Order Code RL30731
CRS Report for Congress
Received through the CRS Web
AIDS Funding for Federal Government Programs:
FY1981-FY2005
Updated April 21, 2004
Judith A. Johnson
Specialist in Life Sciences
Domestic Social Policy Division
Sharon Coleman
Technical Information Specialist
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress

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AIDS Funding for Federal Government Programs:
FY1981-FY2005
Summary
Federal government AIDS spending is estimated at $18.5 billion in FY2004:
63% is for treatment programs; research receives 16%; income support programs
receive 9%; and, prevention programs receive 12%. The government-wide request
level for FY2005 is $19.8 billion. AIDS programs within the Department of Health
and Human Services (HHS) account for 77% of the total amount spent on HIV/AIDS
by the federal government. Funding for HIV/AIDS research, prevention and
treatment programs within the HHS discretionary budget has increased from
$200,000 in FY1981 to an estimated $6.3 billion in FY2004; the Administration’s
request for FY2005 is $6.4 billion. Funding for HIV/AIDS treatment within HHS
entitlement programs has increased from $10 million in FY1983 to an estimated $8
billion in FY2004. Entitlement spending depends on the number of HIV/AIDS cases
that qualify; the estimate for FY2005 is $8.6 billion for HIV/AIDS treatment within
HHS entitlement programs.

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Contents
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
HHS Discretionary Funding: NIH, CDC, and HRSA . . . . . . . . . . . . . . . . . . 3
NIH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CDC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
HRSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
HHS Entitlement Funding: Medicaid and Medicare at CMS . . . . . . . . . . . . 4
Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Funding for Other AIDS Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Ricky Ray Hemophilia Relief Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
HIV/AIDS Minority Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
International HIV/AIDS Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
List of Figures
Figure 1. Estimated Total Federal Spending on HIV/AIDS by Function,
FY2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Figure 2. Estimated Total Federal Spending on HIV/AIDS, FY2004 . . . . . . . . . 2
Figure 3. Estimated Federal Government Spending On HIV/AIDS
Treatment, FY2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Figure 4. HHS Spending on HIV/AIDS Programs . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 5. HHS HIV/AIDS Spending by Program/Function as a % of Total . . . . 14
List of Tables
Table 1. HHS Discretionary Funding for HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . 8
Table 2. HHS Discretionary Funding for HIV/AIDS, by Agency . . . . . . . . . . . . 9
Table 3. Total Federal Government Spending on HIV/AIDS by Function . . . . . 10
Table 4. Federal Government Spending on HIV/AIDS: FY1982-FY2005 . . . . 11
Table 5. Federal Government Spending on International HIV/AIDS Programs
by Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

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AIDS Funding for Federal Government
Programs: FY1981-FY2005
Background
AIDS (acquired immune deficiency syndrome) impairs the immune system and
leaves affected individuals susceptible to certain opportunistic infections and cancer.
Since 1981, a cumulative total of 886,575 AIDS cases in the United States have been
reported to the Centers for Disease Control and Prevention (CDC).1 Of this total,
384,906 persons were reported to be living with AIDS as of the end of December
2002. In addition to the total number of people living with AIDS, another 281,931
persons were known to be infected with the human immunodeficiency virus (HIV)
(in the 29 states and the Virgin Islands that have been reporting confidential name-
based HIV infection case numbers to CDC since 1998).
Federal government AIDS spending is estimated at $18.5 billion in FY2004 (see
Table 4). The Bush Administration request for FY2005 is $19.8 billion. Of the total
amount spent by the federal government on HIV/AIDS in FY2004, the majority
(63%) of funding is for treatment programs; funding for research receives 16% of the
total (see Figure 1 and Table 3). The remaining amounts are for prevention
programs (12%) and income support for persons with AIDS (9%).
Figure 1. Estimated Total Federal Spending
on HIV/AIDS by Function, FY2004
Total $18.5 billion
Treatment 63%
Research 16%
Income Support 9%
Prevention 12%
Source: HHS Budget Office, February 6, 2004.
1 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2002, v. 14,
p. 12.

