Facing Sequestration, Senate Appropriates Funding for HIV

With sequestration cuts savaging federal funding for HIV prevention and care, the Senate Appropriations Committee on July 11 moved to pass legislation to keep the funding at 2013 levels, with an additional $51M for the Ryan White HIV/AIDS Program. But some wonder what the cuts will do to HIV research programs, and services for young MSM of color.

"Sequestration has devastated our nation's response to HIV at a time when we can least afford it," said National Minority AIDS Council Director of Legislative and Public Affairs Kali Lindsey. "For the first time in three decades, science has provided us with the tools to realistically end this epidemic. But the climate of gridlock and budget cuts that continues to grip our nation's capital has left America's researchers, health care providers and outreach workers struggling to realize this vision. The Senate has recognized the importance of this collective effort and has demonstrated a strong commitment to achieving an AIDS-free generation."

Hundreds of millions of dollars have been stripped from funding for federal HIV/AIDS programs -- a move that provides small deficit reduction benefits, but has a serious and devastating effect on lives.

According to the amfAR brief "Estimating the Human Impact of Budget Sequestration on HIV/AIDS in the United States in Fiscal Year 2013," the cuts will cause 15,700 people to lose ADAP funding, 5,000 households with PLWHAs to lose housing, the equivalent of 460 AIDS research grants to be eliminated and major cuts in HIV prevention services.

Under the FY14 spending bill passed by the Senate Appropriations Subcommittee on Labor, HHS, Education and Related Agencies, funding for the Ryan White HIV/AIDS Program would increase by $51 million over FY13 enacted levels. The Ryan White Program provides medical care, treatment and other services to 550,000 low-income people with HIV and has been struggling to keep up with growing patient loads.

The Senate Appropriations Committee would earmark $47M for additional ADAP (AIDS Drug Assistance Program) funding, which has seen funding shortfalls and waiting lists in recent years. The Committee has also included increases in funding for the National Institutes of Health, continued funding for the Centers for Disease Control and Prevention at last year's levels and restored some funding stripped by sequestration cuts.

Estimates indicate that sequestration cuts would result in $64.7M in the CDC's HIV prevention programs, including $27.6M from HIV prevention and $2.4M from HIV adolescent and school health.

Since there was a dramatic loss of ADAP funding in FY13, the Obama Administration recently transferred $35 million in emergency funding to ADAP to ensure that patients currently on medications can continue to receive them. The Subcommittee action ensures those patients will continue to receive their medications next year and provides for an additional $12 million in new funding.

Because of bipartisan gridlock, the House's budget will likely never become law, but activists hold on to hope that the chambers will come together and decide to fund programs that will help end the domestic HIV/AIDS epidemic.

"Both the President and the Senate have demonstrated great leadership in addressing HIV/AIDS at home," said Michael Ruppal, executive director of The AIDS Institute. "We are still waiting to see what the House of Representatives will do, which has differing views on how to address federal spending."

Recently, The AIDS Institute released an analysis that showed sequestration and other budget cuts have already resulted in cuts of $375 million from the federal government's response to the domestic HIV/AIDS epidemic. If the cuts outlined in the House of Representative's budget are applied across the board, an additional $1.1 billion would be slashed.

The appropriation bills being considered by the Senate, along with the President's budget, restore the damaging cuts caused by sequestration. Unfortunately, the House is taking a different approach.

"We hope that all parties soon can come to an agreement that will end the ongoing uncertainty surrounding the federal budget and in the process, adequately fund critical public health programs, including those that prevent HIV and provide for care and treatment for people living with HIV," said Ruppal.

Still, the Senate Appropriations Committee has promised to maintain spending for HIV prevention at the CDC at $755 million. There continue to be about 50,000 new HIV infections each year, yet the federal government allocates only 4 percent of its domestic HIV spending on prevention.

"The AIDS Institute recognizes Chairman Tom Harkin for his leadership in maintaining the United States Senate's strong commitment to domestic HIV programs by increasing funding for the AIDS Drug Assistance Program (ADAP) and maintaining funding for the rest of the Ryan White HIV/AIDS Program and HIV prevention at the CDC," commented Carl Schmid, Deputy Executive Director of The AIDS Institute.

Medical Research Efforts Hurt By Cuts

Due to these cuts, medical research at the National Institutes of Health under the bill would increase by a modest $307 million. These budget cuts threaten the unprecedented breakthroughs in 2011 that promise new options to end the AIDS epidemic.

According to the new report "From Research to Reality: Investing in HIV Prevention Research in a Challenging Environment" released at 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur, more funding is needed to explore these options.

Steady progress in research and development for HIV vaccines, pre-exposure prophylaxis using antiretroviral drugs (PrEP) and treatment as prevention have confirmed the critical role science has to play in providing solutions to end the AIDS epidemic, yet the ninth annual report from the HIV Vaccines and Microbicides Resource Tracking Working Group shows that funding has essentially plateaued.

In 2012, funders invested a total of $1.31B across R&D for six key prevention areas: preventive HIV vaccines, microbicides, PrEP (pre-exposure prophylaxis) using antiretroviral drugs, treatment as prevention, operations research related to voluntary medical male circumcision and prevention of vertical transmission. This is a six percent increase over funding in 2011. But a significant portion of this increase is likely due to improved reporting by several donors.

"Science has a critical role to play in ending the AIDS epidemic," said Luiz Loures, Deputy Executive Director, Programme, UNAIDS. "The potential returns on investments are hugely important and I strongly urge donors to make funding for research and development a top priority."

This report comes as new guidelines are being released from the World Health Organization (WHO) on when to start taking antiretroviral therapy (ART) for HIV. These new guidelines recognize recent advances made in HIV prevention R&D and will help countries maximize the impact of antiretroviral therapy on keeping people alive and well and helping prevent new infections.

It is too early to tell what additional resources will be needed to support countries and programs in adopting the new WHO guidelines and effectively rolling out these proven prevention options, which represents an investment opportunity for countries heavily impacted by HIV, particularly emerging economies.

According to the report, the United States remained the largest public sector funder of HIV prevention research, spending a total of $925M in 2012 -- 70 percent of the total investment in HIV prevention R&D -- and underscoring the importance of fostering broader commitments by additional global partners. These cuts threaten partner funding as well.

"As the report highlights, the HIV vaccine field has been a leader in catalyzing innovative partnerships across the public, private, philanthropic and academic sectors," said Margaret McGlynn, President and CEO of the International AIDS Vaccine Initiative. "Such partnerships can help integrate new funders and help enhance the information exchange and collaboration that is required as we tackle remaining critical questions in immunology as we move forward to develop even more effective prevention options."