President Biden’s FY24 budget proposal shows promise for HIV advocates

The Biden administration released its proposed 2024 budget on Thursday. And while there are details still to be released, we wanted to provide an initial breakdown and what it would mean for HIV advocacy if it were to pass.

Taken as a whole, the proposal is encouraging, but far from perfect. While the proposed budget included funding for several pivotal programs, such as Ending the HIV Epidemic efforts, a PrEP program, and a new national hepatitis C elimination program, it fell short of many of the HIV community’s other priorities, including for the Housing Opportunities for People With HIV/AIDS program and the Minority HIV/AIDS Fund.

Ending the HIV Epidemic Initiative

The Ending the HIV Epidemic Initiative is crucial to achieving health equity and for expanding health care to the communities who need it most.

Reducing new HIV cases, increasing access to preexposure prophylaxis, or PrEP (a medication that prevents HIV), and ensuring equitable access to services and support for those living with HIV align directly with the Biden administration’s commitment to ending the HIV epidemic. We were pleased to see the administration propose funding this initiative at $850 million, a $227 million increase over the 2023 budget.

The bulk of those proposed increases come from initiative funding of both the Ryan White HIV/AIDS Program (a $125 million increase) and the Centers for Disease Control and Prevention (a $90 million increase). Modest increases were also proposed for the Indian Health Service ($47 million) and community health centers ($15 million).

Unfortunately, the proposal provided no increases for core Ryan White funding. Given the rate of inflation, this would represent a sizable cut to Ryan White funding in real terms.

The proposal calls for a $153 million increase in the HIV, viral hepatitis, sexually transmitted infection and tuberculosis prevention line of the CDC budget. With that being said, $90 million of that increase would go toward CDC Ending the HIV Epidemic Initiative funding, leaving $63 million for the other divisions, and we don’t know how that would be broken down.

National PrEP and hepatitis C programs

Biden’s proposal would invest in the treatment and prevention of infectious diseases, including hepatitis C and HIV, by supporting comprehensive programs that would expand access to care and medications.

The proposed budget re-proposes the creation of a National PrEP Program — which they are calling The PrEP Delivery Program — to the tune of $9.6 billion in mandatory spending over 10 years. The program would guarantee PrEP at no cost for all uninsured and underinsured people and eliminate barriers to accessing PrEP for Medicaid beneficiaries. The program would provide essential wrap-around services through states and localities and establish a network of community providers to reach underserved areas and populations.

The budget proposal also includes a new, five-year, $11 billion Hepatitis C elimination program, which would significantly expand screening, testing, treatment, prevention and monitoring of Hepatitis C, with a specific focus on populations with high infection levels. This program would support the procurement of lifesaving treatments, all while strengthening provider capacity and related public health efforts, including testing, communication and surveillance.

These funds would be a timely and important investment in public health infrastructure and prevention more broadly, especially given the setbacks created by mpox and COVID-19. These national Hepatitis C and PrEP programs would allow us to address any gaps or barriers and improve access to prevention services.

We praise the administration’s investment in the efforts, and we hope to contribute to upcoming conversations about making this ambitious budget ask a reality.

Housing Opportunities for People with AIDS Program

One of the biggest disappointments with the proposed budget was the lack of support for the HOPWA program. The proposal included $505 million for HOPWA, a $6 million increase over what Congress appropriated for the program this year. This amount wouldn’t even cover the cost of inflation.

Coming in the wake of a similarly small increase in the president’s 2023 budget proposal, HIV advocates might rightly wonder why the Biden administration is consistently failing to support HOPWA. Given the overwhelming evidence that housing status is one of the strongest predictors of health care outcomes for people living with HIV, we would expect a greater investment in the HOPWA program.

Harm reduction

There is good news concerning harm reduction in the proposed budget. While we don’t know what, if any, increases were proposed for the CDC’s opioid-related infectious diseases line, we do know that the Biden administration has proposed a $50 million investment in funding for harm reduction organizations through the Substance Abuse and Mental Health Services Administration, using the same first-of-its-kind harm reduction funding initiative that was part of the American Rescue Plan Act.

Minority HIV/AIDS Fund

The Minority AIDS Initiative is an incredible program that is actively changing HIV prevention, care and treatment for communities of color by bringing together federal, state and community organizations to create solutions for emerging needs.

The budget proposal, unfortunately, would flat fund this innovative program at $60 million.

We must significantly increase funding for the Minority AIDS Initiative. Doing so will expand access to high-quality HIV services and reduce disparities in health outcomes in Black, Brown, and Indigenous communities.

Sexual and reproductive health

Since its creation in 1970, Title X has been the only federal program dedicated to providing family planning services and affordable birth control for people with low incomes. Title X was created to ensure that millions of people get the care they need.

The proposal would fund the program at $512 million, which would represent a $225.5 million increase after years of flat funding. If enacted, this would increase the number of patients served to 4.5 million. This proposal is especially encouraging in the light of the impact of the reversal of Roe.

What’s next?

The president’s budget is only a proposal. Various committees in Congress will meet in the coming weeks to create their own budgets. They will use the president’s proposal as a guide to see what Biden’s policy priorities are. The budgets that come through Congress will likely be very different.

That’s why congressional advocacy, like what will happen at AIDSWatch, is so important. AIDSWatch is the largest and most influential HIV advocacy event in the country. Hundreds of advocates will be in Washington, D.C., March 19-21, to meet with members of Congress and their staff. We will tell our stories and push for the funding and policies we know are necessary to end the HIV epidemic.

If you register by March 13, we can schedule these congressional meetings on your behalf.

We must continue to protect and advocate for funding to programs that provide life-saving treatment, resources and services for those of us living with and vulnerable to HIV in Congress’ 2024 budget to remain on target to end the HIV epidemic by 2030.