HIV advocates have much to praise in the Biden-Harris administration’s proposed budget for fiscal year 2023. The budget seeks a $377 million increase in funding for the Ending the HIV Epidemic in the United States initiative, devoting a total of $850 million to the programs. What’s more, the budget seeks to invest $9.8 billion over 10 years in expanding access to PrEP, or pre-exposure prophylaxis, which refers to pills and injections that prevent HIV.

“In many ways, this is a very bold budget,” said Carl Schmid, executive director of the  HIV+Hepatitis Policy Institute, in a press statement about Biden’s requested budget. “The increases are especially needed after COVID-19 stalled progress and Congress fell short in providing the requested increases for this year. Hopefully, Congress will support these proposals so our efforts to end HIV can get back on track.”

The institute points out that the proposed budget also includes “a bump of $13.5 million” for the hepatitis division within the Centers for Disease Control and Prevention (CDC). That amount falls short of the requested $140 million to fund a plan to end hepatitis by 2030 but would nonetheless “help improve hepatitis testing and linkage to care and cure programs,” Schmid said.

While also applauding Biden’s proposed budget, advocates with PrEP4All stressed the importance of developing a national PrEP strategy to get HIV prevention to those communities that need it most. In a press statement on the budget, PrEP4All spells out the situation:

Coverage of comprehensive services for PrEP users is a major obstacle for the communities who most need access. The estimated 30 million Americans who remain without insurance are disproportionately Black, Latinx, and transgender, the very same populations who have the lowest rates of PrEP use. In 2019, the CDC found that 63% of White Americans recommended for PrEP received a prescription, compared to 14% of Latinx/Hispanic Americans and just 8% of Black Americans. While some options do exist to cover PrEP expenses, they are incomplete, fragmented, and complicated. The new funding in the FY 2023 proposed budget can be used to overcome these barriers and help put the national HIV strategy on track for success.

 

The new funding must be paired with a strategic approach for the investment to have the greatest impact. Such an approach should smartly and effectively use public funding to cover essential PrEP services—including medication and required labs—and create an expanded PrEP access network for uninsured, under-insured, and Medicaid-covered individuals. Without a strategic approach, there is a high risk that new funding will go to high priced medications instead of the essential outreach and wraparound services that can mean the difference in access for hundreds of thousands of people.

In the past year, several members of Congress introduced legislation to establish national PrEP programs, namely the PrEP Assistance Program Act (HR 5605) and the PrEP Access & Coverage Act (S 3295, HR 6117). To read more about these efforts see “111 Groups Urge Biden: Create a PrEP Program to Prevent HIV” and “2021 Was a Year of HIV Progress; Now Let’s Focus on PrEP Access.”

“A national PrEP infrastructure must move away from the current reliance on high-cost brand-name drugs that have resulted in overly complex, difficult-to-navigate programs for the un- and underinsured and a relatively small number of access points in the Medicaid program,” said Kenyon Farrow, managing director of advocacy and organizing at PrEP4All.

Of course, the proposed budget is more like a request from the White House. It’s a starting point that reflects the administration’s funding preferences. The final version must be approved by both the Senate and House of Representatives.

In the bigger picture, the 2023 budget proposal calls for $5.8 trillion in federal spending, including higher taxes on the wealthy, lower deficits and more funds for police, education, health and housing, reports The Associated Press.

The budget proposal was released Monday, March 28. Since then, other HIV groups have released statements regarding the funding. NMAC, Black AIDS Institute, the San Francisco Community Health Center and the Latino Commission on AIDS—all organizations led by people of color—emailed a joint statement expressing “strong support.” And in a separate statement, amfAR, the Foundation for AIDS Research, “applauds President Biden’s commitment to ending the HIV epidemic.”

You can read the entire 158-page 2023 budget here. In laying out the funding for the Department of Health and Human Services, the budget “commits to ending the HIV/AIDS epidemic” by:

The National HIV/AIDS Strategy for the United States 2022–2025 commits to a 75% reduction in HIV infection by 2025. To meet this ambitious target and ultimately end the HIV/AIDS epidemic in the United States, the Budget includes $850 million across HHS to aggressively reduce new HIV cases, increase access to pre-exposure prophylaxis (also known as PrEP), and ensure equitable access to services and supports for those living with HIV. This includes increasing access to PrEP among Medicaid beneficiaries, which is expected to improve health and lower Medicaid costs for HIV treatment. The Budget also proposes a new mandatory program to guarantee PrEP at no cost for all uninsured and underinsured individuals, provide essential wraparound services through States, his [Indian Health Service], tribal entities, and localities, and establish a network of community providers to reach underserved areas and populations.

In a section on tackling global challenges, the budget reads in part:

The Budget includes $10.6 billion to bolster U.S. leadership in addressing global health and health security challenges, a $1.4 billion increase above the 2021 enacted level. Within this total, the Budget demonstrates U.S. leadership by supporting a $2 billion contribution to the Global Fund’s seventh replenishment, for an intended pledge of $6 billion over three years, to save lives and continue the fight against HIV/AIDS, tuberculosis, and malaria, and to support the Global Fund’s expanding response to the COVID-19 pandemic and global health strengthening.

To learn more about the Ending the HIV Epidemic initiative, read an overview at HIV.gov and visit the official web page at HRSA.org. For a related POZ article, see “Plans to End the HIV Epidemic at Home and Abroad.”

That initiative isn’t the only U.S. plan to tackle HIV. For example, see “What’s New in the Updated National HIV/AIDS Strategy?”