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Figure 2. Estimated Total Federal Spending on
HIV/AIDS, FY2004
HHS Discretionary 34%
Other Federal 3%
Veterans 2%
OPM-FEHB 2%
State Dept. 3%
HHS Entitlement 43%
AID 5%
Social Security 8%
Source: HHS Budget Office, February 6, 2004.
Note: OPM-FEHB, Office of Personnel Management-Federal
Employees Health Benefits; AID, Agency for International
Development. See Table 4.
AIDS programs within HHS (Health and Human Services) account for 77% of
the total amount spent on AIDS by the federal government (see Figure 2). HHS
entitlement funding supports the treatment of HIV/AIDS patients via Medicaid and
Medicare which are administered by the Centers for Medicare and Medicaid Services
(CMS).2 HHS discretionary funding supports AIDS research and prevention
programs, as well as treatment programs. Table 1 provides a history of HHS
discretionary funding for HIV/AIDS from the beginning of the epidemic in FY1981
to the present. As shown in Figure 4 near the end of this report, funding for
HIV/AIDS programs within HHS has increased markedly over the past 10 years as
measured in constant 1996 dollars. However, most of the rise can be attributed to
increased spending on Medicaid, Medicare, and treatment programs in the
discretionary budget, largely through the Ryan White CARE Act program
administered by the Health Resources and Services Administration (HRSA). The
increase in HIV/AIDS research and prevention programs has been much less
pronounced, and their portion of the total amount spent by HHS on HIV/AIDS has
declined over the past decade (see Figure 5). For example, in FY1992 HIV/AIDS
research and prevention programs at HHS accounted for 51% of the total amount
spent by HHS on HIV/AIDS; by FY2004, such programs were about 28% of the total
amount spent by HHS on HIV/AIDS, reflecting the growing amounts spent on
treatment services under Medicaid and Medicare.
About 93% of FY2004 HHS discretionary funding for HIV/AIDS is allocated
to three HHS agencies: the National Institutes of Health (NIH), which supports
HIV/AIDS research; CDC, which supports HIV/AIDS prevention programs; and,
HRSA, which administers the Ryan White CARE Act, an HIV/AIDS treatment
2 This agency was formerly known as Health Care Financing Administration (HCFA).

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program (see Table 2 and Table 3). The budgets and activities of these three
agencies are briefly described below followed by a discussion of entitlement program
spending on HIV/AIDS.
HHS Discretionary Funding: NIH, CDC, and HRSA
NIH. NIH is the principal agency of the federal government charged with the
conduct and support of biomedical and behavioral research. NIH conducts research
at its own 26 institutes and centers and supports over 50,000 scientists at 2,000 U.S.
institutions. NIH funding for FY2004 was provided in P.L. 108-199 (H.R.2673), and
NIH estimates FY2004 funding for AIDS research at $2.85 billion. The
Administration’s request for FY2005 is $2.93 billion. Funding for AIDS research is
distributed among the NIH institutes in accordance with the scientific priorities
identified in the annual comprehensive plan for AIDS research which is developed
by the institutes along with the Office of AIDS Research (OAR).
OAR was established in statute by the National Institutes of Health
Revitalization Act of 1993 (P.L. 103-43) and given substantially enhanced authority
and responsibility beyond the office NIH had established under the same name.
Congress appropriated funds to OAR in FY1995. However, since FY1996, Congress
has not provided a direct appropriation for the OAR (aside from amounts identified
for the operations of the office itself). For FY2004, both the House and Senate
reports (H.Rept. 108-188 and S. Rept 108-81) accompanying the Labor, HHS, and
Education and Related Agencies Appropriation bills (H.R. 2660 and S. 1356) do not
specify a funding amount for AIDS research at NIH. Instead, funding for AIDS
research is included within the appropriation for each Institute/Center/Division of
NIH with decisions as to specific projects to fund and levels of funding left to the
Director of NIH and the Director of OAR.
CDC. CDC works with community, state, national, and international public
health agencies to prevent HIV infection and reduce AIDS-associated morbidity and
mortality through its information and education programs. CDC also supports
research, surveillance, and epidemiology studies on HIV/AIDS. In prior fiscal years,
about 80% of CDC HIV funds were distributed to state and local agencies through
cooperative agreements, grants and contracts. CDC funding for FY2004 was
provided in P.L. 108-199 (H.R. 2673). According to the HHS Office of Budget,
CDC will be spending $931 million on HIV/AIDS activities in FY2004. The
Administration’s request for FY2005 is $932 million.
HRSA. The HIV/AIDS Bureau within HRSA administers the Ryan White
CARE Act, a four-part federal grant program designed to provide emergency relief
and essential health care services to patients infected with HIV. The program funds
hundreds of grantees who serve 533,000 people affected by HIV/AIDS each year.
HRSA funding for FY2004 was provided in P.L. 108-199 (H.R. 2673). According
to the HHS Office of Budget, HRSA will be spending $2.052 billion for Ryan White
activities in FY2004. The Administration’s request for FY2005 is $2.087 billion.
(For further information on Ryan White programs, see CRS Report 98-476, AIDS:
Ryan White CARE Act.)

