Federal HIV Budget

To continue progress toward ending the HIV epidemic, each year, the U.S. government invests billions of dollars to support HIV prevention, testing, care and treatment, and research initiatives in the U.S. and around the world.

Congress annually appropriates funds to Departments and agencies across the federal government that are designated to address HIV prevention, care, treatment, and research priorities. Each year, these agencies provide information to Congress and the public about how these dollars are spent. Additional information about the funding discussed below can be found on the budget pages of each agency's website.

Federal Domestic HIV/AIDS Programs & Research Spending

The U.S. government investment in the domestic response to HIV has risen to more than $28 billion per year, including both discretionary and mandatory spending. Discretionary spending levels are determined each year by Congress through the appropriations process.

In contrast, mandatory spending is required by existing laws and not dependent on annual Congressional appropriations. The laws establishing mandatory spending programs set eligibility rules and payment formulas. Mandatory spending includes spending for entitlement programs such as Social Security, Medicare, Medicaid, veterans’ benefits, and certain other payments to people, businesses, and state and local governments. Mandatory spending that supports HIV services includes Medicaid, Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and a few other programs providing health coverage and cash assistance.

The table below provides an overview of the Congressionally enacted budgets for domestic discretionary spending on HIV services and research in Fiscal Years (FY) 2021, 2022, 2023, 2024, and the President’s budget proposal for FY 2025. The U.S. government fiscal year runs from October 1 to September 30 each year. For information about federal funding supporting the Ending the HIV Epidemic in the U.S. (EHE) initiative, see Ending the HIV Epidemic Funding.

U.S. Federal Domestic Discretionary Funding for HIV/AIDS: FY 2021-2025 (proposed)
(in USD $ Millions)

^{NOTES: *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.}

FY 2025 President’s Budget Request

In addition to the discretionary funding levels indicated in the table above, the President’s FY 2025 budget also:

• eliminates barriers to accessing pre-exposure prophylaxis (PrEP) for Medicaid beneficiaries and proposes a new mandatory program to guarantee PrEP at no cost for all uninsured and underinsured individuals and provide essential wrap-around services with initial year funding of $213 million.
• invests in State and local efforts to promote equity and protect civil rights through a new $10 million Department of Justice grant program to support modernization of outdated state criminal statutes with a discriminatory impact on HIV-positive individuals.

HIV-Related Syndemic Funding

As noted in the National HIV/AIDS Strategy, a comprehensive response to HIV also addresses the set of linked health conditions, including viral hepatitis, sexually transmitted infections (STIs), and alcohol and substance use and mental health disorders that are part of a syndemic—the clustering and interaction of two or more diseases, impacted by social and structural determinants of health, that leads to excess burden of disease in a population. Federal agencies involved in funding work related to these syndemic conditions include:

• Bureau of Primary Health Care, HRSA
• Department of Veterans Affairs
• Division of Adolescent and School Health, CDC
• Division of STD Prevention, CDC
• Division of Viral Hepatitis, CDC
• Office of Population Affairs, HHS
• Substance Abuse and Mental Health Services Administration, HHS

U.S. Investment in the Global Response to HIV/AIDS

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of the more than 39 million individuals living with HIV/AIDS around the world. PEPFAR was launched in 2003 with strong bipartisan support sustained across four presidencies and 10 U.S. Congresses.

Through PEPFAR, the U.S. government has invested over $100 billion in the global HIV/AIDS response, the largest commitment by any nation to address a single disease in history, saving over 25 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/AIDS epidemic in more than 50 countries. For details on current and recent funding, view PEPFAR’s Results and Impact page. The PEPFAR Dashboards allow users to view and utilize PEPFAR planned funding, program results, and expenditure analysis data in an accessible and easy-to-use format.

PEPFAR is managed and overseen by the U.S. Department of State’s Bureau of Global Health Security and Diplomacy. PEPFAR leverages the power of a whole-of-government approach to controlling the global HIV/AIDS epidemic, implemented by seven other U.S. government departments and agencies: the U.S Agency for International Development; the U.S. Department of Health and Human Services and its agencies, including the Centers for Disease Control and Prevention, Health Resources and Service Administration and the National Institutes of Health; the U.S. Department of DefenseExit Disclaimer; the Peace Corps; the U.S. Department of Labor; the U.S. Department of Commerce; and the U.S. Department of the Treasury.