President Biden released his full FY 2022 budget request to Congress on May 28, 2021 (an initial topline discretionary FY 2022 budget proposal was released on April 9, 2021). The President’s first budget request builds on past efforts to address the domestic HIV response, including the “Ending the HIV Epidemic” (EHE) initiative. The EHE, established by the Trump Administration, was accompanied by the first significant increases in federal HIV funding in decades. President Biden also requests an increase for the EHE, which accounts for most of the increase in discretionary funding for HIV and would be the biggest increase for the initiative to date.
The request includes discretionary funding 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 third year of appropriations requests for the EHE. Overall, funding for these programs totals $6.73 billion, an increase of $330.8 million (5%) over the FY 2021 enacted level. Funding specifically targeted towards the EHE initiative totaled $670 million, $265 million (66%) over the FY 2021 enacted level. 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 therefore is not captured in this overview.
Key budget highlights are as follows. Details on additional funding in other departments/agencies will be provided, when available.
CDC – HIV prevention
FY 2022 funding for domestic HIV prevention at the CDC, which accounts for almost all federal funding for domestic HIV prevention, totals $1.06 billion in the request, an increase of $100 million (10%) over the FY 2021 enacted level. The FY 2022 increase is all attributed to the EHE.
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 $2.55 billion in the FY 2022 request, a $131 million (5%) increase over the FY 2021 enacted level. Most of the increase (65%) is attributed to EHE activities; the EHE receives $190 million in the request, an increase of $85 million (81%) over the FY 2021 enacted level. Additionally, several “parts” of the Ryan White Program also received increases in the request including, Parts A , B, and C.
- The FY 2022 budget request also includes HIV funding for the Health Center Program at HRSA, all of which is for the EHE initiative, totaling $152 million, a $50 million (49%) increase over the FY 2021 enacted level.
- In past years, a small amount of EHE funding was also allocated to technical assistance within health centers for rural health. This amount totaled $1 million in FY2020 and $1.5 million in FY2021. The amount in the FY 2022 request is not yet known.
NIH – Domestic HIV Research
- The National Institutes of Health (NIH) carries out almost all federally funded HIV research activities. In the FY 2022 budget request, domestic HIV research funding at NIH totaled $2.48 billion, which if finalized, would be an increase of $10 million (0.4%) over the FY 2021 enacted level.
- Of that total, the agency received $26 million in EHE funding in the request. If finalized, NIH EHE funding in the FY 2022 request would be an increase of $10 million (63%) over the FY 2021 enacted level.
- The FY 2022 budget request includes $27 million for EHE activities at the Indian Health Service (IHS), $22 million, or a more than four-fold increase, over the FY21 enacted level of $5 million.
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 2022 budget request includes $450 million, a $20 million (5%) increase over the FY 2021 enacted level.
The tables below compare federal funding levels for domestic HIV, where specified, in the FY 2022 request to the FY 2021 enacted levels. Funding for the “Ending the HIV” Initiative is included in the overall table (Table 1) and in a dedicated table (Table 2).
|Agency/Program||FY21 Enacted||FY22 Request||Difference: FY22 Request– FY21 Enacted|
|CDC – HIV Prevention||$964.712||$1,064.712||10.4%|
|Of which EHE||$175.00||$275.000||57.1%|
|Of which EHE||$105.000||190.000||81.0%|
|Community Health Centers (EHE Only)||$102.25||152.000||48.7%|
|Health Centers (EHE Rural Health TA)||$1.500||NA||NA|
|NIH – Domestic HIV Research||$2,473.290||$2,482.887||0.4%|
|Of which EHE||$16.000||$26.000||62.5%|
|HUD – HOPWA||$430.000||$450.000||4.7%|
|IHS (EHE Only)||$5.000||$27.000||440.0%|
|Key Accounts Total||$6,400.533||$6,731.380||5.2%|
|FY21 Enacted||FY22 Request||Difference: FY22 Request– FY21 Enacted|
|Community Health Centers||$102.250||152.000||49%|
|Health Centers (Rural Health TA)||$1.500||NA||NA|