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CRS-4
HHS Entitlement Funding: Medicaid and Medicare at CMS
Medicaid. Medicaid is a federal-state matching entitlement program that
provides medical assistance for eligible low-income persons and families and certain
aged, disabled and medically needy individuals. Within broad federal guidelines,
each state designs and administers its own Medicaid program, resulting in wide
variations among the states in coverage, benefits offered and payment for services.
The portion of a state’s Medicaid budget provided by the federal government varies
from 50% in relatively affluent states to 80% in poorer states. Medicaid is the largest
source of federal funding for AIDS treatment and health care services (see Figure 3).
Figure 3. Estimated Federal Government
Spending On HIV/AIDS Treatment, FY2004
Total $11.7 billion
Medicaid 46.3%
Other 2.5%
AID 1.7%
Medicare 22.3%
State Dept. 3.6%
OPM-FEHB 2.9%
VA 3.1%
Ryan White 17.6%
Source: HHS Budget Office, February 6, 2004.
Note: Other agencies include SAMSHA, PH Emergency
Fund, DoD, Bureau of Prisons. See Table 3.
In FY2003, total Medicaid spending (federal + state) on AIDS treatment is
estimated at $8.5 billion, and the federal share is estimated at $4.8 billion.3 For
FY2004, the federal share estimate is $5.4 billion and for FY2005, the federal share
estimate is $5.7 billion. According to CMS, approximately 55% of adults with AIDS
and up to 90% of children with AIDS depend on Medicaid to pay for their care. In
order to obtain Medicaid coverage, persons must belong to one of the categories of
persons who can qualify for coverage (such as families with children and disabled
persons) and have low income or deplete their income on the cost of their care.
3 U.S. Dept. of Health and Human Services. Center for Medicare and Medicaid Services.
Center for Medicaid and State Operations. Medicaid and Acquired Immune Deficiency
Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Infection. Fact Sheet. Jan.
2004. This fact sheet can be found at the following website:
[http://www.cms.gov/hiv/hivfs.asp].

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Medicaid plays an important role in needed health care for persons with HIV and
AIDS because of its coverage of prescription drugs.
Medicare. Medicare is a federal health care insurance program for the elderly
and certain disabled persons. In general, in order to qualify for coverage under
Medicare, a person must be age 65 or older, disabled, or suffering from kidney failure
(end-stage renal disease or ESRD). According to one estimate, by the end of 1996,
about 12% of people living with AIDS were covered by Medicare; 83% of these
beneficiaries qualified because of a disability,4 the remainder were eligible because
they were 65 or older or had ESRD.5 The elderly qualify the month they turn 65, and
those with ESRD qualify within 3 months of being diagnosed with irreversible
kidney disease requiring dialysis or a kidney transplant. However, disabled people,
including those with AIDS, must wait for a total of 29 months after a determination
that they are disabled before they become eligible for Medicare coverage.6
Early in the epidemic, few individuals with AIDS survived the long waiting
period. With improved drug therapies, the life expectancy of individuals with HIV
has increased, and it is expected that the number able to qualify for Medicare
coverage will continue to rise.7 Medicare currently does not cover prescription drugs.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L.
108-173) provides for the implementation of a prescription drug program effective
January 1, 2006. In the interim, the legislation requires the Secretary of HHS to
establish a temporary prescription drug discount card program to provide discounts
to persons who have elected to enroll in a card plan; this interim program also
provides $600 in assistance in both 2004 and 2005 for low income persons enrolled
in the card program.8 For FY2004, funding for the care of persons with HIV/AIDS
under Medicare is estimated to be $2.6 billion, and the estimate for FY2005 is $2.9
billion. Once Medicare’s new outpatient prescription drug benefit is implemented
in 2006, Medicare spending for persons with HIV/AIDS can be expected to increase
significantly.
4 An HIV positive individual must have a recognized AIDS-defining illness in order to meet
the disability classification.
5 Fasciano, Nancy, et al. Profile of Medicare Beneficiaries with AIDS: Application of an
AIDS Case Finding Algorithm. Executive Summary, Oct. 14, 1999. Submitted by
Mathematica Policy Research, Inc.
6 Disabled people begin collecting Social Security disability cash benefits five months after
a determination that they are disabled and then must wait an additional 24 months for a total
of 29 months before becoming eligible for Medicare.
7 Combination drug therapies do not work for everyone with HIV. However, for individuals
who are successfully treated, the drug therapies will keep them healthy longer, thereby
preventing some from qualifying for disability.
8 For further information, see CRS Report RL32283, Medicare Endorsed Prescription Drug
Discount Card Program, by Jennifer O’Sullivan.

