Washington Blade - May 8, 2009
Lou Chibbaro Jr.

Figures released Thursday by the Office of Management & Budget show that $53 million of the $107 million increase would go to the U.S. Centers for Disease Control & Prevention's programs aimed at reducing the number of HIV infections and increasing access to health care.

The additional allocation of funds will raise the budget for CDC programs, including HIV prevention programs, to a total of $745 million in 2010, representing the first increase in domestic HIV prevention funds in more than two years.

The president's budget calls for an increase in funding for HIV/AIDS research at the National Institutes of Health from $3.05 billion in the current fiscal year to $3.10 billion in FY 2010, a hike of $50 million.

To the disappointment of some AIDS advocacy groups, Obama's budget calls for leaving the funding level for the Department of Housing and Urban Development's Housing Opportunities for People With AIDS program, known as HOPWA, at the same level as the current fiscal year - $310 million. The program subsidizes housing for low-income people with AIDS.

HUD spokesperson Melanie Roussell said the president and HUD Secretary Shaun Donovan remain strongly committed to the HOPWA program. She said housing needs shifted as a result of the downturn in the nation's economy, forcing HUD to relocate funds.

"A lot of programs were straight-lined in the budget," she said, in an effort to prevent outright cuts in programs like HOPWA.

AIDS advocacy groups were also disappointed that the president did not include language in his proposed budget calling for lifting a longstanding ban on federal funds to pay for syringe exchange programs aimed at curtailing the spread of HIV among injection drug users. The groups say they will urge Congress to lift the funding ban when it reviews the Obama budget.

The same groups praised Obama for eliminating funding for abstinence-only HIV prevention programs that the Bush administration made a priority in the nation's domestic and international AIDS efforts. Most LGTB and AIDS activists have said abstinence-only programs have been ineffective and a waste of funds needed for more effective prevention programs.

The groups say they favor abstinence education as part of a comprehensive sex education program that also informs population groups at risk for HIV - especially young gay males - about condom use as a means of preventing the spread of HIV.

According to an OMB official, the higher CDC funding in the president's proposed budget would enable state and local health departments to administer an additional 600,000 HIV tests and identify 6,000 new HIV infections each year.

The official said the increased testing would place an "emphasis on gay and bisexual men of all races, ethnicities, African Americans and Hispanics."

An increase of $54 million in new domestic AIDS funds would go toward the Ryan White HIV/AIDS program to expand access to health care for people who don't have private health insurance or whose insurance isn't sufficient to adequately cover AIDS-related medical costs, the official said.

The increase means a total of nearly $2.3 billion in funding will be provided for the Ryan White HIV/AIDS program.

The $107 million funding increase proposed by the Obama administration for CDC and Ryan White related programs falls considerably short of the suggested funding level for the two agencies made last fall by a coalition of more than 100 national, state, and local AIDS and LGBT advocacy organizations.

AIDS Action, AIDS Institute, the Human Rights Campaign and others called for an $877 million increase in CDC funding for HIV prevention and surveillance programs for fiscal year 2010. The groups called for an overall funding increase in FY 2010 of $614.5 million for the Ryan White program.

Carl Schmid, director of federal affairs for the AIDS Institute, said the CDC itself came up with the $877 figure as an estimate of what would be needed to reduce the number of new HIV infections in the country by half by the year 2020.

"They said this was their professional judgment of what we need to accomplish that goal," he said. "It's about priorities. It's not unrealistic to get significant increases to meet an important need."

In statements released Thursday, AIDS Institute and AIDS Action, another national advocacy group, praised the president for calling for an increase in funding for CDC prevention programs and for the Ryan White program.

But officials with the groups said they had hoped the proposed increases would be greater.

"In the context of this budgetary environment, we think the president's budget request represents a positive step and certainly is a departure from the previous administration's budget request," said Ronald Johnson, deputy director of AIDS Action.

"But they are not enough to match the need and we will certainly continue to press Congress to build on the president's budget request to reach funding levels that are more responsive to the real needs," he said.

Administration officials, including OMB Director Peter Orszag, said the president's proposed reform of the nation's health care system would play an important role in boosting the AIDS-related programs covered in the budget.

News of the Obama administration's proposed domestic AIDS budget followed Tuesday's release by the White House of its proposed fiscal year 2010 budget for the U.S. Global Health Initiative, which includes the highly popular President's Emergency Plan for AIDS Relief, also known as PEPFAR, which was initiated by President Bush.

The Obama budget calls for spending $63 billion cumulatively over six years - 2009 through 2014 - for global health programs, including PEPFAR.

At least one organization that advocates for global AIDS relief, Health Global Access Project, said the Obama proposal represents a decrease of $6.6 billion from the funding level authorized by Congress for global HIV and tuberculosis programs when it renewed the U.S. global health program last year.

A White House statement Tuesday said the president's proposed funding changes "focus attention on broader global health challenges, including child and maternal health, family planning, and neglected tropical diseases, with cost effective intervention."

The statement says the president's global health budget "provides robust funding for HIV/AIDS" but adds that the proposed budget "adopts a more integrated approach to fighting diseases, improving health, and strengthening health systems."

In March, AIDS activists said they were cautiously optimistic when the White House released a summary of the president's proposed $3.6 trillion fiscal year 2010 budget. The summary indicated the budget would include an unspecified increase in funding for domestic AIDS programs.

The White House announcement in March came less than a week after Congress belatedly approved a fiscal year 2009 budget that included a modest increase in funds for the Ryan White program but no increase for the CDC's HIV prevention programs.

Advocacy groups noted the "flat funding" for HIV prevention program in 2009 followed a decision by Congress to decrease CDC prevention programs for HIV by $3.5 million in fiscal year 2008.

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