AIDS Policy Experts Pleased By House and Senate Funding Bills

Last week, House and Senate Appropriation Committees passed FY16 funding bills that maintain, for the most part, funding for specific domestic HIV and hepatitis programs while they drastically cut many other programs that are critical to preventing and treating HIV and hepatitis. Policy experts were pleased with the funding.

"The AIDS Institute thanks the leadership of the Appropriation Committees for maintaining their support of HIV/AIDS prevention, care, treatment, research and housing programs," commented Carl Schmid, Deputy Executive Director of The AIDS Institute. "This is particularly noteworthy given that the overall spending caps are billions of dollars below current spending levels and some programs have been dramatically cut or zeroed out. While we are pleased with Congress' ongoing bipartisan commitment to people with HIV/AIDS, we are deeply disappointed with the Senate's cut of $61 million to the Minority AIDS Initiative in the Secretary's Office and at SAMHSA, together with a $25 million cut to the Ryan White HIV/AIDS Program. Additionally, both bills cut funding to the Affordable Care Act (ACA) and several other programs that prevent HIV, particularly among women."

Under the Labor, HHS, Education and Related Agencies Appropriation bills, the House maintains $2.3 billion in funding for the Ryan White HIV/AIDS Program, including $900 million for the AIDS Drug Assistance Program (ADAP). The Senate reduces Ryan White Program funding by $25 million by zeroing out the Special Projects of National Significance, which have been critical in developing innovative systems to improve care and treatment. The Ryan White Program provides health care, medications, and coverage completion services to approximately 536,000 low-income, uninsured and underinsured individuals living with HIV.

The AIDS Institute thanked Congress for again rejecting a proposal in the President's budget that would have eliminated funding to Part D of the Ryan White Program, which serves women, infants, children and youth with HIV/AIDS.

Also commenting on this was AIDS Action Committee, who were extremely pleased that lawmakers decided to continue to invest in public health.

"We are grateful to House and Senate leadership for increasing the Commonwealth's investment in fighting HIV/AIDS by approving $33.1 million to fight HIV/AIDS in FY2016," said AIDS Action Committee Executive Director Carl Sciortino. "Since the beginning of the AIDS epidemic, Massachusetts has distinguished itself among the 50 states by being one of the few that has wisely invested resources in fighting HIV. As a result, the state leads the nation in reducing new diagnoses of HIV and improving the health of those living with HIV. Meanwhile, Massachusetts has also saved hundreds of millions of dollars in HIV-related health care costs."

Both the House and Senate will maintain $787 million for HIV prevention at the CDC. There continues to be about 50,000 new HIV infections each year, with a growing number of youth, particularly young black gay men, being infected. Proposed increases by the President to address these populations were not realized.

Under the Senate version of bill, funding for Hepatitis prevention at the CDC would be increased by $5 million, far less than the nearly $32 million increase proposed by the President. The House bill would maintain the current $31 million funding level. Policy experts were less thrilled about this.

"While we are pleased the Senate did increase funding slightly, The AIDS Institute is disappointed that the Congress is not doubling its investment in hepatitis prevention given the magnitude of the number of hepatitis infections and the need for increased surveillance, testing, and education," commented Michael Ruppal, Executive Director of The AIDS Institute. "As the bill progresses throughout the year, it is our hope that this is one area where increased resources will be prioritized."

In Massachusetts, HIV diagnoses plateaued around 700 per year. This renewed investment in fighting HIV/AIDS will help the state break through that plateau and get to zero new infections.

"We will do this, in part, by increasing awareness about new tools to fight HIV such as Pre-Exposure Prophylaxis (PrEP). By taking just one pill per day, those who are uniquely vulnerable to HIV infection can reduce their risk by more than 90 percent," said Sciortino. "Despite its effectiveness as a prevention tool, few of those in the Commonwealth who could benefit from it even know about it. By broadly educating the public -- as well as health care providers -- about PrEP, which is already covered by health insurers, Massachusetts once again has a unique opportunity to lead the nation in HIV treatment, education, and prevention."

Meanwhile, the work of improving the health of those already living with HIV will continue. Since 2000, the numbers of those living with HIV in Massachusetts has increased 49 percent. These are some of the Commonwealth's most vulnerable residents: Black and Latino men and women; gay and bisexual men; transgender women; people who are homeless, particularly young people; and those who are incarcerated.

While Blacks make up only six percent of Massachusetts' population, they comprise 30 percent of those living with HIV/AIDS. While Hispanics make up only 10 percent of the state's population, they comprise 24 percent of those living with HIV/AIDS. And rates of new HIV diagnoses are decreasing among all demographic groups, except one: the proportion of new HIV infection diagnoses among gay and bisexual men in Massachusetts increased from 33 percent in 2003 to 46 percent in 2012.

"In Massachusetts, public spending should be aligned with effective, successful programs," said Sciortino. "Since 2000, HIV diagnoses in Massachusetts have been cut by 41 percent, which has meant that thousands of people who might have become HIV-positive have been spared the risks to health that can come with HIV. The state, meanwhile, will save an estimated $1.7 billion in avoided HIV-related health care costs."

Both the House and Senate significantly increased medical research at the National Institutes of Health. The AIDS Institute thanked the Senate Appropriations Committee for rejecting, by a vote of 6 to 23, an amendment offered by Sen. Bill Cassidy (R-LA) that would have decreased infectious disease research at the NIH by $325 million. A wide majority of Senators recognize the need for continued research on an AIDS vaccine, new prevention and treatment technologies, and cure research that not only will benefit the U.S. but the entire world as we seek to end AIDS.

Funding for the Housing Opportunities for People with AIDS (HOPWA), contained in the Transportation, HUD bill, would increase to $335 million under the House-passed version, while Senate appropriators recommend level funding of $330 million. The Senate bill also takes the long overdue step of modernizing how HOPWA funds are distributed. As proposed by the Obama Administration, funds would no longer be distributed based on outdated cumulative AIDS cases but a combination of HIV cases along with rental costs and poverty levels. Jurisdictions would not lose more than 10 percent of their funding in a year, while at the same time no jurisdiction can receive more than a 20 percent increase.

While both the House and Senate are still prohibiting federal funding of syringes for syringe exchange programs, they would allow funding of ancillary services for syringe exchange programs in areas experiencing increases of HIV or hepatitis C infections due to injection drug use.

While there are many positive elements in these bills, there are a number of very damaging cuts. In addition to the Senate cuts to the Minority AIDS Initiative and the Ryan White Program, the Senate cuts $32 million to CDC's STD Prevention Division. Both chambers restrict implementation of the ACA, which is providing health care to millions, including people with HIV and hepatitis. Both the House and Senate would eliminate almost all funding for the Teen Pregnancy Prevention Initiative and increase funds for failed abstinence only programs. The House would also totally zero out Title X Family Planning services, while the Senate would cut it by $29 million.

"Now that we have seen what happens when funding bills have to be written under restrictive budget caps, and in the case of health care and housing programs, billions of dollars less than current spending levels, we hope Congress and the President will join together and adjust up the spending caps," concluded Ruppal. "Sequestration is harmful, and in the instance of HIV and hepatitis programs, it is harmful to the public health of our nation. We congratulate the Congress on the work they have done on moving these appropriation bills, but they know these bills will never be signed by the President. We look forward to working with the Congress and the Administration on funding bills that will restore these harmful cuts and can be signed by the President."