Today, federal budget sequestration is scheduled to go into effect. This will result in across-the-board cuts of 5.3 percent in most non-defense discretionary programs, including Ryan White, HIV prevention, HIV research, AIDS housing support, and prevention and treatment programs for people with substance abuse problems.1 By withholding vital funding from essential HIV programs that have seen minimal increases in recent years, these looming cuts will undermine efforts to achieve the targets set forth in the National HIV/AIDS Strategy.2 The most severe effects will be felt in Black America, which has been more heavily affected by the HIV epidemic than any other racial or ethnic group.
We are at a deciding moment in the trajectory of the AIDS epidemic. We are either going to decide to do what's necessary to end the epidemic in this country or we're going to decide to continue to see American citizens get infected, get sick and die from AIDS. The decision to let sequestration go into effect is a decision to let people get sick and die. Sequestration will have a devastating impact upon the fight to end the HIV/AIDS epidemic in Black communities.
Cuts to Vital HIV Programs Will Not Contribute to Deficit Reduction. Discretionary health spending of any kind accounts for only 1.5 percent of the nearly $4 trillion in federal spending,3 and domestic HIV-related spending ($22.25 billion in FY2013, as proposed in the President's executive budget4) represents a mere 2.4 percent of total federal outlays on health ($920.0 billion in FY20135).
Black America Will Feel the Effects of These Cuts the Most. Although Black Americans represent approximately 13 percent of the U.S. population, Blacks account for 44 percent of all new HIV infections. Effects of these cuts are likely to be most pronounced in the South, where Black people account for only about a quarter of the total population but for the large majority of people living with HIV.
Sequestration Will Deprive At Least 3,241 HIV-Positive Black Americans of Life-Saving HIV Treatment. With Black people accounting for 32 percent of all ADAP clients in 20116 -- and with the epidemic's disproportionate toll in Black communities increasing over time -- under the sequester we can assume that at least 3,241 Black Americans living with HIV will lose access to essential antiretroviral treatments and other HIV drugs in Fiscal Year 2013 alone.
Fewer Black Americans Will Learn Their HIV Status. Black Americans are more likely to seek HIV testing than other Americans -- the percentage of Black adults who have ever been tested is more than twice as high as for whites7 -- so Black America will account for a disproportionate share of the 424,000 Americans who fail to access HIV testing as a result of across-the-board budget cuts. This will mean delayed entry to care for hundreds, perhaps thousands, of Black Americans, and will also contribute to unknowing HIV transmission among individuals who would have learned their HIV-positive status had these cuts not gone into effect.
More Than 350 Black Americans Will Be Needlessly Infected. Assuming that recent epidemiological patterns continue, at least 350 Black Americans would needlessly acquire HIV as a result of diminished access to critical HIV prevention services.
Budget Sequestration Will Undermine the Search for a Preventive Vaccine. Almost 300 HIV-related research grants will be without funding, including 32 for vaccine-related research.8
We have the tools to end the AIDS epidemic. We have better surveillance, better diagnostics, better treatment and better prevention tools. Our President is committed to better health for all Americans, including those of us living with or at risk of HIV infection.
Clearly having the tools is not enough. Having a National HIV/AIDS Strategy is not enough. Having the Affordable Care Act is not enough. Ending the AIDS epidemic is going to require a greater level commitment on our part-all of us. Including our national leadership.
To learn more about the impact of sequestration on Black America, click here or visit www.blackaids.org/docs/fs-sequestration.pdf
- Congressional Budget Office (2013). The budget and economic outlook. Available: www/cbo.gov/sites/default/files/cbofiles/attachments/43907_Outlook_2012-2-5_Corrected.pdf.
- White House (2010). National HIV/AIDS Strategy for the United States. Available: www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf.
- National Priorities Project (2013). Federal Budget 101: Where Does the Money Go? Available: http://nationalpriorities.org/budget-basics/federal-budget-101/spending/.
- Henry J. Kaiser Family Foundation (2012). U.S. Federal Funding for HIV/AIDS: The President's FY2013 Budget Request. Available: www.kff.org/hivaids/upload/7029-08.pdf.
- US Federal Budget Analyst. Available: www.usgovernmentspending.com/health_care_budget_2012_1.html.
- National Alliance of State and Territorial AIDS Directors (2012). National ADAP Monitoring Project National Report.
- Henry J. Kaiser Family Foundation, Washington Post (2012). 2012 Survey of Americans on HIV/AIDS. Available: www.kff.org/kaiserpolls/upload/8334-F.pdf.
- Ibid., amfAR (2013).