Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”
President Joe Biden on Oct. 14, 2023, in remarks on the 2023 Human Rights Campaign National Dinner.
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Are Republicans threatening to cease spending federal cash to finish one of many world’s most urgent public well being epidemics? That’s what President Joe Biden mentioned throughout a dinner hosted by an LGBTQ+ advocacy group.
“In the United States Congress, extreme MAGA Republicans are trying to undo virtually every bit of progress we’ve made,” Biden mentioned Oct. 14 on the Human Rights Campaign occasion. “They’re trying to wipe out federal funding to end the HIV epidemic.”
Programs to deal with HIV and combat its unfold have loved bipartisan funding assist lately, consultants mentioned, so Biden’s portrayal indicators a big departure.
When we requested the White House what Biden was referring to, it pointed us to experiences of funds suggestions from House Republicans that decision for big cuts to the Ending the HIV Epidemic initiative, a Trump administration-era program designed to cut back new HIV infections within the U.S., in addition to different applications.
The Senate Appropriations Committee handed a separate spending plan. The suggestions will probably be topic to negotiation because the House and Senate face a Nov. 17 deadline to move one other spending invoice.
We discovered that though Republicans are recommending vital cuts to HIV prevention efforts throughout quite a lot of public well being companies, the proposal retains core funding intact. Meanwhile, political variations are eroding bipartisan assist for world HIV-prevention funding.
Despite nice strides in prevention and therapy since HIV was first reported within the U.S. within the Eighties, HIV stays at epidemic ranges within the U.S. right now, with roughly 1.2 million folks residing with HIV and round 30,000 to 35,000 new infections annually. Experts mentioned instances are rising within the South and in rural areas, and new an infection statistics present it’s disproportionately affecting Black and Hispanic populations.
What Are the Proposed Cuts?
The AIDS Budget and Appropriations Coalition, a bunch of greater than 100 public well being advocacy organizations that monitor modifications in HIV-related federal spending, mentioned a majority of the proposed cuts to home HIV funding stem from House Republicans’ effort to eradicate the Ending the HIV Epidemic initiative.
The program began in 2019 with the purpose of decreasing new HIV infections within the U.S. by 75% by 2025 and 90% by 2030. The program to this point labored regionally, concentrating on areas which have the very best charges of HIV instances for funding.
In 2023, about $573 million was allotted for this system throughout varied companies, in line with KFF’s funding tracker.
- $220 million to the Centers for Disease Control and Prevention.
- $165 million to the Ryan White HIV/AIDS program. (It was named for a 13-year-old recognized with HIV in 1984 and is overseen by the Health Resources and Services Administration.)
- $5 million to the Indian Health Service.
- $26 million to the National Institutes of Health for analysis.
- $157.3 million to group well being facilities, which have handled round 200,000 HIV sufferers yearly.
The program lags its objectives because it approaches the 2025 benchmark. “It’s well designed, well planned, it has targets that makes sense,” mentioned Jeffrey Sturchio, a lead researcher on a Center for Strategic and International Studies report.
Sturchio mentioned the issue is just not a fault of design, however funding, including, “Congress has never fully funded the initiative.”
Sturchio pointed to a variety of native and state “bureaucratic hurdles.” Jurisdictions that have pulled collectively ample sources have seen “tremendous progress,” he mentioned, and total indicators appear to be shifting in the appropriate route.
But COVID-19 diminished HIV testing and will have diverted public well being efforts, CDC directors mentioned. KFF Health News reported in April that stakeholders noticed progress however anxious that it gained’t be sufficient to make the 2030 deadline.
Democrats seem to share this concern. The spending invoice proposed by the Democratic-controlled Senate Appropriations Committee maintained or barely elevated funding ranges to all HIV-related applications. The committee requested extra information about this system, describing its “lack of quantifiable data showing outcomes.”
The House has not but handed the invoice out of committee. We know of some proposed cuts from the invoice, which the Republican-led House Appropriations Subcommittee launched in July.
It outlines a $1.6 billion minimize to the CDC, together with a $220 million discount in “HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention” and a $238.5 million minimize from the Ryan White HIV/AIDS program. The Ryan White program supplies medical care and assist providers to low-income HIV sufferers and serves greater than half of these recognized within the U.S.
The invoice additionally proposes chopping funding to the Minority HIV/AIDS fund by greater than half — from $60 million to $28 million. According to HIV.gov, the fund helps prevention and care tasks concentrating on disparities that have an effect on communities of coloration.
Additional particulars about how these cuts might have an effect on applications are detailed in a committee report that has not been made public. PolitiFact and a few advocacy organizations obtained copies of the report, however the House Appropriations Committee didn’t reply to questions on it. The report we noticed really useful chopping all funding for the Ending the HIV Epidemic initiative.
