Testimony of AIDS United CEO Jesse Milan, Jr. on Fiscal Year 2020 HIV Appropriations

April 9, 2019

AIDS United Fiscal Year 2020 Testimony prepared for the House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies

As the Committee begins its important deliberations on the Fiscal Year (FY) 2020 Labor, Health and Human Services, Education and Related Agencies appropriations bill, we thank you for your continued commitment to addressing HIV/AIDS in the United States and we ask that you maintain the federal government’s commitment to safety net programs that protect the public health.

In his recent State of the Union address, President Trump challenged this Congress and the nation to end the domestic HIV epidemic by 2030. Secretary Azar championed this auspicious goal through the Department of Health and Human Service’s FY 2020 budget request, which calls for $291 million in increased funding for HIV prevention, care, and treatment to the domestic HIV/AIDS portfolio. We are encouraged by the Administration’s increased funding request for the Ryan White HIV/AIDS Program, HIV prevention programs at the Centers for Disease Control and Prevention (CDC), and HRSA’s Community Health Centers Program and urge the Committee to build upon these proposed funding increases in your FY 2020 appropriations. We appreciate the call for increased funding after years of flat funding for these vital programs. However, we also encourage you to align with the Administration’s stated goal to end the epidemic by providing adequate funding for AIDS research at the National Institutes of health (NIH) and maintaining the federal government’s commitment to safety net programs that protect public health in FY 2020.

We have a unique opportunity to make history. For the first time since the CDC originally reported a few HIV cases in its Morbidity and Mortality Weekly Report 38 years ago, we are able to end the HIV epidemic the United States. Scientific advances and groundbreaking HIV research have shown us that it is not only possible for people to live long, healthy lives with HIV, but that people on antiretroviral medication that have achieved an undetectable viral load cannot transmit the virus to others. Period. This knowledge alone, however, will not affect the change we need.

Over one million Americans are living with HIV, and annual HIV diagnoses continue to hover around 40,000 new HIV transmissions each year due in part to increases in injection drug use across the country that are resulting in new HIV outbreaks, especially in areas with scarce public health resources. It is only through significant federal investment in the following programs and an unyielding commitment to providing access to the support services needed to ensure populations impacted by HIV adhere to their care and treatment that we will be able to end the HIV epidemic:

The Ryan White HIV/AIDS Program

The Ryan White HIV/AIDS Program, a payer of last resort, provides medications, medical care, and essential coverage completion services to almost 550,000 low-income, uninsured, and/or underinsured individuals living with HIV. Viral suppression, and the preventive benefits thereof, are only possible if an individual is in care and on treatment. Over 85 percent of Ryan White clients have achieved viral suppression, compared to just 49 percent of people living with HIV nationwide. This is achieved through clients’ access to the high-quality, patient-centered, comprehensive care that the Ryan White Program provides, which enables clients to remain in care and on treatment.

The Ryan White Program continues to serve populations that are disproportionally impacted by HIV, including racial and ethnic minorities, who make up three-quarters of the program’s clients. Almost two-thirds are living at or below the federal poverty level. To improve the continuum of care and advance our goal of ending the epidemic, sustained funding for all parts of the Ryan White Program is critically important to ensure that people living with HIV have uninterrupted access to health care, medications, and services.

Funding for the Ryan White Program is critical to improving health coverage and outcomes for people living with HIV. Therefore, we urge you to fund the Ryan White Program at a total of $2.535 billion in FY 2020, including the $70 million of new funding in the President’s Budget Request (refer to attached chart for more detailed funding allocation requests).

Prevention – CDC HIV & STD Prevention and Surveillance

There has been incredible progress in the fight against HIV/AIDS and other sexually transmitted diseases (STDs) over the last 30 years. Because of the efforts by CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) and its grantees, hundreds of thousands of new infections have been averted and billions of dollars in treatment costs have been saved. This confirms that STD prevention efforts can work, but STD rates continue to rise at historic levels. Through expanded HIV testing efforts, largely funded by the CDC, the number of people who are aware of their HIV status has increased, but 15 percent of all people living with HIV do not know their status.

