2012 Budget Fighting the HIV/AIDS Epidemic and Supporting People Living with HIV/AIDS

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

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

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.

CDC funding: $359 million annually, FY2012-FY2016 (assumes level funding)

A new approach to health department funding that better matches prevention dollars to the HIV burden in every state, territory, and heavily affected city, focusing on high-impact interventions.

Expanded Testing Initiative

CDC funding: $111 million total, FY2007-FY2010

Targeted funding for HIV testing in communities at risk. Between 2007 and 2010, provided 2.8 million tests; resulted in more than 18,000 new HIV diagnoses; and helped avert $1.2 billion in direct medical costs.

Enhanced Comprehensive HIV Prevention Planning (ECHPP)

CDC funding: $34.8 million anticipated total, FY2010-FY2012

Innovative demonstration projects implementing combination prevention in 12 cities with the highest AIDS burden. For example, the Houston ECHPP project brought together a diverse range of government agencies to create new links between prevention, care, substance abuse, and other services that can reduce new HIV infections.

Community-Based HIV Prevention for Young MSM and Transgender Persons of Color

CDC funding: $50 million total, FY2012-FY2016 (assumes level funding)

Support for local HIV prevention efforts to reach young MSM and transgender people of color with HIV testing and linkages to care, support, and prevention services, as well as targeted behavioral interventions and other effective approaches.

We have worked really hard over years of following the money. Our programs

Estimated Return on U.S. Investment in HIV Prevention, 1991 – 2006

More than 350,00 infections averted

More than $125 billion in direct medical costs saved

Our national investment in HIV prevention has contributed to dramatic reductions in the annual number of new infections since the peak of the epidemic in the mid-1980s, and an overall stabilization of new infections in recent years.14 Given continued increases in the number of people living with HIV, this stabilization is in itself a sign of progress. Other important signs of progress include dramatic declines in mother-to-child HIV transmission and reductions in new infections among injection drug users and heterosexuals over time.

HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $360,000 is saved in the cost of providing lifetime HIV treatment, resulting in significant cost-savings for the health care systems

http://www.whitehouse.gov/omb/factsheet/fighting-the-hiv-aids-epidemic

Increase Support for Global AIDS Programs.

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.

Since taking office, President Obama and his Administration have taken enormous steps to address the HIV epidemic, both domestically and globally. This World AIDS Day, we remember those lost to this epidemic, and reflect on the progress of the past year to prevent HIV infections, improve the health of people living with HIV worldwide, and address HIV stigma and discrimination. Earlier this year, PEPFAR celebrated its tenth anniversary. Domestically, we are refocusing our efforts to lower new HIV infections, improve health outcomes, and reduce disparities. In July, President Obama signed an Executive Order to launch the HIV Care Continuum Initiative, the next step in implementing the National HIV/AIDS Strategy.

Global Leadership on HIV/AIDS

The Obama Administration has strengthened the impact and sustainability of the President’s Emergency Plan for AIDS Relief (PEPFAR) and led efforts to reform and drive increased investments in the Global Fund to Fight AIDS, Tuberculosis and Malaria. The U.S. was the largest donor to HIV efforts in low- and middle-income countries in 2012, accounting for 64% of total international assistance for HIV/AIDS. Together, the PEPFAR and the Global Fund account for over 90% of donor funding for the AIDS response in the world’s highest-burdened and lowest-resourced countries. PEPFAR and the Global Fund are working together to invest resources in a coordinated, complementary, and synergistic manner to combat HIV/AIDS.

PEPFAR has delivered on the President’s 2011 World AIDS Day targets:

PEPFAR has exceeded the President’s 2011 World AIDS Day target to put 6 million people on lifesaving treatment. As of September 30, 2013, PEPFAR is supporting treatment for 6.7 million people. This signifies an almost four-fold increase (from 1.7 million in 2008 to 6.7 million in 2013) since the start of the Obama Administration.

PEPFAR has reached the prevention of mother-to-child transmission target by reaching 1.5 million pregnant women with HIV with antiretroviral drugs to prevent HIV transmission to their children.

As of September 30, 2013, PEPFAR will have directly supported more than 4.2 million voluntary medical male circumcision procedures worldwide, and by the end of calendar year 2013, PEPFAR will have reached the President’s target of 4.7 million.

In June 2013, we reached the one millionth infant born HIV-free because of PEPFAR support. In Fiscal Year 2013 alone, PEPFAR’s investments meant that over 240,000 babies were born HIV-free.

The most recent UNAIDS data shows that, in sub-Saharan Africa, the number of AIDS-related deaths decreased by 32% from 2005 to 2012, and the number of new HIV infections fell by nearly 39% from 2001 to 2012, due in large part to the efforts of PEPFAR and the Global Fund.

PEPFAR’s success in treating 6.7 million people with HIV has helped to drive down new infections and AIDS-related deaths in many PEPFAR-supported countries. To address the high rates of HIV in key populations, PEPFAR supports initiatives to end stigma and discrimination against people living with HIV and key populations, improving their access to, and uptake of, comprehensive HIV services. As outlined in the PEPFAR Blueprint, to prevent the spread of HIV, PEPFAR will continue to make strategic, scientifically sound investments to expand core HIV prevention, treatment and care interventions and maximize impact.

U.S. Investment in the Global Fund

The U.S. has been the largest donor to the Global Fund, contributing $8.5 billion to date. The Global Fund is a vital partner to the United States in supporting a country-owned response to AIDS, tuberculosis (TB), and malaria. The Obama Administration has driven transformational reforms of the Global Fund, tying its last pledge to development and implementation of a comprehensive reform agenda, and conditioning its current pledge to successful execution of critical reforms. The Administration’s goal is to further secure the Global Fund’s role as an efficient, accountable and results-driven mechanism to fight HIV/AIDS, TB and malaria.

In 2010, following our successful three-year, $4 billion pledge to the Global Fund for FY 2011-2013, the President’s FY 2014 Budget requested $1.65 billion for the Global Fund. To leverage future funding from other donors, the U.S. announced that its commitment for the 2014 replenishment is conditional on other donors’ stepping up their contributions to match the U.S. investment two-to-one, and the Global Fund's continuing implementation of its ambitious reform agenda. The U.S. will match incoming contributions to the Global Fund through September 2014 and will provide 33% of investments in the Global Fund for the 2014-2016 replenishment. As of December 2013, the Global Fund reports that supported programs have helped:

6.1 million people receive antiretroviral treatment for HIV/AIDS;

Detect and treat 11.2 million new cases of infectious TB; and

Distribute 360 million bed nets to protect families from malaria.