And House Democrats, advocacy organizations, and KFF Health News have every reported that the Ryan White program and CDC cuts end result from a plan to eradicate the Ending the HIV Epidemic initiative.
“If they cut funding, it’s going to have a dramatic and draconian impact on the ability of all of the people who are working in these jurisdictions to improve public health,” mentioned Sturchio, the researcher.
Although the cuts could be dramatic, consultants mentioned, they’d not eradicate all home HIV funding.
“There is certainly a demonstration and a commitment to some of the core HIV programs, but there are millions of dollars of proposed cuts in other areas,” mentioned Lindsey Dawson, affiliate director for HIV coverage at KFF. “These cuts would have a meaningful impact on the ability of programs to provide lifesaving interventions for both HIV care and treatment, as well as prevention.”
The cuts would imply a 16% minimize to the CDC’s division of STD prevention, a 9% minimize to the Ryan White HIV/AIDS program, and a 53% minimize to the Minority HIV/AIDS Fund from fiscal 12 months 2023 to 2024.
These funding cuts are solely proposals. They require a vote from the complete appropriations committee and must move the House and be negotiated with a Democratic-controlled Senate.
“We’ve heard for a long time that HIV is a bipartisan issue. But what some people forget, is that that bipartisanship was hard fought for over the first decade of the HIV epidemic,” mentioned Dawson.
Other Challenges to HIV/AIDS Spending
The U.S. dedication to world HIV prevention, in the meantime, can also be beneath scrutiny. Rep. Chris Smith, R-N.J., challenged reauthorizing the President’s Emergency Plan for AIDS Relief, often known as PEPFAR, with out first making some modifications. Started in 2003 by President George W. Bush, the program distributes funds in additional than 50 international locations for HIV testing, prevention, therapy, and medicines. It additionally strengthens well being care methods to combat AIDS.
Funding for this system has grown over the previous 20 years, totaling greater than $110 billion. The program reported 25 million lives saved by medical intervention.
Smith, who chairs the House Foreign Affairs subcommittee on Global Health, has expressed considerations that cash is being given to nongovernmental organizations that assist abortion rights and entry.
U.S. legislation prohibits the direct use of abroad funding to supply abortions or to foyer for entry to abortions. This has been the case since 1973. However, organizations that obtain U.S. funding can achieve this with their very own non-U.S. funding.
An official from the State Department, which runs this system, confirmed to PolitiFact that PEPFAR is legally restricted from funding abortion or lobbying for abortion entry; the official cited the coaching of workers and companions and the monitoring of procedures to make sure compliance.
Other anti-abortion teams have favored a“Mexico City Policy,’‘ which has required international nongovernmental organizations to certify that they’d not carry out or promote abortion with funds from any supply to be eligible for U.S. authorities funding. Trump utilized the coverage to PEPFAR, however Biden rescinded it.
The failure to reauthorize PEPFAR wouldn’t eradicate this system, and Congress can proceed to fund this system with out reauthorization, but it surely might trigger some provisions to lapse over the following few years.
The lack of a reauthorization would have vital symbolic impression, mentioned Kellie Moss, KFF’s affiliate director of world well being and HIV coverage. “It could make the program more vulnerable during funding discussions without a clear signal of bipartisan support.”
Although reauthorization is being held up, funding has progressed. On Sept. 28, the House handed a State Department and Foreign Operations Appropriations invoice, which might fund PEPFAR for an additional 12 months however implement a Mexico City-like coverage provision on all world well being funding. This invoice would additionally prolong the lapsing provisions for an additional 12 months.
Our Ruling
Biden mentioned that Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”
A subcommittee of House Republicans has proposed chopping some HIV prevention applications anyplace from 53% to 9% in fiscal 2024, relying on this system.
A committee’s draft report cited by advocacy and coverage teams exhibits these cuts stem from the elimination of the Trump-era Ending the HIV Epidemic initiative, though the committee didn’t reply to questions on that.
Taken collectively, these cuts wouldn’t eradicate — or “wipe out” — all federal home HIV spending, however they do characterize a big minimize.
Meanwhile, the House has not moved forward to reauthorize PEPFAR, which provides U.S. {dollars} for world HIV prevention, over Republican considerations about the place organizations that obtain the cash stand on abortion entry. But the House has handed one 12 months of PEPFAR funding with some circumstances about how it’s distributed, which it might do with out reauthorizing this system.
Biden’s assertion is partially correct in that vital funding cuts have been proposed by House Republicans, however he exaggerates by saying these efforts would “wipe out” federal funding.
We price this declare Half True.
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(KFF Health News, previously referred to as Kaiser Health News (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications of KFF — the unbiased supply for well being coverage analysis, polling and journalism.)
©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.
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