Figure 1. Estimated Total Federal Spending on HIV/AIDS,
by Function, FY2008
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<font size="+1">List of Tables</font>
Federal government spending on HIV (the human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) is estimated at $23.3 billion in FY2008. Of the total, 63% is for treatment programs; research programs receive 13%; prevention programs receive 14%, and income support programs receive 10%. The Administration's government-wide request level for all HIV/AIDS programs in FY2009 is $24.1 billion.
AIDS programs within the Department of Health and Human Services (HHS) account for 66% of the total amount spent on HIV/AIDS by the federal government in FY2008, a total of $15.2 billion for both discretionary and entitlement programs. Within the HHS discretionary budget, funding for HIV/AIDS research, prevention, and treatment programs has increased from $200,000 in FY1981 to an estimated $6.586 billion in FY2008; the Administration's request for FY2009 is $6.592 billion.
This report provides an overview of HHS spending on HIV/AIDS as well as budget numbers for other federal government programs targeting HIV/AIDS. This report is updated once per year to reflect the new budget figures.
Untreated HIV infection leads to a gradual deterioration of the immune system and leaves
affected individuals susceptible to the opportunistic infections and cancers that typify AIDS. Since
1981, a cumulative total of 1,014,797 AIDS cases in the United States and dependent areas have
been reported to the Centers for Disease Control and Prevention (CDC).(1) Of this total, 448,871 persons
were reported to be living with AIDS as of the end of December 2006. In addition to the total
number of people living with AIDS, another 233,079 persons were known to be infected with HIV
(does not include data from five states and the District of Columbia; these areas have not been
reporting name-based HIV infection case numbers to CDC since at least 2003).
Source: HHS Budget Office, March 20, 2008.
Federal government AIDS spending is estimated at $23.3 billion in FY2008 (see Table 5). The Bush Administration request for FY2009 is $24.1 billion. Of the total amount spent by the federal government on HIV/AIDS in FY2008, the majority (63%) of funding is for treatment programs; funding for research receives 13% of the total (see Figure 1 and Table 4). The remaining amounts are for prevention programs (14%) and income support for persons with AIDS (10%).
AIDS programs within HHS (Health and Human Services) account for 66% of the total amount spent on AIDS by the federal government (see Figure 2). HHS entitlement funding supports the treatment of HIV/AIDS patients through Medicaid and Medicare, which are administered by the Centers for Medicare and Medicaid Services (CMS). HHS discretionary funding supports AIDS research and prevention programs, as well as treatment programs. Table 2 provides a history of HHS discretionary funding for HIV/AIDS from the beginning of the epidemic in FY1981 to the present.
Funding for HIV/AIDS programs within HHS has increased markedly over the past 15 years as measured in constant 2000 dollars, shown in Figure 4 near the end of this report. Even though HHS has revised its estimates of spending by Medicaid for FY2007 through FY2009, Figure 4 still shows that most of the overall rise can be attributed to increased spending on Medicaid, Medicare, and treatment programs in the discretionary budget, largely through the Ryan White 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 15 years (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 FY2008, such programs were about 27% of the total amount spent by HHS on HIV/AIDS, reflecting the growing amounts spent on treatment services under Medicaid and Medicare.
Source: HHS Budget Office, March 20, 2008.
Note: USAID, U.S. Agency for International Development. See Table 4.
About 90% of FY2008 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 program, an HIV/AIDS treatment program (see Table 3 and Table 4). The budgets and activities of these three agencies are briefly described below, followed by a discussion of entitlement program spending on HIV/AIDS.