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Funding for Other AIDS Programs
Ricky Ray Hemophilia Relief Fund. The Ricky Ray Hemophilia Act of
1998 established within the Treasury Department a trust fund to provide
compassionate payments of $100,000 to individuals who have blood clotting
disorders, such as hemophilia, and who contracted HIV due to contaminated blood
products administered between July 1, 1982 and December 31, 1987.9 For FY2000,
P.L. 106-113 provided (within the Office of the Secretary in the Public Health and
Social Services Emergency Fund) $75 million for the trust fund; $10 million of the
total was for program management. The trust fund, known as the Ricky Ray
Hemophilia Relief Fund, was administered by HRSA. Payments were made to
eligible individuals who filed petitions (with the required documentation) postmarked
between July 31, 2000 and November 13, 2001. Payments were made in the order
in which the petitions were received. HRSA received more than 5,700 petitions. For
FY2001 the trust fund was appropriated $580,000,000. According to the HRSA
website, more than $555 million in compassionate payments have been made to more
than 7,100 eligible individuals. All eligible petitions have been processed for
payment. The Administration did not request appropriations for the trust fund for
subsequent years because prior funding was sufficient to make compassionate
payments on all eligible petitions. The trust fund was terminated in November
2003.10
HIV/AIDS Minority Initiative. In 1998 the White House announced a series
of initiatives targeting appropriated funds for HIV/AIDS prevention and treatment
programs in minority communities. The Congressional Black Caucus worked with
the Clinton Administration to formulate the approach. For FY2004, a total of $404.3
million is provided to continue these activities. The agency breakdown is as follows:
HRSA, $129.6 million; CDC, $103.3 million; SAMSHA, $110.2 million; Office of
Minority Health (OMH), $10.6 million; Office of Women’s Health, $1 million; and
$49.5 million in the Office of the Secretary for the Minorities Communities Fund.
For FY2005, the Administration has requested $407.6 million. The agency
breakdown is as follows: HRSA, $129.6 million; CDC, $103.3 million; SAMSHA,
$110.3 million; OMH, $10.6 million; Office of Women’s Health, $1 million; and
Office of the Secretary /Minorities Communities Fund, $52.8 million.
International HIV/AIDS Programs. As indicated in Table 5, federal
government spending on international HIV/AIDS programs in FY2004 is $2.24
billion; the Administration’s request for FY2005 is $2.70 billion.11 On January 28,
2003, President Bush announced in the State of the Union speech a new 5-year $15
billion Emergency Plan for AIDS Relief.12 The emergency plan targets African and
9 Further information can be found at:[http://bhpr.hrsa.gov/rickyray/].
10 HRSA Newsbrief, Sept. 24, 2002. See the HRSA website at: [http://newsroom.
hrsa.gov/NewsBriefs/2002/rickyray.htm].
11 For additional information, see CRS Report RS21181, HIV/AIDS International Programs:
Appropriations, FY2002-FY2004 by Raymond W. Copson.
12 The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (H.R.
(continued...)

