Federal HIV Budget
Funding for the Ending the HIV Epidemic Initiative
For information about Fiscal Year 2023 (FY 2023) HHS budget resources supporting implementation of the Ending the HIV Epidemic in the U.S. (EHE) initiative and the President’s funding request for FY 2024, see Ending the HIV Epidemic Funding.
Each year, the U.S. government spends billions of dollars to help people in the United States and countries around the world who have or are at risk for HIV.
By law, federal programs must provide information on how they spend the funds they receive. Transparency in government promotes accountability and provides meaningful access to information so that citizens can know what their government is doing and how federal dollars are being spent. Review the chart below for an overview of federal budget allocations for domestic HIV programs and research for Fiscal Years 2021-2023. For information about federal resources supporting the Ending the HIV Epidemic (EHE) initiative, see Ending the HIV Epidemic Funding.
Federal Domestic HIV/AIDS Programs & Research Spending
The U.S. government investment in the domestic response to HIV has risen to more than $28 billion per year, including discretionary spending as well as mandatory spending for Medicare, Medicaid, Social Security benefits, and other mandatory spending.
Funding for HIV services and activities is spread across multiple federal departments, including Health and Human Services (HHS), Housing and Urban Development (HUD), Justice, Veterans Affairs (VA), and Defense. Within HHS, in particular, responsibility for HIV programs and services is spread across multiple agencies including the Centers for Medicare & Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Indian Health Service (IHS), the Food and Drug Administration (FDA), the Office of Infectious Disease and HIV /AIDS Policy (OIDP), and others. Responsibility for HIV research is led by the National Institutes of Health (NIH); in addition, CDC, VA, Defense, and the United States Agency for International Development also support research initiatives. This distribution of responsibility is appropriate, as each agency has its own expertise and different agencies operate different programs with varying legislative mandates, purposes, and unique histories. (Read more about Federal agencies engaged in HIV activities.)
The table below summarizes the Congressionally enacted budgets for Fiscal Years (FY) 2021, 2022, and 2023 and the President’s budget proposal for FY 2024. The U.S. government fiscal year runs from October 1 to September 30 each year.
U.S. Federal Domestic Discretionary Funding for HIV/AIDS: FY 2021-2024 (proposed)
(in USD $ Millions)
|Program/Account||FY 2021||FY 2022||FY 2023||FY 2024|
CDC Domestic HIV Prevention
CDC Domestic HIV PreventionIncluding Ending the HIV Epidemic initiative (EHE)
HRSA Ryan White HIV/AIDS Program
HRSA Ryan White HIV/AIDS Program Including ADAP (AIDS Drug Assistance Program)
HRSA Ryan White HIV/AIDS Program Including EHE
HRSA Health Centers Program (only EHE funding)
Indian Health Service (only EHE funding)
NIH – AIDS research*
NIH – AIDS research* Including EHE
SAMHSA (all Minority AIDS Initiative)
HHS Minority HIV/AIDS Fund
HUD – Housing Opportunities for Persons With AIDS (HOPWA)
Subtotal: HIV Discretionary Spending
NOTES: *NIH does not define HIV research as “domestic” given its broad application; the figure listed is for all HIV research regardless of whether it is global or domestic.
FY 2024 President’s Budget Request
In addition to the discretionary funding figures listed in the table above, the President’s FY 2024 budget also reproposes mandatory spending on a Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (“PrEP Delivery Program”). The PrEP Delivery Program will provide PrEP and associated services at no cost to uninsured and underinsured individuals and expand the number of providers serving underserved communities. The President requests $237 million in FY 24 for the first year of this multi-year program. The budget also increases PrEP access for Medicaid and CHIP beneficiaries by requiring states to cover PrEP and associated laboratory services with no cost sharing, and places guardrails on utilization management practices like prior authorization and step therapy. Together these two proposals will produce net savings over 10 years while saving lives.
U.S. Investment in the Global Response to HIV/AIDS
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of the more than 37.7 million individuals living with HIV/AIDS around the world. PEPFAR was launched in 2003 with strong bipartisan support sustained across four presidencies and 10 U.S. Congresses.
Through PEPFAR, the U.S. government has invested over $100 billion in the global HIV/AIDS response, the largest commitment by any nation to address a single disease in history, saving over 25 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/AIDS epidemic in more than 50 countries. For details on current and recent funding, view PEPFAR’s Results and Impact page. The PEPFAR Dashboards allow users to view and utilize PEPFAR planned funding, program results, and expenditure analysis data in an accessible and easy-to-use format.