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 27 institutes and centers and supports more than 200,000 scientists and research personnel working at over 3,100 U.S. institutions. NIH funding for FY2008 was provided in P.L. 110-161 (H.R. 2764), and NIH estimates FY2008 funding for AIDS research at $2.913 billion. The Administration's request for FY2009 is $2.913 billion.(2) 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 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 FY2008, the House and Senate 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 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. CDC distributes much of its HIV funds to state and local agencies through cooperative agreements, grants, and contracts. CDC funding for FY2008 was provided in P.L. 110-161 (H.R. 2764). According to the HHS Budget Office, CDC will be spending $872 million on HIV/AIDS activities in FY2008; the Administration's request for FY2009 is $871 million.(3)
The HIV/AIDS Bureau within HRSA administers the Ryan White program, 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 that serve 531,000 people each year. The Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415, H.R. 6143) reauthorized the Ryan White program through September 30, 2009.
HRSA funding for FY2007 was provided in P.L. 110-161 (H.R. 2764). According to the HHS Budget Office, HRSA will be spending $2.170 billion on Ryan White program activities in FY2008. The Administration's request for FY2009 is $2.171 billion.(4) (For further information on the Ryan White program, see CRS Report RL33279, The Ryan White HIV/AIDS Program, by Judith A. Johnson.)
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. 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. Medicaid has played an important role in needed health care for persons with HIV and AIDS because of its coverage of prescription drugs.
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 one of the largest source of federal funding for AIDS treatment and health care services (see Figure 3).
For FY2008, the federal share of Medicaid spending on AIDS treatment is estimated at $4.1
billion, and for FY2009, the federal share estimate is $4.4 billion. Total FY2008 federal and state
Medicaid spending for AIDS treatment will be an estimated $7.2 billion ($4.1 billion federal and
$3.1 billion state).(5) CMS
analysts have significantly lowered their estimate of the federal share of Medicaid spending on AIDS
treatment due to two factors: (1) the impact of Medicare Part D prescription drug coverage and (2)
lowered per capita health care costs based on internal CMS data and external data.(6) However, a study by analysts
outside of CMS found that although "implementation of Medicare drug benefit resulted in a major
shift of prescription drug spending from Medicaid to Medicare ... spending for antiretroviral
medications decreased by a much smaller percentage than did spending for many other classes.
People with HIV and AIDS continue to depend heavily on Medicaid to pay for their health care, as
most do not qualify for Medicare."(7)
Source: HHS Budget Office, March 20, 2008.
Notes: Other includes the following: Substance Abuse and Mental Health; Public Health Emergency Fund; Department of Defense; Bureau of Prisons; Federal Employee Health Benefits Program; Global AIDS Trust Fund. See Table 3.
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, about 80% of beneficiaries with HIV/AIDS that qualified for Medicare did so because of a disability,(8) the remainder were eligible because they were 65 or older or had ESRD.(9) The elderly qualify the month they turn 65, and those with ESRD qualify within three 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.(10)
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.(11) The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173) provided for the implementation of a prescription drug program, often called Medicare Part D, which became effective January 1, 2006. CMS analysts have adjusted their estimate of Medicare spending on AIDS treatment based on two factors: (1) the impact of Medicare Part D prescription drug coverage and (2) lowered per capita health care costs based on internal CMS data and external data.(12) For FY2008, funding for the care of persons with HIV/AIDS under Medicare is estimated to be $4.5 billion, and the estimate for FY2009 is $4.8 billion.
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 FY2008, a total of $403 million is provided to continue these activities. For FY2009, the Administration has requested $387 million. See Table 1 below for further details.
Table 1. HIV/AIDS Minority Initiative
| Program | FY2005 | FY2006 | FY2007 | FY2008 | FY2009 |
| HRSA | $129 | $129 | $131 | $135 | 139 |
| CDC | 94 | 96 | 96 | 96 | 76 |
| SAMHSA | 112 | 112 | 111 | 112 | 112 |
| Minority Communities Fund | 52 | 52 | 52 | 51 | 52 |
| Office of Minority Health | 8 | 10 | 9 | 7 | 7 |
| Office of Women's Health | 1 | 1 | 1 | 2 | 1 |
| Total, Minority HIV/AIDS Initiative | 397 | 399 | 400 | 403 | 387 |
Source: Table prepared by the Congressional Research (CRS) based on analysis from the HHS Budget Office, February 15, 2008.
