Ending the HIV Epidemic Funding

In 2024: Requested $593 Million in FY2025 to Support Continuation of the Ending the HIV Epidemic Initiative

On March 11, 2024, the Administration published the Fiscal Year (FY) 2025 budget proposal, which includes $593 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 $20 million increase over the FY23 enacted funding level.

The specific funding amounts proposed by agency are:

• $220 million for the Centers for Disease Control and Prevention (CDC)
• $332 million for the Health Resources and Services Administration (HRSA)
  • $175 million to deliver HIV care through HRSA’s Ryan White HIV/AIDS Program (RWHAP)
  • $157 million to provide HIV testing, linkage to care, and prescription of HIV PrEP and associated medical costs through HRSA’s Health Center Program
• $15 million to the Indian Health Service (IHS) for an initiative to treat or reduce the transmission of HIV and HCV
• $26 million for the National Institutes of Health (NIH) for implementation research projects in the EHE jurisdictions

Fiscal Year 2024 HHS Budget Resources for the Ending the HIV Epidemic Initiative

In late March 2023, the FY 2024 federal budget for October 1, 2023–September 30, 2024 was signed, which included a total of $573.25 million for implementation of the Ending the HIV Epidemic in the U.S. (EHE) initiative. These funds included:

• $220 million for CDC to implement high impact HIV prevention and reduce new HIV infections.
• $322.25 million for HRSA:
  • $165 million to deliver HIV care through the Ryan White HIV/AIDS Program
  • $157.25 million to expand access to HIV testing, linkage to care, and prescription of HIV PrEP and associated services through the Health Center Program.
• $5 million to the IHS for diagnosis, prevention, and treatment initiatives for HIV, HCV, and STIs with the stipulation that the funds shall be used at the discretion of the Director of the IHS and remain available until expended.
• $26 million for NIH for implementation research projects in the EHE jurisdictions.

The FY 2024 total appropriation was less than the $850 million requested in the Administration's FY 2024 budget proposal to support continued scale-up and implementation of the EHE initiative.

With the appropriated resources, the following FY 2024 funding awards were made:

• CDC awarded more than $126 million to state and local health departments in the 57 EHE jurisdictions to continue expanding HIV prevention and treatment efforts. This funding was awarded through the High-Impact HIV Prevention and Surveillance Programs for Health Departments (PS24-0047) program to provide disproportionately affected communities with additional expertise and resources to address the HIV epidemic locally. The funding will support expansion of HIV testing; linkage to treatment; HIV prevention approaches including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) efforts; and detection and outbreak response capacity. Funding was also awarded through the Support and Scale Up of HIV Prevention Services in Sexual Health Clinics (PS24-0003) for PrEP provision, staff training, and to provide prevention, treatment, and care for syndemic infections, which include HIV and other sexually transmitted infections. Additional EHE funding supported external investments with national and community-based organizations to increase access to HIV-related services for critical populations including the expansion of HIV self-testing, the implementation of syndemic approaches, enhanced PrEP implementation, and provision of additional capacity building assistance for EHE jurisdictions. EHE resources also helped provide essential support to rapidly detect, evaluate, and respond to HIV clusters and outbreaks in EHE jurisdictions.
• HRSA’s Bureau of Primary Health Care (BPHC) awarded more than $157 million in continuation funding to over 400 health centers in EHE jurisdictions to expand prevention services to reduce HIV transmission risk, including HIV PrEP prescribing and management, HIV testing, patient outreach, care coordination, and associated services through the Health Center Program. Continuation funding was provided to health centers whose work in EHE jurisdictions began in FY 2020, FY 2021, FY 2022, and FY 2023.
• IHS awarded $1.2 million in three-year cooperative agreements to seven tribal/urban Indian organizations to support work toward eliminating the syndemic of HIV, hepatitis C, and STIs in Indian Country. This cooperative agreement program, called Ending the HIV Epidemic in Indian Country (or ETHIC), enabled first-year awardees to increase HIV/HCV/STI testing in their communities, increase timely linkage to care, and attend HIV syndemic-related training to enhance knowledge of current best practices. Year two showed tremendous growth and development of the grantees’ syndemic programs, with increases in testing, screening, diagnosing, linkage to care, and treatment of syndemic conditions. The early successes of ETHIC led IHS to offer another funding opportunity for FY 2025, called ETHIC II with additional funding and up to 15 additional grantees. In addition, in FY 2024, with EHE funds, the IHS created the HIV/HCV/STI Branch within the Office of Clinical and Preventive Services at IHS Headquarters, hired a data analyst, a clinical nurse, a public health nurse/Great Plains Area Syndemic Coordinator, a management analyst, and two pharmacists. Finally, with EHE funds, the IHS offered targeted funding to federally-operated sites called Special Projects of National Significance to help with HIV/HCV/STI diagnosis, treatment, prevention, and response.
• NIH made 12 new awards and continued support for 59 projects in their second year of funding, totaling $26 million for EHE-focused research awards*. The funding supports research projects in 41 of the EHE priority jurisdictions to strengthen research-community collaborations and enhance the implementation science knowledge base to end the HIV epidemic. It also includes support for coordination centers and regional consultation hubs. The research projects involve partnerships between investigators and local health officials and community groups in one or more EHE jurisdictions.

Visit the EHE Timeline for highlights of other activities that have taken place since the initiative began. To learn about prior fiscal year funding, please click here.

Ending the HIV Epidemic in the U.S.
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