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Caribbean countries with a very high prevalence of HIV infection: Botswana, Cote
d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda,
South Africa, Tanzania, Uganda, and Zambia.13 These countries account for almost
20 million HIV-infected people, nearly 70% of infected persons in Africa and the
Caribbean and 50% worldwide.14 In the targeted countries, the goals of the 5-year
plan are to prevent 7 million new infections, provide treatment to 2 million HIV-
infected people, and provide care for 10 million HIV-infected individuals and AIDS
orphans. Details of the Administration’s plans can be found in a report released by
the Department of State on February 23, 2004.15
On June 19, 2002, President Bush announced the Mother-to-Child HIV
Prevention Initiative, a $500 million program that targets the same African and
Caribbean countries mentioned above that have been hard hit by the HIV/AIDS
epidemic. The goal of the Mother-to-Child HIV Prevention Initiative is to improve
health care delivery and reduce mother to infant transmission of HIV by 40% within
5 years.16 The Administration requested $200 million in FY2003 and $300 million
in FY2004. Funding for the Initiative was provided by the Foreign Operations
appropriation through the U.S. Agency for International Development (USAID) and
the Labor, HHS appropriation through international HIV/AIDS programs at CDC.
Congress provided $140 million for the Mother-to-Child HIV Prevention Initiative
in FY2003 ($100 million through USAID and $40 million through CDC) and full
funding of $300 million for FY2004 ($150 million via both USAID and CDC). For
FY2005, the Administration has proposed continuing the Mother-to-Child HIV
Prevention Initiative within the budget of the Department of State.
A third program, the Global Fund to Fight AIDS, Tuberculous and Malaria, was
first proposed at the July 2000 G-8 Summit in Okinawa.17 The purpose of the Global
Fund is to attract, manage and disburse funding through a public-private partnership
dedicated to the reduction of infections, illness and death caused by these three
diseases in countries in need. The concept of the Global Fund was unanimously
endorsed at special session on HIV/AIDS held by United Nations General Assembly
12 (...continued)
1298, P.L. 108-25), signed into law on May 27, 2003, authorizes $15 billion for
international HIV/AIDS programs. On July 2, 2003, President Bush nominated Randall
Tobias as coordinator for international HIV/AIDS assistance the Department of State, a
position created by H.R. 1298. The appointment has the rank of ambassador, reporting
directly to the Secretary of State.
13 Fact Sheet: The President’s Emergency Plan for AIDS Relief, Jan. 28, 2003.
[http://www.whitehouse.gov/news/releases/2003/01/20030129-1.html]
14 For further information about the HIV/AIDS epidemic in Africa, see CRS Issue Brief
IB10050, AIDS in Africa by Raymond Copson.
15 U.S. State Department. The President’s Emergency Plan for AIDS Relief. Feb. 23, 2004.
103 p. [http://www.state.gov/documents/organization/29831.pdf]
16 President Bush’s International Mother and Child Prevention Initiative, June 19, 2002.
[http://www.whitehouse.gov/news/releases/2002/06/20020619-1.html]
17 Fact Sheet, Office of the Spokesman, U.S. Department of State, Dec. 13, 2002.
[http://www.state.gov/r/pa/prs/ps/2002/15583.htm]

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in June 2001. The Global Fund was established in January 2002 as a charitable
foundation in Geneva, Switzerland; the first round of grants was approved in April
2002. United States support of the fund occurs through USAID and HHS.18
Table 1. HHS Discretionary Funding for HIV/AIDS
($ in thousands)
$ Increase over
% Increase over
Year
Funding
prior year
prior year
FY1981
$200
—
—
FY1982
5,555
$5,355
2,678%
FY1983
28,736
23,181
417%
FY1984
61,460
32,724
114%
FY1985
108,618
47,158
77%
FY1986
233,793
125,175
115%
FY1987
502,455
268,662
115%
FY1988
962,018
459,563
94%
FY1989
1,304,012
341,994
36%
FY1990
1,592,756
288,744
22%
FY1991
1,891,232
298,476
19%
FY1992
1,963,414
72,182
4%
FY1993
2,079,591
116,639
6%
FY1994
2,568,682
489,091
24%
FY1995
2,700,498
131,816
5%
FY1996
2,897,923
197,425
7%
FY1997
3,267,220
369,297
13%
FY1998 3,536,519
269,299
8%
FY1999
4,094,489
557,970
16%
FY2000
4,546,326
451,837
11%
FY2001
5,225,645
679,319
15%
FY2002
5,788,553
562,908
11%
FY2003
6,093,846
305,293
5%
FY2004 enacted
6,295,065
201,219
3%
FY2005 request
6,368,899
73,834
1%
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS
budget office, Mar. 31, 2004.
18 For further information, see CRS Report RL31712, The Global Fund to Fight AIDS,
Tuberculosis and Malaria: Background and Current Issues, by Raymond W. Copson and
Tiaji Salaam.