Notes: Totals may not add due to rounding. FY2009 is based on the Administration's budget request.
In January 2003, President Bush announced in the State of the Union speech a five-year $15 billion program, the President's Emergency Plan for AIDS Relief (PEPFAR).(13) The five-year program targets countries with a very high prevalence of HIV infection; its goals 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.
The Global Fund to Fight AIDS, Tuberculous and Malaria, was first proposed at the July 2000 G-8 Summit in Okinawa.(14) Its purpose 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. It was established in January 2002 as a charitable foundation in Geneva, Switzerland; the first round of grants was approved in April 2002. U.S. support of the fund occurs through USAID and HHS.
As indicated in Table 6, federal government spending on international HIV/AIDS programs in FY2008 is $5.8 billion; the Administration's request for FY2009 is $5.9 billion.(15)
Table 2. HHS Discretionary Funding for
HIV/AIDS
| Year | Funding | $ Increase over prior year |
% Increase over 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 | 6,242,501 | 148,655 | 2% |
| FY2005 | 6,279,141 | 36,640 | 0.6% |
| FY2006 | 6,235,251 | -43,890 | -0.7% |
| FY2007 | 6,357,719 | 122,468 | 2% |
| FY2008 | 6,586,086 | 228,367 | 4% |
| FY2009 Request | 6,592,399 | 6313 | 0.1% |
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Note: FY2009 is based on the Administration's budget request.
Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency
| Agency | FY2000 | FY2001 | FY2002 | FY2003 | FY2004a | FY2005a | FY2006 | FY2007 | FY2008 | FY2009 |
| FDA | $76,317 | $75,818 | $75,818 | $72,830 | $73,847 | $87,661 | $88,758 | $90,563 | $94,425 | $95,369 |
| HRSA | 1,599,231 | 1,815,000 | 1,917,200 | 2,024,962 | 2,066,861 | 2,075,296 | 2,064,705 | 2,141,195 | 2,170,192 | 2,171,312 |
| IHS | 3,770 | 3,810 | 3,886 | 3,940 | 4,013 | 4,074 | 4,261 | 4,437 | 4,587 | 3,629 |
| CDC | 687,164 | 859,045 | 931,141 | 936,426 | 862,854 | 855,535 | 838,225 | 879,241 | 872,427 | 871,314 |
| NIH | 2,004,428 | 2,247,015 | 2,499,458 | 2,716,218 | 2,849,952 | 2,920,551 | 2,901,859 | 2,905,788 | 2,913,345 | 2,913,345 |
| SAMHSA | 110,347 | 156,677 | 169,034 | 170,614 | 171,205 | 173,024 | 171,872 | 171,545 | 172,226 | 172,907 |
| AHRQ | 1,787 | 3,381 | 2,913 | 1,825 | 2,017 | 1,088 | 2,750 | 2,800 | 2,800 | 2,800 |
| OS | 63,282 | 64,899 | 64,103 | 67,681 | 62,637 | 62,712 | 63,821 | 63,150 | 61,325 | 61,723 |
| Global AIDS Trust Fund | -- | -- | 125,000 | 99,350 | 149,115 | 99,200 | 99,000 | 99,000 | 294,759 | 300,000 |
| Total | $4,546,326 | $5,225,645 | $5,788,553 | $6,093,846 | $6,242,501 | $6,279,141 | $6,235,251 | $6,357,719 | $6,586,086 | $6,592,399 |
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: FY2009 is based on the Administration's budget request. FDA: Food and Drug Administration; HRSA: Health Resources and Services Administration; IHS: Indian Health Service; CDC: Centers for Disease Control and Prevention; NIH: National Institutes of Health; SAMHSA: Substance Abuse and Mental Health Services Administration; AHRQ: Agency for Healthcare Research and Quality; OS: Office of the Secretary (includes the 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/Minority Communities Fund); Global Aids Trust Fund: While budgeted in NIH, HHS contributions to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis are not reflected in the NIH HIV/AIDS spending figures, but are accounted for separately.
a. CDC reported funding for HIV/AIDS expenditures have been comparably adjusted downward to reflect the new budget structure at CDC that excludes administrative and management costs. The FY2004 adjustment was about $68 million, and the FY2005 adjustment was about $74 million.
