Strengthening the Economy for Those Living With HIV/AIDS and Fighting the HIV/AIDS Epidemic
The President’s Fiscal Year 2014 Budget demonstrates that we can make critical investments to strengthen the middle class, create jobs, and grow the economy while continuing to cut the deficit in a balanced way.
The President believes we must invest in the true engine of America’s economic growth – a rising and thriving middle class. He is focused on addressing three fundamental questions: How do we attract more jobs to our shores? How do we equip our people with the skills needed to do the jobs of the 21st Century? How do we make sure hard work leads to a decent living? The Budget presents the President’s plan to address each of these questions.
To make America once again a magnet for jobs, the Budget invests in high-tech manufacturing and innovation, clean energy, and infrastructure, while cutting red tape to help businesses grow. To give workers the skills they need to compete in the global economy, it invests in education from pre-school to job training. To ensure hard work is rewarded, it raises the minimum wage to $9 an hour so a hard day’s work pays more.
The Budget does all of these things as part of a comprehensive plan that reduces the deficit and puts the Nation on a sound fiscal course. Every new initiative in the plan is fully paid for, so they do not add a single dime to the deficit. The Budget also incorporates the President’s compromise offer to House Speaker Boehner to achieve another $1.8 trillion in deficit reduction in a balanced way. When combined with the deficit reduction already achieved, this will allow us to exceed the goal of $4 trillion in deficit reduction, while growing the economy and strengthening the middle class. By including this compromise proposal in the Budget, the President is demonstrating his willingness to make tough choices and his seriousness about finding common ground to further reduce the deficit.
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The 2014 Budget also aligns with the President’s commitment to reaching an AIDS-free generation. To advance this goal in the U.S. and around the world, the Budget will:
Continue to Support the National HIV/AIDS Strategy (NHAS) and Expand Investments in Prevention, Care, and Research. The Budget expands access to HIV/AIDS prevention and treatment activities and supports the goals of the National HIV/AIDS Strategy to reduce HIV incidence; increase access to care and optimize health outcomes for people living with HIV; and reduce HIV-related health disparities. By providing resources for Affordable Care Act implementation, the Budget will support increased health care coverage for thousands of people living with HIV/AIDS and expand access to HIV testing for millions of Americans. The Budget makes smarter investments by prioritizing HIV/AIDS resources within high-burden communities and among high-risk groups, including gay men, black Americans and Latino Americans. Compared to 2012, the Budget increases domestic discretionary Health and Human Services (HHS) HIV/AIDS funding by $73 million and Veterans Affairs (VA) HIV/AIDS funding by $155 million. Overall, total U.S. Government-wide spending on HIV/AIDS increases from $27.8 billion in FY 2012 to $29.7 billion in the FY 2014 Budget.
Support the Ryan White HIV/AIDS Program. The Budget includes an increase of $20 million for care and treatment through the Ryan White HIV/AIDS Program. The Budget includes $943 million for AIDS drug assistance programs, an increase of $10 million above FY 2012 to ensure that individuals living with HIV have access to and remain on their antiretroviral (ARV) treatments. The Budget also increases funding for the Ryan White Part C program by $10 million above FY 2012 to expand access to care and improve systems for linking people to and retaining them in care and on their ARV medications over time. By helping people living with HIV remain in care and on their medications, the Ryan White program plays a critical role in preventing the spread of the HIV epidemic, as recent research has shown that ARV treatment reduces HIV transmission by 96 percent.
Increase Funding for HIV/AIDS Prevention and Service Integration. The Budget includes $833 million, an increase of $10 million for the Centers for Disease Control and Prevention (CDC) to continue implementing the goals of the National HIV/AIDS Strategy by preventing HIV/AIDS among high-risk communities using evidence-based interventions. The Budget redirects $40 million from less effective activities to support a new $40 million Community High-Impact Prevention initiative to improve systems that link persons recently diagnosed with HIV to care. The Budget also increases funding for data collection by $10 million to improve timeliness of data and invests $10 million to build the infrastructure and capacity that State Public Health Departments and community-based organizations will need to bill private insurers for infectious disease testing.