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Table 2. HHS Discretionary Funding for HIV/AIDS, by Agency
($ in thousands)
Agency
FY1996
FY1997
FY1998
FY1999
FY2000
FY2001 FY2002
FY2003 FY2004
FY2005
req.
NIH
$1,410,926
$1,501,073
$1,602,814
$1,792,739
$2,004,428
$2,247,015
$2,499,458
$2,716,218
$2,849,952
$2,930,397
CDC
584,080
616,790
624,944
656,590
687,164
859,045
931,141
936,426
930,821
932,389
SAMHSA
54,201
63,857
65,607
91,894
110,347
156,677
169,034
170,614
171,118
172,593
FDA
72,745
72,745
76,690
70,400
76,317
75,818
75,818
72,830
73,847
75,083
HRSA
762,398
1,001,248
1,154,508
1,415,847
1,599,231
1,815,000
1,917,200
2,024,962
2,051,856
2,086,857
AHRQ
6,343
4,193
1,719
1,839
1,787
3,381
2,913
1,825
1,700
1,500
OS
3,754
3,811
6,697
61,531
63,282
64,899
64,103
67,681
62,642
65,973
IHS
3,476
3,503
3,540
3,649
3,770
3,810
3,886
3,940
4,014
4,107
Global AIDS Trust Fund
— -
— -
— -
— -
— -
— -
125,000
99,350
149,115
100,000
Total
$2,897,923
$3,267,220
$3,536,519
$4,094,489
$4,546,326
$5,225,645
$5,788,553
$6,093,846
$6,295,065
$6,368,899
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS budget office, Mar. 31, 2004.
NIH: National Institutes of Health
CDC: Centers for Disease Control and Prevention
SAMHSA: Substance Abuse and Mental Health Services Administration
FDA: Food and Drug Administration
HRSA: Health Resources and Services Administration
AHRQ: Agency for Healthcare Research and Quality (established as AHCPR in 1990 (formerly in OASH); renamed in 1999)
OS: Office of the Secretary (Office of HIV/AIDS Policy, Office for Civil Rights, Office of Minority Health, Office of Women’s Health, and the Public Health and Social Services
Emergency Fund)
IHS: Indian Health Service
Global Aids Trust Fund: While budgeted in NIH, HHS contributions to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis in FY2002 and FY2003 are not reflected in
the NIH HIV/AIDS spending figures, but are accounted for separately.
International Mother-Child Transmission: While budgeted in CDC, HHS contributions to the Mother-to-Child Transmission Prevention Initiative are not reflected in the CDC
HIV/AIDS spending figures, but are not accounted for separately.

