Funding for HIV Programs & Research in President Biden’s FY24 Budget
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On March 9, 2023, the White House published President Joe Biden’s Fiscal Year 2024 budget for the federal government. The budget includes funding for domestic HIV activities across multiple agencies, a boost in funding for the Ending the HIV Epidemic in the U.S. initiative, and proposals for a national PrEP delivery program and for improving PrEP access for Medicaid beneficiaries.
“A critical component of the Biden-Harris Administration’s commitment to addressing health equity is addressing the disproportionate impact of infectious diseases on racial minorities and the LGBTQI+ communities,” notes a White House fact sheet, President Biden’s Budget Advances Equity, about these HIV investments and others focused on the treatment and prevention of infectious diseases.
Funding for Domestic HIV Activities in President’s FY24 Budget
The President’s budget includes funding for HIV activities administered by several agencies across the U.S. Department of Health and Human Services as well as the Department of Housing and Urban Development as indicated in the table below.
| U.S. Federal Domestic HIV Budgets FY20-FY23 Enacted + FY24 President's Budget (in USD millions) | ||||||
| Agency/Program | FY 2020 | FY 2021 | FY 2022 | FY 2023 | FY 2024 President's Budget | FY 24 PB vs. FY 2023 Enacted |
| CDC Domestic HIV Prevention | $928.70 | $964.70 | $986.70 | $1,013.71 | $1,155.71 | $142.00 |
| Including EHE | $140.00 | $175.00 | $195.00 | $220.00 | $310.00 | $90.00 |
| HRSA Ryan White HIV/AIDS Program | $2,389.00 | $2,424.00 | $2,495.00 | $2,571.04 | $2,696.04 | $125.00 |
| Incl. ADAP (AIDS Drug Assistance Prog.) | $900.30 | $900.30 | $900.30 | $900.31 | $900.31 | $0.00 |
| Including EHE | $70.00 | $105.00 | $125.00 | $165.00 | $290.00 | $125.00 |
| HRSA Health Centers Program (only EHE part) | $50.00 | $102.30 | $122.20 | $157.25 | $172.00 | $14.75 |
| Indian Health Service (only EHE funds) | $0.00 | $5.00 | $5.00 | $5.00 | $52.00 | $47.00 |
| NIH – AIDS research* | $3,076.00 | $3,090.00 | $3,194.00 | $3,294.00 | $3,294.00 | $0.00 |
| Including EHE | $6.00 | $16.00 | $26.00 | $26.00 | $26.00 | $0.00 |
| SAMHSA (all Minority AIDS Initiative) | $116.00 | $116.00 | $116.00 | $119.31 | $119.31 | $0.00 |
| HHS Minority HIV/AIDS Fund | $53.90 | $55.40 | $56.90 | $60.00 | $60.00 | $0.00 |
| HUD – Housing Opportunities for Persons With AIDS (HOPWA) | $410.00 | $430.00 | $450.00 | $499.00 | $505.00 | $6.00 |
| Subtotal: HIV Discretionary Spending | $7,023.60 | 7,187.40 | $7,425.80 | $7,719.31 | $8,054.06 | $334.75 |
*The NIH does not define HIV research as “domestic” given its broad application; the figure listed is for all HIV research regardless of whether it is global or domestic.
President Requests $850M to Continue EHE Initiative
The President’s budget includes $850 million in funding across CDC, HRSA, IHS, and NIH to support continued scale-up and implementation of the Ending the HIV Epidemic in the U.S. initiative. This represents a $277 million (48%) increase over the FY23 enacted funding level. This investment is intended to “aggressively reduce new HIV cases, increase access to preexposure prophylaxis (also known as PrEP), and ensure equitable access to services and support for those living with HIV,” notes the budget proposal. The investments by agency/program are detailed in the table below.
| Ending the HIV Epidemic Initiative Funding, FY2020-FY23 Enacted + FY24 President’s Budget (in USD Millions) | ||||||
| FY2020 | FY2021 | FY2022 | FY2023 | FY2024 | ||
| Enacted | Enacted | Enacted | Enacted | President's Request | Difference (Request vs FY23 Enacted) | |
| CDC Division of HIV Prevention | $140.00 | $175.00 | $195.00 | $220.00 | $310.00 | $90.00 |
| HRSA | ||||||
| Ryan White HIV/AIDS Program | $70.00 | $105.00 | $125.00 | $165.00 | $290.00 | $125.00 |
| Health Centers | $50.00 | $102.00 | $122.20 | $157.25 | $172.00 | $14.75 |
| Health Centers (rural TA) | $1.00 | $1.50 | $0.00 | $0.00 | $0.00 | $0.00 |
| IHS | $0.00 | $5.00 | $5.00 | $5.00 | $52.00 | $47.00 |
| NIH | $6.00 | $16.00 | $26.00 | $26.00 | $26.00 | $0.00 |
| SAMHSA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| HHS OASH OIDP | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| TOTAL | $267.00 | $404.50 | $473.20 | $573.25 | $850.00 | $276.75 |
Proposed National PrEP Program & Improved PrEP Access through Medicaid
The President’s FY24 budget also proposes new activities to expand access to and utilization of HIV pre-exposure prophylaxis (PrEP).
The budget proposes a new mandatory program to guarantee PrEP at no cost for all uninsured and underinsured individuals; provide essential wrap-around services through States, IHS, tribal entities, and localities; and establish a network of community providers to reach underserved areas and populations. According to additional details provided in the HHS FY24 budget justification, the “PrEP Delivery Program is designed to advance equitable access to HIV prevention by addressing many of these systemic barriers [to PrEP access and utilization] and supporting all components of PrEP service delivery. The program will provide access to PrEP medication and laboratory services at no cost for uninsured and underinsured individuals; eliminate costs for essential associated services; and greatly expand the network of PrEP providers supporting underserved communities.” The President has requested $237 million in FY24 to begin this multi-year program.
The FY24 budget also proposes to eliminate barriers to PrEP under Medicaid, requiring states to cover PrEP and associated laboratory services with no cost-sharing for Medicaid and CHIP beneficiaries. The proposal also places guardrails on utilization management practices, like prior authorization and step therapy, that can pose barriers to individuals’ access and utilization of PrEP. This proposal is projected to yield $10.2 billion in savings over 10 years.
Also of note, given the prevalence of HIV-hepatitis C coinfection, the President’s budget proposes a new mandatory spending proposal to support a national program to eliminate hepatitis C infections in the United States, with a specific focus on high-risk populations. “This program would support Federal procurement of life-saving treatments, while bolstering provider capacity and related public health efforts such as testing, communication, and surveillance,” the White House budget document states. The HHS Budget-in Brief adds, “This five-year program will increase access to curative medications, and expand implementation of complementary efforts such as screening, testing, and provider capacity. Implementation of the program will increase the number of people treated for hepatitis C, preventing severe illnesses, avoiding serious complications, and saving lives.”
Visit HIV.gov’s Federal HIV Budget and EHE Funding pages to learn more. You can also access the President’s budget here and find the HHS budget-in-brief and agency budgets here.