In the wake of extended deliberations, Congress included in its deal to provide coronavirus relief and fund the government for fiscal year 2021 an increase of $137 million for the Trump administration’s plan to beat HIV/AIDS, but stopped short of the full request, much to the disappointment of advocates fighting the epidemic.
The $1.4 trillion deal, unveiled Monday after days of negotiations amid fears of a potential government shutdown, notably includes $600 in stimulus checks to U.S. adults and new money for small businesses under the Paycheck Protection Program. In mere hours after the deal became public, Congress voted to approve the measure Monday evening.
The deal, however, also contains funds for the Ending the HIV Epidemic initiative, which seeks to beat the HIV epidemic by 2030.
Announced by President Trump at the State of the Union address in 2019, the PrEP-centric initiative under the Department of Health & Human Services seeks to reduce new HIV infections by 75 percent in 2025, then 90 percent in 2030. It remains to be seen if President-elect Joe Biden will adopt this plan and the infrastructure set up by the Trump administration to eliminate HIV (which Biden said he could do by 2025, outdoing Trump’s goal by five yeas) or adopt another plan to go his own way.
The FY-21 deal appropriated $403 million for the initiative, increasing the FY-20 funding levels by $137 million. The $137 million increase breaks down as follows:
- $35 million for Centers for Disease Control’s HIV prevention efforts;
- $35 million for the Ryan White HIV/AIDS Program;
- $52 million for HRSA Community Health Centers to focus on PrEP to prevent HIV transmission;
- $5 million for Indian Health Service for HIV and hepatitis; and
- $10 million for National Institute for Health’s Centers for AIDS Research.
The final package also includes important funding increases for other domestic HIV programs, including an increase of $20 million for HUD’s Housing Opportunities for People with AIDS, or HOPWA, $1.5 million for the Minority HIV/AIDS Fund and $1 million for the CDC’s School Health program.
But the funding is a far cry from the $412 million increase sought by the Department of Health & Human Services, making a total appropriation of $678 million in FY-21, to ramp up the Ending the HIV Epidemic initiative in each designated high-incident jurisdiction with testing, linkage to care and PrEP activities.
Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement the funds Congress appropriated aren’t what the Trump administration, or advocates against HIV/AIDS, were seeking, but he was hopeful they would be enough to keep the initiative going.
“We thank the president for initially proposing and now the Congress for including increased funding for the second year of the Ending the HIV Epidemic Initiative,” Schmid said. “While it is not as much as we anticipated, it is reassuring that both the House and Senate, in a bipartisan fashion, support increases to our public health efforts so that we can continue the momentum already created and make further progress in ending HIV in the U.S.”
The deal appropriated money for the Ending the HIV Epidemic initiative somewhere in between the amount proposed by both chambers of Congress. Counterintuitively, House Democrats under House Speaker Nancy Pelosi (D-Calif.) approved just $65 million in increases, while Senate appropriations had proposed $207 million.
Evan Hollander, a House Appropriations Committee spokesperson, said the $403 million allocated by Congress represents a 48.8 percent increase, which he said “far outpaces the overall increase in non-defense discretionary spending.”
Taking a jab at the Trump administration, Hollander said the $678 million sought by the Trump administration sounds better than it is because it was “predicated on cuts to other labor, health and human services, and education programs.”
No HIV money was included in the coronavirus relief portion of the package. That stands in contrast to the CARES Act, which included $155 million for Ryan White programs as part of the earlier coronavirus package.
Hollander said House Democrats included $100 million in the Heroes Act, the $4 trillion COVID-19 relief passed in October, but Republicans “insisted on dramatic cuts to the emergency appropriations that were included in that bill.”
The Senate Appropriations Committee didn’t respond to a request to comment for this article. The White House referred the Blade to the Office of Management & Budget, which didn’t respond to a request to comment. HHS also didn’t respond to a request to comment.
Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation, was more bleak in her assessment and openly wondered if the amount Congress appropriated would be enough to complete the HIV initiative by its 2030 goals.
“The funding in the bill for the Ending the HIV Epidemic initiative is below the president’s request, and it’s unclear if this will be sufficient for reaching the initiative’s goals within the timeline, particularly since the timeline itself has already been threatened by COVID-19,” Kates said.
Meanwhile, Congress also agreed to reject the draconian cuts the Trump administration had sought for global AIDS programs as part of its FY-21 budget request.
The deal allocated $5.9 billion for the President’s Emergency Plan for AIDS Relief, or PEPFAR, the same amount as FY-20 and $2.1 billion above Trump’s request. Congress also allocated $1.56 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is $903 million above Trump’s request.
Jessica Bassett, a spokesperson for the New York-based grassroots group Health GAP, said via email to the Blade, however, the allocation for global programs is “another punt from Congress when what people with HIV need is urgent, decisive action.”
“The U.S. was already underfunding its share of the global AIDS response via PEPFAR and the Global Fund to Fight AIDS, Tuberculosis & Malaria – and that was before COVID-19,” Bassett said, “The COVID-19 pandemic has exposed and exacerbated weaknesses in the HIV response, triggering life-threatening disruptions to HIV treatment, prevention, and care for adults and children, and undermining years of progress in the fight against HIV in just a matter of months.”
Bassett concluded she wants to see big changes when the Biden administration begins on Jan. 20, when she said Congress “won’t be able to use Trump’s perennial slash-and-burn budget proposals as cover for flatlining global AIDS funding.”
“The Biden-Harris administration should work with Congress to deliver a bold global HIV catch-up plan to save lives, particularly the lives of those who have suffered the most during the pandemics: LGBTQ+ people, children, pregnant people, sex workers, people who use drugs, and incarcerated people,” Bassett said. “Scaling up the U.S. investment to put the global AIDS response back on track must be a priority for the new administration, first to mitigate the harms done by COVID-19, and then year after year to successfully expand access to quality HIV treatment and evidence-based prevention services to all who need them.”