Domestic HIV Funding in the White House FY 2024 Budget Request

President Biden released his full FY 2024 budget request on March 9, 2023. The President’s third budget request builds on past efforts to address the domestic HIV response, including by proposing funding increases for the “Ending the HIV Epidemic” (EHE) initiative. In addition, this is the second year the budget proposes a new mandatory HIV prevention program aimed at expanding the use of pre-exposure prophylaxis (PrEP), a medication that prevents HIV for those at higher risk.

The request also includes discretionary funding1 for key programs aimed at addressing the domestic HIV epidemic, including at the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS and Health Center Programs, the National Institutes of Health (NIH), the Dept. of Housing and Urban Development’s Housing Opportunities for People with AIDS (HOPWA) Program, and the Indian Health Service (IHS) and marks the fifth year of budget requests for the EHE. Together, funding for these programs totals $7.4 billion, an increase of $333 million (5%) over the FY 2023 enacted level, if finalized. Funding for the EHE initiative totals $850 million, $277 million (48%) over the FY 2023 enacted level, if finalized.

Key budget highlights are as follows.

CDC – HIV prevention

The FY 2024 funding request for domestic HIV prevention at the CDC, which accounts for almost all federal funding for domestic HIV prevention, totals $1.2 billion, an increase of $142 million (14%) over the FY 2023 enacted level.

HRSA – Ryan White and Health Center HIV Funding

  • The Ryan White HIV/AIDS Program, the nation’s safety net for HIV care and treatment, receives $2.7 billion in the FY 2024 request, a $125 million (5%) increase over the FY 2023 enacted level. All of the increase is attributed to EHE activities; the EHE receives $290 million in the request, an increase of $125 million (76%) over the FY 2023 enacted level.
  • The FY 2024 budget request also includes HIV funding for the Health Center Program at HRSA, all of which is for the EHE initiative, totaling $172 million, a $15 million (10%) increase over the FY 2023 enacted level.

NIH – Domestic HIV Research

  • The National Institutes of Health (NIH) carries out almost all federally funded HIV research activities. In the FY 2024 budget request, domestic HIV research funding at NIH totaled $2.7 billion, a decrease of $1.3 million (<1%) over the FY 2023 enacted level.
  • Of that total, the agency received $26 million in EHE funding in the request which is the same as the FY 2023 enacted level.

Indian Health Service (IHS)

The FY 2024 budget request includes $52 million for EHE activities at the Indian Health Service (IHS), described in the budget justification as funding for the “Elimination of HIV, Hepatitis C, and Sexually Transmitted Infections.” This is a $47 million, or a nearly ten-fold increase, over the FY 2023 enacted level of $5 million.

Housing Opportunities for People with AIDS (HOPWA)

HOPWA is a program of the Department of Housing and Urban Development which provides housing assistance and supportive services to low-income people with HIV facing housing insecurity. The FY 2023 budget request includes $505 million, a $6 million (1%) increase over the FY 2023 enacted level.

Mandatory PrEP Program

In addition, for the second year in a row, the Budget proposes to create a new mandatory program that would provide PrEP to uninsured and underinsured people without cost-sharing. The program would aim to “expand access to PrEP and essential wraparound services for uninsured and underinsured individuals at high risk of HIV infections across the United States.” The proposed program would invest $237 million in FY 2024 and $9.8 billion in funding over a 10 year period.

The budget also calls on the Medicaid program, the largest payer for HIV care and treatment, to expand access to PrEP and associated services without cost sharing or utilization management for enrollees.

The tables below compare federal funding levels for domestic HIV, where specified, in the FY 2024 request to the FY 2023 enacted levels. Funding for the “Ending the HIV” Initiative is included in the overall table (Table 1) and in a dedicated table (Table 2). Funding for the new PrEP program is not included below as the following tables include discretionary funding only.

Table 1: FY 2023 Key Discretionary Accounts in the Domestic HIV Budget Request (in Millions),
FY 2024 Budget Request and FY 2023 Enacted
Agency/Program FY23 Enacted FY24 Request Difference: FY24 Request– FY23 Enacted
($)
Difference: FY24 Request– FY23 Enacted
(%)
CDC HIV Prevention $1,014 $1,156 $142 14%
   EHE (non-add) $220 $310 $90 41%
RWP 2,571 $2,696 $125 5%
   EHE (non-add) $165 $290 $125 76%
Health Centers (EHE Only) $157 $172 $15 10%
NIH (domestic HIV) $2,719 $2,717 $2 -0.05%
   EHE (non-add) $26 $26 $0 0%
HOPWA $499 $505 $6 1%
IHS (EHE Only) $5 $52 $47 940%
MAI $60 $60 $0 0%
Key Accounts Total

$7,025

$7,358 $333

5%

Table 2: FY 2023 Ending the  HIV Epidemic Budget Request (in Millions), FY 2024 Budget Request and FY 2023 Omnibus
Agency/Program FY23 Enacted FY24 Request Difference: FY24 Request– FY23 Enacted
($)
Difference: FY24 Request– FY23 Enacted
(%)
CDC $220 $310 $90 41%
HRSA
    RWP $165 $290 $125 76%
    Health Centers $157 $172 $15 10%
NIH $26 $26 $0 0%
IHS $5 $52 $47 940%
EHE Total $573 $850 $277 48%

 Key Documents:

Endnotes
  1. Funding for mandatory programs (e.g. Medicaid and Medicare), is determined by eligibility rules and cost of services, and is not dependent on Congressional appropriations and is not captured in this overview.

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