President Obama’s budget request for the upcoming fiscal year has won praise for including an increase in funds for domestic HIV treatment programs, although concerns persist about flat-funding for research programs and reductions in the chief program aimed at fighting the global AIDS epidemic.
The White House unveiled on Monday the president’s $3.8 trillion proposal to fund the U.S. government for fiscal year 2013, which includes funds for federally funded HIV/AIDS programs. The proposal was sent to Congress for lawmakers to act on and amend before passing into law.
Advocates for HIV/AIDS programs were largely happy with the recommendations made by the president on funding levels, which the White House says increases HIV/AIDS funding by $800 million, particularly with the Ryan White AIDS Drugs Assistance Programs, which provides grants to states for HIV/AIDS support services.
Carl Schmid, deputy executive director of the AIDS Institute, said the budget demonstrates Obama’s “strong commitment” to fight HIV by increasing funds “for prevention and lifesaving care and treatment for those who cannot afford it in the United States.”
“President Obama recognizes the importance of the federal government’s role in addressing infectious diseases, such as HIV, and the need to provide care and treatment to people with HIV/AIDS to keep them healthy and reduce new infections,” Schmid said. “We now urge Congress to show the same level of support as it considers federal spending priorities for the upcoming year.”
Under the budget, funding for the Ryan White AIDS Drug Assistance Program would increase by $102 million over the FY-12 levels that Congress appropriated for a total of $1 billion. Additionally, the president also proposes an increase of $20 million for Part C of the Ryan White HIV/AIDS Program to fund primary care for more than 550,000 people who have HIV/AIDS.
The increase will likely be welcome to news to individuals on wait lists for these programs. According to the National Alliance of State and Territorial AIDS Directors, 4,118 people are on ADAP waiting lists in 12 states and more than 445 people in six states have been disenrolled from the program due to budget constraints and growing enrollment.
Brian Hujdich, executive director of HealthHIV, also commended the president for increasing domestic HIV/AIDS funding, which he said is necessary until the government fully implements the health care reform law signed in 2009.
“The president has clearly identified HIV as a priority in 2013 by increasing funding for HIV care and treatment to those in the U.S. who cannot afford it, expanding access to life-saving HIV medication for the uninsured and underinsured, and increasing HIV prevention funding,” Hujdich said.
On World AIDS Day in December, President Obama announced an additional $35 million for the ADAP program and $15 million more for Part C of the Ryan White program. The proposed budget continues funds for those programs into FY-13 and increases it.
But funding for Ryan White hasn’t increased across the board. Obama proposes a decrease of $8 million to Part D of the Ryan White Program, which funds programs aimed at youth, women and families.
Other domestic HIV/AIDS programs are also seeing continued funds. The proposal requests $330 million for the Department of Housing & Urban Development’s Housing Opportunities for Persons with AIDS (HOPWA) program, which addresses housing needs for people with HIV/AIDS. The funding level this programs has been reduced by $2 million.
The president proposes an increase of HIV funding at the Centers for Disease Control and Prevention (CDC) by $40 million. These funds are expected to help CDC focus on communities most impacted by HIV, including blacks and gay men, by increasing testing programs and linking people to care.
Obama also restores a $10 million cut to HIV Adolescent and School Health as young people continue to account for new HIV infections. Congress cut that program in FY-12 by 25 percent of its budget.
Despite these funds, advocates are also concerned about flat-level funding for research programs that develop new ways to combat HIV/AIDS. The National Institutes for Health, the nation’s medical research agency, was allocated $31 billion in the president’s budget proposal —the same overall level as FY-12.
With regard to specific HIV/AIDS initiatives at NIH, the budget proposes $3.1 billion for intramural and extramural HIV/AIDS-related research. Funding for HIV/AIDS research was about $3.2 billion in FY-12.
Michael Cole-Schwartz, spokesperson for the Human Rights Campaign, expressed concern about funding for these research programs while generally supporting the level of HIV/AIDS funding in the budget.
“Given the constraints imposed by last year’s budget agreement, we are very happy to see some significant increases in key areas, including for the AIDS Drug Assistance Programs and early intervention in vulnerable populations,” Cole-Schwartz said. “However, we are concerned by flat funding and cuts in other areas, particularly at the National Institutes of Health, where ongoing research on HIV/AIDS is critical to the goal of ending the epidemic.”
Spencer Lieb, the AIDS Institute’s HIV/AIDS research coordinator, said the flat-level funding for NIH is peculiar given the president’s past support for this program.
“This is surprising given the recognition President Obama has given to the recent monumental advances in biomedical prevention research conducted by the NIH and the need for continued prevention research, including on vaccines and new drug therapies,” Lieb said.
Additionally, the budget makes cuts to efforts to combat HIV/AIDS programs overseas. Obama’s proposal cuts more than a half billion dollars, or almost 13 percent, from the President’s Emergency Plan for AIDS Relief (PEPFAR), which was established by President George W. Bush to provide anti-retroviral treatment to people with AIDS overseas.
Judith Aberg, chair of the HIV Medicine Association, said in a statement funding for PEPFAR in Obama’s request “falls short” of support needed “to put us on course to end AIDS globally.”
“The president is not providing the resources necessary to fulfill his commitment to putting 6 million on HIV treatment under the program or to scale up male circumcision or prevention of vertical transmission programs,” Aberg said. “Now is not the time to retreat on our investment in either of these lifesaving programs.”
Shin Inouye, a White House spokesperson, justified the reductions in PEPFAR by saying the program is “a real life success story of doing more with less” because it continues efficiency while lowering costs.
“The most important metric for PEPFAR is lives saved, not dollars spent, and through smart investments we are delivering results,” Inouye said.
According to the White House, the necessary funds for PEPFAR are lower because of generic drugs, the ability to ship commodities more cheaply in addition to task-shfiting to nurses and community health workers. Inouye said the cost to the United States per-patient of providing treatment for AIDS patients has fallen by over 50 percent since 2008.