prescribed antiretroviral treatment and 25 percent are virally suppressed. In order to improve the continuum of care for people with HIV and progress toward an AIDS-free generation, then continued funding for all parts of the Ryan White Program will be necessary along with implementation of the Affordable Care Act.

To help achieve the goal of the National HIV/AIDS Strategy to reduce the number of new HIV infections, which now stands at over 50,000 per year, the President is proposing to slightly increase HIV funding at the Centers for Disease Control and Prevention (CDC).

The Budget focuses HIV resources on implementing effective, scalable and sustainable prevention strategies for persons living with HIV and populations at highest risk for HIV. The AIDS Institute was pleased that as a part of its existing budget, the CDC is proposing to allocate $8 million to assist HIV prevention grantees to increase their capacity to seek reimbursement for covered services.

Funding for Hepatitis Prevention at the CDC would be maintained at approximately $29 million, a level far too small to conduct testing, surveillance, and other hepatitis prevention and educational programs for the entire country.

The President is requesting that Congress allow federal funding of syringe exchange programs, a scientifically proven HIV and hepatitis prevention service that Congress has rejected.

Under the President's proposed budget, medical research at the National Institutes of Health (NIH) would receive a slight increase while the Housing Opportunities for Persons with AIDS (HOPWA) program at HUD, which provides housing for low-income people with AIDS, would receive an increase of $2 million and be funded at its FY13 level of $332 million. Additionally, the formula for distributing HOPWA money would be modernized in order to better distribute funding to areas most in need.

"The President has put forth a budget that replaces many of the harmful sequestration cuts that domestic HIV/AIDS programs have experienced in recent years. He upholds his commitment to making progress to ending AIDS by investing in domestic HIV/AIDS programs," said Ruppal.

For more information, visit http://www.theaidsinstitute.org/federal-policy/ryan-white

Winnie McCroy is the Women on the EDGE Editor, HIV/Health Editor, and Assistant Entertainment Editor for EDGE Media Network, handling all women's news, HIV health stories and theater reviews throughout the U.S. She has contributed to other publications, including The Village Voice, Gay City News, Chelsea Now and The Advocate, and lives in Brooklyn, New York.