Table 4. Total Federal Government Spending on HIV/AIDS, by Function
| Agency/Department | FY2007 Actual | FY2008 Enacted | FY2009 President's Budget | ||||||||||||
| Research | Prevent | Treatmt | Income support |
Total | Research | Prevent | Treatmt | Income support | Total | Research | Prevent | Treatmt | Income support |
Total | |
| FDA HRSA IHS CDC NIH SAMHSA AHRQ OS PH emergency fund Global AIDS trust fund |
$91 -- 1 -- 2,906 -- 3 -- -- |
-- 3 3 879 -- 40 -- 11 37 50 |
-- 2,138 -- -- -- 131 -- -- 15 50 |
-- -- -- -- -- -- -- -- -- |
$91 2,141 4 879 2,906 172 3 11 52 99 |
$94 -- 1 -- 2,913 -- 3 -- -- |
-- 3 3 872 -- 40 -- 10 36 147 |
-- 2,167 -- -- -- 132 -- -- 14 147 |
-- -- -- -- -- -- -- -- -- |
$94 2,170 5 872 2,913 172 3 10 51 295 |
$95 -- 1 -- 2,913 -- 3 -- -- -- |
-- 3 2 871 -- 40 -- 10 37 150 |
-- 2,168 -- -- -- 133 -- -- 15 150 |
-- -- -- -- -- -- -- -- -- -- |
$95 2,171 4 871 2,913 173 3 10 52 300 |
| HHS discretionary | $3,001 | $1,024 | $2,333 | -- | $6,358 | $3,012 | $1,114 | $2,460 | -- | $6,586 | $3,013 | $1,114 | $2,465 | -- | $6,592 |
| CMS/Medicaid CMS/Medicare |
-- -- |
-- -- |
3,900 4,200 |
-- -- |
3,900 4,200 |
-- -- |
-- -- |
4,100 4,500 |
-- -- |
4,100 4,500 |
-- -- |
-- -- |
4,400 4,800 |
-- -- |
4,400 4,800 |
| Subtotal, HHS | $3,001 | $1,024 | $10,433 | -- | $14,458 | $3,012 | $1,114 | $11,060 | -- | $15,186 | $3,013 | $1,114 | $11,665 | -- | $15,792 |
| Social Security -- DI Social Security -- SSI Veterans Affairs Defense Department. Agency for Int. Dev. Justice/Bureau of Prisons State Department Labor Department Education Dept. HUD OPM-FEHB Subtotal, Non-HHS |
-- -- 5 26 -- -- -- -- -- -- -- $31 |
-- -- 35 10 466 2 1,147 -- -- -- -- $1,660 |
-- -- 465 58 124 19 2,101 -- -- -- 107 $2,874 |
$1,450 420 -- -- -- -- -- -- -- 286 -- $2,156 |
$1,450 420 505 94 590 21 3,248 -- -- 286 107 $6,721 |
-- -- 5 30 -- -- -- -- -- -- -- $35 |
-- -- 35 18 371 2 1,645 -- -- -- -- $2,071 |
-- -- 500 58 -- 19 3,017 -- -- -- 114 $3,708 |
$1,484 479 -- -- -- -- -- -- -- 300 -- $2,263 |
$1,484 479 540 106 371 21 4,662 -- -- 300 114 $8,077 |
-- -- $3 23 -- -- -- -- -- -- -- $26 |
-- -- $35 10 342 2 1,626 -- -- -- -- $2,015 |
-- -- $607 58 -- 19 3,153 -- -- -- 123 $3,959 |
$1,519 490 -- -- -- -- -- -- -- 300 -- $2,309 |
$1,519 490 645 91 342 21 4,779 -- -- 300 123 $8,310 |
| Total, federal government | $3,032 | $2,684 | $13,307 | $2,156 | $21,179 | $3,047 | $3,185 | $14,768 | $2,263 | $23,263 | $3,039 | $3,130 | $15,624 | $2,309 | $24,102 |
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: HHS: Department of Health and Human Services; CMS: Centers for Medicare and Medicaid Services; DI: Disability Insurance; HUD: Department of Housing and Urban Development; SSI: Supplemental Security Income; OPM-FEHB: Office of Personnel Management-Federal Employees Health Benefits.
Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009
| Year | HHS | SS | VA | Defense | AID | DOJ-Prisons | State | Labor | HUD | OPM-FEHB | Education | Total | |||
| Discretionary | CMS | ||||||||||||||
| Medicaid | Medicare | DI | SSI | ||||||||||||
| 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 |
| 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 | $6,243 | 5,400 | 2,600 | 1,050 | 415 | 402 | 105 | 963 | 17 | 638 | 11 | 295 | 343 | -- | $18,481 |
| 2005 | $6,279 | 5,700 | 2,900 | 1,250 | 450 | 445 | 110 | 633 | 20 | 1,376 | 2 | 282 | 370 | -- | $19,817 |
| 2006 | $6,235 | 3,600b | 3,900b | 1,365 | 440 | 468 | 102 | 621 | 21 | 1,977 | -- | 286 | 100 | -- | $19,116 |
| 2007 | $6,358 | 3,900b | 4,200b | 1,450 | 420 | 505 | 94 | 590 | 21 | 3,248 | -- | 286 | 107 | -- | $21,179 |
| 2008 | $6,586 | 4,100b | 4,500b | 1,484 | 479 | 540 | 106 | 371 | 21 | 4,662 | -- | 300 | 114 | -- | $23,263 |
| 2009 | $6,592 | 4,400b | 4,800b | 1,519 | 490 | 645 | 91 | 342 | 21 | 4,779 | -- | 300 | 123 | -- | $24,102 |
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: FY2009 is based on the Administration's budget request. May not add due to rounding. HHS: Department of Health and Human Services; Discretionary AIDS budget; CMS: Centers for Medicare and Medicaid Services; SS: Social Security; DI: Disability Insurance; SSI: Supplemental Security Income; VA: Veterans Affairs; AID: U.S. 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.
a. FY2000 total includes $75 million for the HRSA Ricky Ray Hemophilia program, and FY2001 total includes $580 million for the HRSA Ricky Ray Hemophilia program.
b. Medicaid and Medicare amounts have been revised due to the impact Medicare Part D prescription drug coverage and lowered per capita health care costs.
Source: HHS Budget Office, March 20, 2008.
Note: FY2009 is based on the Administration's budget request.
Source: HHS Budget Office, March 20, 2008.
Note: FY2009 is based on the Administration's budget request.