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Table 3. Total Federal Government Spending on HIV/AIDS by Function
($ in millions)
FY2003 Enacted
FY2004 Congressional Action
FY2005 President’s Budget
Income
Income
Income
Agency/Department
Research
Prevent
Treatmt
support
Total
Research
Prevent
Treatmt
support
Total
Research
Prevent
Treatmt
support
Total
FDA
$73
—
—
—
$73
$74
—
—
—
$74
$75
—
—
—
$75
HRSA
—
2
2,023
—
2,025
—
2
2,050
—
2,052
—
2
2,085
—
2,087
IHS
1
3
—
—
4
1
3
—
—
4
1
3
—
—
4
CDC
—
936
—
—
936
—
931
—
—
931
—
932
—
—
932
NIH
2,716
—
—
—
2,716
2,850
—
—
—
2,850
2,930
—
—
—
2,930
SAMHSA
—
41
130
—
171
—
41
131
—
171
—
41
132
—
173
AHRQ
2
—
—
—
2
2
—
—
—
2
2
—
—
—
2
OS
—
18
—
—
18
—
13
—
—
13
—
13
—
—
13
PH emergency fund
—
35
14
—
50
—
35
14
—
50
—
38
15
—
53
Global AIDS trust fund
50
50
99
75
75
149
—
50
50
—
100
HHS discretionary
$2,792
$1,085
$2,216
—
$6,094
$2,927
$1,099
$2,269
—
$6,295
$3,008
$1,079
$2,282
—
$6,369
-CMS/Medicaid
—
—
4,800
—
4,800
—
—
5,400
—
5,400
—
—
5,700
—
5,700
-CMS/Medicare
—
—
2,400
—
2,400
—
—
2,600
—
2,600
—
—
2,900
—
2,900
Subtotal, HHS
$2,792
$1,085
$9,416
— $13,294
$2,927
$1,099
$10,269
— $14,295
$3,008
$1,079
$10,882
— $14,969
Social Security — DI
Social Security — SSI
—
—
—
$1,019
$1,019
—
—
—
$1,050
$1,050
—
—
—
$1,082
$1,014
Veterans Affairs
—
—
—
395
395
—
—
—
415
415
—
—
—
460
460
Defense Department.
8
35
353
—
396
8
35
359
—
402
$8
$35
$369
—
412
Agency for Int. Dev.
10
17
55
—
82
32
17
56
—
105
21
17
57
—
95
Justice/Bureau of Prisons
—
650
124
—
774
—
765
199
—
964
—
590
50
—
640
State Department
—
2
15
—
17
—
2
15
—
17
—
2
18
—
20
Labor Department
—
141
—
—
141
—
213
425
—
638
—
485
967
—
1,452
Education Dept.
—
11
—
—
11
—
11
—
—
11
—
1
—
—
1
Housing & Urban
—
-
—
—
-
—
-
—
—
-
—
—
—
—
—
Development
—
—
—
290
290
—
—
—
295
295
—
—
—
295
295
OPM-FEHB
—
—
321
—
321
—
—
343
—
343
—
—
370
—
370
Subtotal, Non-HHS
$18
$856
$868
$1,704
$3,446
$40
$1,043
$1,397
$1,760
$4,240
$29
$1,130
$1,831
$1,837
$4,827
Total, Federal Govt
$2,810
$1,941
$10,284
$1,704 $16,739
$2,967
$2,142
$11,666
$1,760 $18,535
$3,037
$2,209
$12,712
$1,837 $19,796
Change from previous year
% change from previous
$197
$315
$1,163
$76
$1,751
$157
$202
$1,381
$56
$1,796
$71
$66
$1,047
$77
$1,261
year
8%
19%
13%
5%
12%
6%
10%
13%
3%
11%
2%
3%
9%
4%
7%
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS budget office, February 6, 2004. HHS: Department of Health and Human Services;
CMS: Centers for Medicare and Medicaid Services; DI: Disability Insurance; SSI: Supplemental Security Income; OPM-FEHB: Office of Personnel Management-Federal Employees
Health Benefits.