Support Research at the National Institutes of Health (NIH). To address critical AIDS research priorities, the FY 2014 President’s Budget request for the trans-NIH AIDS research is $3.12 billion, an increase of $48 million above the FY 2012 level. This FY 2014 request reflects several shifts of funds to address the many new and exciting scientific opportunities in AIDS research, including etiology and pathogenesis that provides the underlying foundation for all HIV research; development of vaccines and microbicides; and new and innovative approaches for research toward a cure.
Support Housing Assistance for People Living with HIV/AIDS. The Budget includes $332 million for the Department of Housing and Urban Development’s Housing Opportunities for Persons with AIDS (HOPWA) program, to address housing needs among people living with HIV/AIDS and their families. The program is designed to provide States and localities with the resources to create comprehensive strategies for providing housing assistance that gives patients the stability needed for effective treatment. However, the existing formula for distributing HOPWA funds does not reflect the current nature of the epidemic. To modernize the HOPWA program, the Administration is proposing an updated formula based on cases of people living with HIV and adjusted for an area’s fair market rent and poverty rates, focusing HOPWA on the areas with the most need. The proposal will also include several changes that will allow better targeting of HOPWA resources and more flexibility for grantees to provide the most cost-effective, timely interventions. These changes, which will be proposed in subsequent authorizing legislation, will improve the Nation’s response to the specialized housing needs of HIV/AIDS patients.
Increase Support for Our Veterans Living with HIV/AIDS. The Budget includes $1.1 billion within the Department of Veterans Affairs (VA), a 16 percent above the 2012 level, to ensure that veterans living with HIV and AIDS receive high quality, comprehensive clinical care, including diagnosis of their infection and timely linkage to medical care. VA also promotes evidence-based HIV prevention services and is implementing its plan to meet the goals outlined in the President’s National HIV/AIDS Strategy.
Fight HIV/AIDS Related Stigma and Discrimination. To strengthen civil rights enforcement against racial, ethnic, sexual orientation, religious, and gender discrimination, the Budget includes a 7.4 percent increase in funding above the 2012 level to the Department of Justice’s Civil Rights Division. This investment will help the Division handle enforcement of civil rights protections for people living with HIV/AIDS.
Support the President’s Ambitious Goals for Global AIDS. On World AIDS Day 2011, the President announced ambitious new targets for the prevention and treatment of HIV/AIDS that will bring us closer to the goal of an AIDS-free generation. Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the Budget request of $6.0 billion for global AIDS supports focused investments on proven methods to prevent new HIV infections, including supporting voluntary medical male circumcision, preventing mother-to-child transmission, and expanding access to condoms. In addition, PEPFAR is on track to reach the President’s goal of supporting 6 million patients on antiretroviral treatment (ART) in 2013, and will continue to expand access to ART in 2014. These accomplishments are possible in a constrained budget environment due to the strong programmatic foundation that the U.S. has built under Presidents Bush and Obama, and relentless work to bring down costs and find efficiencies. The per-patient cost to the U.S. of providing antiretroviral treatment has fallen by over 50 percent since 2008 because PEPFAR has invested carefully, tailoring prevention to countries’ urgent needs, using generic drugs, shipping more efficiently, and linking PEPFAR to other needed health services.
Support and Leverage Funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria. The U.S. is delivering on our historic 3 year, $4 billion pledge to the Global Fund, which has helped leverage approximately $6 billion in contributions from other donors. PEPFAR and the Global Fund financed programs are complementary and deeply intertwined in countries where both exist. Better program coordination, decreased costs, and greater efficiencies between Global Fund and U.S. investments are helping to increase coverage of essential HIV services and save more lives. Over the last year and with our partners, the U.S. has driven an ambitious reform agenda at the Global Fund, including a comprehensive overhaul of the Fund's management, funding model and fiduciary oversight systems. This year’s $1.65 billion contribution to the Global Fund marks our continued strong support for reforms and challenges other donors to match the U.S. contribution 2-to-1 during the Global Fund’s replenishment.