Table 6. Federal Government Spending on International HIV/AIDS Programs, by Function
| Agency/Department | FY2007 Actual | FY2008 Enacted | FY2009 President's Budget | |||||||||
| Research | Prevent | Treatment | Total | Research | Prevent | Treatment | Total | Research | Prevent | Treatment | Total | |
| Centers for Disease Control | -- | 121 | -- | 121 | -- | 119 | -- | 119 | -- | 119 | -- | 119 |
| National Institutes of Health | 362 | -- | -- | 362 | 364 | -- | -- | 364 | 366 | -- | -- | 366 |
| Global AIDS trust fund | -- | 50 | 50 | 99 | -- | 147 | 147 | 295 | -- | 150 | 150 | 300 |
| Subtotal, HHS | $362 | $170 | $50 | $582 | $364 | $266 | $147 | $777 | $366 | $269 | $150 | $785 |
| Defense Department | -- | -- | -- | -- | -- | 8 | -- | 8 | -- | -- | -- | -- |
| Agency for International Development | -- | 466 | 124 | 590 | -- | 371 | -- | 371 | -- | 342 | -- | 342 |
| State Department | -- | 1,147 | 2,101 | 3,248 | -- | 1,645 | 3,017 | 4,662 | -- | 1,626 | 3,153 | 4,779 |
| Labor Department | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Subtotal, Non-HHS | -- | 1,613 | 2,225 | 3,838 | -- | 2,024 | 3,017 | 5,041 | -- | 1,968 | 3,153 | 5,121 |
| Total | $362 | $1,784 | $2,275 | $4,420 | $364 | $2,290 | $3,164 | $5,818 | $366 | $2,237 | $3,303 | $5,906 |
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: May not add due to rounding. HHS: Department of Health and Human Services.
1. (back) Data in this paragraph are from Table 3, p. 13 and Table 12, pp. 24-25 of the CDC, HIV/AIDS Surveillance Report, 2006, vol. 18, at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.
2. (back) For additional information on OAR budget and research activities for FY2009, see "Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates for Appropriations Committees, National Institutes of Health, Volume I, Overview," pp. 1-17, at http://officeofbudget.od.nih.gov/ui/2008/OAR.pdf.
3. (back) For further information on the CDC HIV/AIDS budget and program activities, see "Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates for Appropriations Committees, Centers for Disease Control and Prevention," pp. 61-78, at http://www.cdc.gov/fmo/PDFs/FY09_CDC_CJ_Final.pdf.
4. (back) For more information on the HRSA Ryan White budget and program activities, see "Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates for Appropriations Committees, Health Resources and Services Administration," pp. 163-193, at ftp://ftp.hrsa.gov/about/budgetjustification09.pdf.
5. (back) Estimate based on average federal Medicaid assistance percentage (FMAP) for the nation as a whole.
6. (back) Personal communication, HHS Budget Office, April 17, 2008.
7. (back) Brian K. Bruen and Laura M. Miller, "Changes in Medicaid Prescription Volume and Use in the Wake of Medicare Part D Implementation," Health Affairs, January/February 2008, v. 27, pp. 196-202.
8. (back) An HIV-positive individual must have a recognized AIDS-defining illness in order to meet the disability classification.
9. (back) Nancy Fasciano et al., Profile of Medicare Beneficiaries with AIDS: Application of an AIDS Case Finding Algorithm, Executive Summary, October 14, 1999. Submitted by Mathematica Policy Research, Inc.
10. (back) 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.
11. (back) 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.
12. (back) Personal communication, HHS Budget Office, April 17, 2008.
13. (back) The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (H.R. 1298, P.L. 108-25), signed into law on May 27, 2003.
14. (back) Fact Sheet, Office of the Spokesman, U.S. Department of State, December 13, 2002, at http://www.state.gov/r/pa/prs/ps/2002/15583.htm.
15. (back) For additional information, see CRS Report RL33771, Trends in U.S. Global AIDS Spending: FY2000-FY2008, by [author name scrubbed]; CRS Report RL33485, U.S. International HIV/AIDS, Tuberculosis, and Malaria Spending: FY2004-FY2008, by [author name scrubbed]; CRS Report RL31712, The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Background, by [author name scrubbed]; CRS Report RL34192, PEPFAR: From Emergency to Sustainability, by [author name scrubbed]; CRS Report RL32001, HIV/AIDS in the Caribbean and Central America, by [author name scrubbed]; and CRS Report RL33584, AIDS in Africa, by [author name scrubbed].
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