HIV Clinicians and Scientists Applaud President's Commitment to HIV at Home, Urge Increased Investment in Combating HIV Globally

We applaud President Obama for sustaining and enhancing funding for programs that play a key role in the nation's response to HIV in the United States, despite funding cuts and spending freezes proposed for many domestic programs. Reflecting a substantial commitment to the National HIV/AIDS Strategy, the president's proposed budget for the 2012 fiscal year would:

• Authorize the Department of Health and Human Services (HHS) to transfer 1 percent of HHS domestic HIV program funding (approximately $60 million) to support collaborations in areas such as increasing linkages to care and developing effective combinations of prevention interventions
• Increase research by expanding funding for HIV/AIDS-related research supported by the National Institutes of Health (NIH) by $74 million from the 2010 enacted level, for a total of nearly $3.2 billion in 2012.
• Expand investments in prevention, care, and research in support of the National HIV/AIDS Strategy, which aims to reduce HIV incidence, increase access to lifesaving care, improve health outcomes, and reduce HIV-related health disparities. The budget includes a $58 million increase for the Centers for Disease Control and Prevention (CDC) to reduce the number of new HIV infections, reduce HIV transmission and acquisition, and increase the number of infected individuals who are aware they are infected with HIV.
• Increase funding for the Ryan White HIV/AIDS Program by $88 million, of which Part C would receive a $5 million increase. These much needed funds would support treatment for 13,000 additional people with HIV and comprehensive HIV care for an additional nearly 7,000 individuals who otherwise would go without.

While these investments will not meet the growing need, they are urgently needed and will provide vital support to a collapsing HIV care system. Funding for Ryan White Part C has increased by roughly 9 percent during the past 9 years, while patient loads have increased by 60 percent. Ryan White Part C-funded clinics serve poor and uninsured people with HIV around the country, and these clinics are struggling to meet demand for HIV care in their communities. Clinics are being forced to cut vital services, including laboratory monitoring, and to freeze hiring of new medical staff to meet the growing need for HIV care. While we await coverage expansions under health care reform, the Affordable Care Act, in 2014, these clinics must have the resources to respond to the complex needs of the increasing numbers of patients with HIV who have no or poor health care coverage.

An estimated 56,300 people are newly infected with HIV each year in this country. The cost of HIV treatment and lost productivity, borne largely by the public sector, can reach $1 million per infection. With new HIV cases increasing by 15 percent from 2004 to 2007 alone, a sustained commitment of federal funds to implement routine HIV screening and support prevention programs targeted at the populations most heavily affected is urgently needed. This commitment must also include maintaining and enhancing research capacity at the NIH, or we risk losing precious ground in our battle against this deadly disease.

We are concerned by the president's proposed modest increases for bilateral global AIDS programs of $49 million, or a 0.9 percent increase over the 2010 enacted budget. Currently, fewer than one-third of people with HIV who are clinically eligible for treatment are receiving it worldwide, and under the proposed funding level it will be difficult to maintain, let alone expand, access to lifesaving therapies or to roll out the latest in effective prevention innovations, such as male circumcision . Our geographic boundaries are invisible to HIV and other infectious diseases. Wise and adequate funding levels are vital and warranted to make real strides in combating HIV disease here at home and abroad. To do otherwise will result in higher costs over the long-term, whether measured in lives or economic instability.

To ensure we as a nation take greater strides in reducing the impact of HIV disease here at home and abroad, we look forward to working with Congress to build on the administration's budget proposals for FY 2012.