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CRS-11
Table 4. Federal Government Spending on HIV/AIDS: FY1982-FY2005
($ in millions)
HHS
CMS (HCFA)
SS
DoJ-
OPM-
Year
Discretionary
Medicaid
Medicare
DI
SSI
VA
Defense
AID
Prisons
State
Labor
HUD
FEHB
Education
Total
1982
$6
—
—
—
—
2
—
—
—
—
—
—
—
—
$8
1983
$29
10
—
—
—
5
—
—
—
—
—
—
—
—
$44
1984
$60
30
—
5
1
7
—
—
—
—
—
—
—
—
$103
1985
$109
70
5
10
3
8
—
—
—
—
—
—
—
—
$205
1986
$234
130
5
30
5
20
79
—
—
—
—
—
5
—
$508
1987
$502
200
15
55
15
51
74
—
1
—
1
—
8
—
$922
1988
$962
330
30
95
20
78
53
30
1
—
1
1
13
1
$1,615
1989
$1,304
490
55
150
35
136
86
40
2
1
1
—
22
—
$2,322
1990
$1,592
670
110
184
55
220
124
71
5
1
1
—
37
—
$3,070
1991
$1,891
870
180
266
95
258
127
78
5
1
1
—
61
—
$3,833
1992
$1,967
800
400
372
150
279
125
94
5
1
1
48
103
—
$4,345
1993
$2,079
1,000
600
481
200
299
155
117
5
1
1
100
175
—
$5,213
1994
$2,569
1,300
800
568
250
312
127
115
6
1
1
156
193
—
$6,398
1995
$2,700
1,500
1,000
631
250
317
110
120
6
1
1
171
212
—
$7,019
1996
$2,898
1,800
1,100
684
250
331
98
115
6
—
1
171
226
—
$7,680
1997
$3,267
2,200
1,300
738
275
350
84
117
7
—
2
196
241
—
$8,777
1998
$3,537
2,600
1,400
787
305
378
95
121
7
—
2
204
253
—
$9,689
1999
$4,094
2,900
1,500
828
330
401
86
139
7
—
2
225
266
1
$10,779
2000a
$4,546
3,300
1,700
870
370
345
97
200
8
—
2
232
279
1
$12,025

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CRS-12
HHS
CMS (HCFA)
SS
DoJ-
OPM-
Year
Discretionary
Medicaid
Medicare
DI
SSI
VA
Defense
AID
Prisons
State
Labor
HUD
FEHB
Education
Total
2001a
$5,226
3,700
1,900
919
340
405
108
430
15
—
11
257
292
1
$14,184
2002
$5,789
4,200
2,050
961
390
391
96
510
16
—
11
277
297
—
$14,988
2003
$6,094
4,800
2,400
1,019
395
396
82
774
17
141
11
290
321
—
$16,739
2004
$6295
5,400
2,600
1,050
415
402
105
964
17
638
1
295
343
—
$18,535
2005b
$6,369
5,700
2,900
1,082
460
412
95
640
20
1,452
1
295
370
—
$19,796
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS budget office, Feb. 6, 2004. May not add due to rounding.
a. FY2000 Total includes $75 million for HRSA Ricky Ray Hemophilia program and FY2001 Total includes $580 million for HRSA Ricky Ray Hemophilia program.
b. FY2005 is the Administration’s request.
HHS: Department of Health and Human Services; Discretionary AIDS budget
CMS: Centers for Medicare and Medicaid Services
HCFA: Health Care Financing Administration
SS: Social Security
DI: Disability Insurance
SSI: Supplemental Security Income
VA: Veterans Affairs
AID: Agency for International Development
DoJ-Prisons: Department of Justice, Bureau of Prisons
HUD: Department of Housing and Urban Development
OPM-FEHB: Office of Personnel Management-Federal Employees Health Benefits

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CRS-13
Figure 4. HHS Spending on HIV/AIDS Programs

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CRS-14
Figure 5. HHS HIV/AIDS Spending by Program/Function as a % of Total

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CRS-15
Table 5. Federal Government Spending on International HIV/AIDS Programs by Function
($ in millions)
FY2003
FY2004 enacted
FY2005 President’s budget
Agency/Department
Research
Prevent
Treatment
Total
Research
Prevent
Treatment
Total
Research
Prevent Treatment
Total
CDC
—
154
—
154
—
154
—
154
—
154
—
154
NIH
279
—
—
279
323
—
—
323
355
—
—
355
Global AIDS trust fund
—
50
50
99
—
75
75
149
—
50
50
100
Subtotal, HHS
$279
$204
$50
$532
$323
$228
$75
$626
$355
$204
$50
$609
Defense Department
—
7
—
7
—
4
—
4
—
—
—
—
Agency for International
Development
—
650
124
774
—
765
199
964
—
590
50
640
State Department
—
141
—
141
—
213
425
638
—
485
967
1,452
Labor Department
—
10
—
10
—
10
—
10
—
—
—
—
Subtotal, Non-HHS
—
808
124
932
—
992
624
1,616
—
1,075
1,017
2,092
Total
$279
$1,011
$174
$1,463
$323
$1,220
$698
$2,242
$355
$1,279
$1,067
$2,701
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS budget office, Feb. 6, 2004. May not add due to rounding. HHS: Department of
Health and Human Services.

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