AIDS United is pleased that the CDC has targeted funds to fight HIV among gay and bisexual men and transgender people, including funding for pre-exposure prophylaxis (PrEP) – a highly effective prevention tool for people who are HIV-negative – plus ongoing medical care and antiretroviral treatment for people living with HIV. While we are making progress in decreasing transmissions among some women, women of color are still disproportionately affected: Black women accounted for 61 percent of all women infected in 2016, and the HIV diagnosis rate among Latinas in 2015 was more than three times that of white women.

Despite dramatic increases in STDs in recent years, funding for the CDC’s STD prevention programs has not increased since 2003, leaving health departments overwhelmed and understaffed. Ending HIV must take a multifaceted approach. Increased funding for CDC’s STD prevention programs will support testing, targeted prevention interventions, public education campaigns, and surveillance activities that support both HIV and STD Prevention outcomes. This funding supports a combination of effective evidence-based approaches including testing, linkage to care, condoms, syringe service programs, and access to PrEP.

For FY 2020, we urge you to fund the CDC Division of HIV prevention and surveillance at $822.7 million, the CDC’s STD division to $227.3 million, and, in accordance with the Administration’s Ending the Epidemic initiative, CDC testing and connection to preventative services programs at $140 million.

HIV/AIDS Research at the National Institutes of Health

U.S. leadership in the global response to HIV/AIDS, particularly in research, is essential and irreplaceable; we must invest adequate resources in HIV research at the NIH. Research supported by the NIH is far-reaching and has supported advances in science as well as innovations that have led to better drug therapies and behavioral & biomedical prevention interventions well beyond HIV itself, saving the lives of millions. Specifically, NIH support proved the efficacy of PrEP, and funding from the Institutes made it possible to learn the effectiveness of treatment as prevention and has gotten us closer than ever before to identifying an effective HIV vaccine. We are appreciative of the Committee’s bipartisan support of funding increases for the NIH over the course of this epidemic and urge you to direct some of these resources to continued HIV/AIDS research so that more effective HIV treatments and ultimately a cure can be realized.

We request that HIV research at the NIH receive a total of $3.45 billion in FY 2020.

Addressing the Infectious Disease Consequences of the Opioid Epidemic

AIDS United strongly urges the Committee to remove all restrictions on federal funds for syringe services programs, particularly in jurisdictions experiencing or at risk for HIV or viral hepatitis outbreaks associated with injection drug use. People with HIV in the United States are often affected by chronic viral hepatitis; about one-third are coinfected with either hepatitis B (HBV) or C (HCV). Over the last several years, the opioid crisis has led to concerning numbers of new infections tied to injection drug use, resulting in nearly 55,000 new hepatitis cases each year. In fact, HCV is now responsible for more deaths annually than all other reportable infectious diseases combined.

The CDC has identified 220 counties that are most vulnerable to outbreaks of HCV and HIV related to injection drug use, representing only the top 5 percent of vulnerable counties overall. At present, more than 93 percent of those 220 counties vulnerable to HIV/HCV outbreaks do not have comprehensive syringe service programs. Over the past thirty years, the CDC has collected compelling evidence of syringe services programs’ effectiveness. Syringe services programs increase access to comprehensive resources such as HIV and hepatitis testing and linkage to treatment, referral to substance use treatment and assistance, behavioral health services, primary care, overdose treatment and education, hepatitis A and B vaccinations, and other ancillary services. Syringe services programs are recommended by AIDS United as a key component of the Department of Health and Human Service’s response to the opioid crisis in CDC, HRSA, and SAMHSA appropriations, and as an indispensable tool in any effort to end the domestic HIV and viral hepatitis epidemics.

AIDS United urges the Committee to increase funding for the CDC Division of Viral Hepatitis activities to $134 million
to ensure appropriate levels of testing, education, screening and linkage to care.

AIDS United looks forward to a positive outcome for the funding request for HIV/AIDS domestic programs that will enable us to end the HIV epidemic in the United States. We thank you for your continued leadership and support of these critical programs for so many people living with HIV, and the organizations and communities that serve them nationwide.