HIV and hepatitis advocates see promising signs in President Joe Biden’s proposed budget for fiscal year 2024, which was released last week. Of note, Biden seeks to increase efforts to end HIV by $313 million and to launch programs to eliminate hepatitis C and increase access to pre-exposure prophylaxis, or PrEP, the daily pills and long-acting injections that prevent HIV.

“Taken as a whole, the proposal is encouraging,” wrote Mackenzie Flynn, a policy associate at AIDS United, on the organization’s website. Noting the lack of desired support for Housing Opportunities for People With HIV/AIDS (HOPWA) and the Minority HIV/AIDS Fund, Flynn said the proposed funding is “far from perfect.”

“President Biden’s budget is yet another demonstration of his leadership in ending HIV,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in a press statement from that organization. “[Biden] recognizes the historic role the federal government must play and the investments needed to end infectious diseases, such as HIV and hepatitis C.”

Below is a Reel posted by the White House explaining “how President Biden’s budget will continue our work to grow the economy from the bottom up and the middle out – not the top down.”

You can read and download a PDF of the budget proposal and read related fact sheets on WhiteHouse.org. Below are the main items that relate to HIV, hepatitis and sexual health, according to AIDS United:

  • A $227 million boost to the Ending the HIV Epidemic initiative, bringing its total funding to $850 million. The increase breaks down as such:

  • $125 million increase to the Ryan White HIV/AIDS Program

  • $90 million increase to the Centers for Disease Control and Prevention

  • $47 million increase to the Indian Health Service

  • $15 million increase to community health centers.

  • A $63 million increase in the viral hepatitis, sexually transmitted infection and tuberculosis prevention line of the CDC budget.

  • $9.6 billion in mandatory spending over 10 years for the creation of a national PrEP program, which the Biden budget refers to as PrEP Delivery Program. This “seems to be a modified version of the proposal included in last year’s budget,” noted the HIV+Hep Policy Institute, adding: “While PrEP was first approved 10 years ago, just 30% of those who can benefit from it are using it. Uptake is especially low among the groups most impacted by HIV, such as Black, Latinos and the uninsured.”

  • $11 billion in the creation of a five-year hepatitis C elimination program.

  • A $225.5 million increase to Title X, which provides family planning and affordable birth control to low-income people. This would bring total funding for Title X to $512 million. “If enacted, this would increase the number of patients served to 4.5 million,” Flynn noted. “This proposal is especially encouraging in the light of the impact of the reversal of Roe.”

“One of the biggest disappointments with the proposed budget was the lack of support for the HOPWA program,” Flynn wrote. “The proposal included $505 million for HOPWA, a $6 million increase over what Congress appropriated for the program this year. This amount wouldn’t even cover the cost of inflation.”

In addition, the proposed budget leaves funding for the Minority AIDS Initiative at $60 million, the same as the previous year.

The proposed budget is more like the Biden administration’s wish list. Compiled by the Office of Management and Budget, it’s a starting point from which lawmakers in the Senate and House of Representatives begin their bargaining. If Congress members do not resolve their differences and pass reconciliation bills to allocate funds by the start of the fiscal year, then parts of the federal government will shut down. (The federal fiscal year 2024, FY24, begins October 1, 2023, and ends September 31, 2024.)

“The president’s proposal for a National PrEP Program last year galvanized the community behind a vision for equitable PrEP access,” said PrEP4All executive director Jeremiah Johnson in a separate statement. “Words must be met with legislative strategy and action. Advocates are already meeting with Congressional appropriators to see what funds can be made available this year, and we are looking for the administration to enthusiastically support these community efforts.”

“Our communities need real progress right now,” added Michael Chancley, PrEP4All communications and mobilization manager and PrEP In Black America organizer. “Ending the HIV epidemic is a matter of equity. President Biden needs to finish the job, and that will mean working with community advocates to find bipartisan support for funding a National PrEP Program this year. We can’t claim mission accomplished with a proposal alone.”

HIV advocates have been pressuring Congress and the White House to launch a national PrEP program, especially in light of legal challenges that threaten access to the effective HIV prevention. For background, click #PrEP. You’ll find headlines including:

“Judge Rules That the Mandate to Cover PrEP for HIV Prevention Violates Religious Freedom,”

“Tennessee Rejects “Free Money” From U.S. Government to Prevent HIV,”

“Racial Disparities in PrEP Use Are Getting Worse” and

“Over 100 HIV Groups Urge Congress to Fund a PrEP Program.”