President Joe Biden's proposed $7.3 trillion budget for Fiscal Year 2025 largely maintains domestic HIV and hepatitis spending, but advocates say that's not enough to meet the federal government's goal of reducing HIV infections by 90% by 2030.
Meanwhile, a federal lawsuit over PrEP coverage continues to make its way through the courts.
"It's disappointing we're facing flat funding when we have these programs, strategies and desires to end HIV, but we're not going to do it," Carl Schmid, gay man who is the executive director of the HIV + Hepatitis Policy Institute in Washington, D.C., told the Bay Area Reporter. "The president has proposed more money than the Congress has been allocating, but now even the president isn't proposing the money that we need."
The ink isn't even dry on the budget for Fiscal Year 2024. House Republicans had proposed cuts to domestic HIV spending in the amount of $767 million. The Senate didn't agree to the cuts in its own bipartisan budget bill.
To avoid a government shutdown, Biden signed a $1.2 trillion funding package Saturday, March 23, after approval from both houses of Congress. The president stated that the "bill I just signed keeps the government open, invests in the American people, and strengthens our economy and national security."
Some LGBTQ advocates are upset, however, that included in the bill is a ban on U.S. embassies flying the LGBTQ Pride flag, as the B.A.R. also reported — an initiative promoted by House Speaker Mike Johnson (R-Louisiana). The administration of then-President Barack Obama first started flying the flag at embassies in 2014.
A White House spokesperson told Axios that the White House "fought against the inclusion of this policy and we will continue to work with members of Congress to find an opportunity to repeal it" and that "We were successful in defeating 50+ other policy riders attacking the LGBTQI+ community that Congressional Republicans attempted to insert into the legislation."
Schmid stated as much to the B.A.R. on March 24.
"There were over 50 anti-LGBT amendments included in the House appropriations bills. Fortunately, through the negotiation process between the Democratic-led Senate and the White House, the Republican-controlled House backed down on almost all of them. It was remarkable that only one made it into law," Schmid stated.
Before this most recent government funding process was done, Biden released his budget for the upcoming fiscal year. Schmid said it's unusual for the two processes to be going on at once. He said the blame lies with House Republicans, who are proposing cuts the Senate and Biden won't accept, he said.
"This has gone on way too long — the [2024] fiscal year started October 1," Schmid said, referring to 2023. "There were a bunch of agreements before the beginning of the year but then the Republicans went lower with their bills."
Biden's proposal
Biden's budget proposal would increase funding toward the Ending the HIV Epidemic in the U.S. initiative by only $20 million over Fiscal Year 2023. Biden had proposed an increase of $277 million from FY 2023 to FY 2024. House Republicans had wanted to cut all funding toward the program — in spite of the fact it was launched under the Trump administration. The former president, now running again in this year's presidential race against Biden, touted it in his 2020 State of the Union address, stating, "we will eradicate the AIDS epidemic in America by the end of the decade."
And indeed the plan seeks to reduce the number of new HIV infections in the U.S. by 90% by 2030 for an estimated 250,000 total HIV infections averted. It has been continued by the Biden administration.
The proposed $20 million increase is in two areas — there's $10 million included for the Ryan White HIV/AIDS Program for care and treatment and $10 million for the Indian Health Service's efforts to combat HIV and hepatitis C.
The San Francisco AIDS Foundation, the largest HIV/AIDS nonprofit in the city, did not return a request for comment on the federal budget proposal.
Hepatitis C is caused by a blood-borne virus (HCV) that is commonly transmitted via needles and other drug injection equipment. It can also be transmitted from mother to child during pregnancy and can spread during sex, especially sex between men. About 25% of people with HCV clear the virus naturally, while the rest develop chronic infection that can lead to cirrhosis, liver cancer, and the need for a liver transplant. Direct-acting antiviral (DAA) tablets for treatment of the hep C virus have only been introduced in recent years.
Just over 1.7 million people were identified as ever having been infected with HCV, as indicated by a positive antibody test. The Viral Hepatitis National Strategic Plan for the United States calls for at least 80% of people with hepatitis C to be cured by 2030.
Separately, Biden's proposed spending plan for the Department of Justice includes $10 million for "a new initiative to reform outdated HIV criminalization statutes, which contribute to HIV-related stigma and discrimination," according to a news release from the institute. HIV criminalization reform became law in California in 2018, as the B.A.R. previously reported. (https://www.ebar.com/story.php?ch=news&sc=news&id=254213)
Schmid stated March 24, "We look forward to taking this proposal to the Congress to ensure that it is funded."
Schmid stated that new programs proposed by Congress will need agreement among service organizations and others.
"Authorizing any new government programs by Congress, including capping prescription drug costs, will take time and stakeholder consensus. We look forward to these historic opportunities," Schmid stated in the news release.
"In the meantime, for immediate outcomes for people at risk of HIV and who live with hepatitis C, we need increased funding now," he added. "Additionally, we must ensure that existing government programs, funding streams, and grantees, along with payers such as Medicaid, Medicare, and private insurance, are all working and held accountable for achieving results."
Schmid told the B.A.R. that while Biden proposed a national PrEP program for the third year in a row, he "can't see that happening this year" with a GOP-led House.
"Same thing with the hep C elimination program as well," he said. "It's nice that they're in there but we need to deal with reality. More money for hep now. More money for PrEP now. These items will probably take years for Congress to consider.
"My hope is we get the current funding and no cuts for this year," he added.
PrEP, or pre-exposure prophylaxis, refers to the use of antiviral drugs to prevent people exposed to HIV from becoming infected. The pill Truvada was first approved for PrEP use in 2012 by the U.S. Food and Drug Administration; since then the FDA has also approved the pill Descovy for some groups, and the drug Apretude as an injectable treatment.
As the B.A.R. reported last year, Centers for Disease Control and Prevention numbers show that a little over one-third of people nationwide who could benefit from PrEP were on it in 2022, and there continue to be major disparities among white, Black, and Latino Americans. Numbers from San Francisco show a much larger proportion of people on PrEP than nationally, and show the same racial and ethnic disparities, but less dramatically so.
PrEP lawsuit update
A group of business owners is suing the federal government on account of the U.S. Preventive Services Task Force's requirements that preventative services such as sexually transmitted disease screenings, depression, and PrEP be covered.
As the B.A.R. reported last June, in the case of Braidwood Management v. Xavier Becerra, the plaintiffs are arguing that covering PrEP makes them "complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman."
U.S. District Judge Reed O'Connor of the Northern District of Texas, appointed by then-President George W. Bush, agreed with the plaintiffs last year, but the implementation of his decision beyond the plaintiffs in the case has been put on hold while the lawsuit works its way through the courts.
On March 4, the 5th U.S. Circuit Court of Appeals heard oral arguments.
"Based on those arguments, it seems like we may not win there and so it'll probably be appealed to the [U.S.] Supreme Court," Schmid said.
The HIV + Hepatitis Policy Institute joined an amicus brief submitted to the appellate court.
"A wholesale invalidation of the coverage requirement for USPSTF's recommendations would strike a critical, unnecessary, and costly blow to the battle to end HIV, hepatitis, and other infectious diseases," the brief states. "Removing access to evidence-based preventive measures will have a devastating impact, not only on those living with HIV and hepatitis, but also for those at risk for acquiring HIV and hepatitis and the population at-large."
LGBTQ Agenda is an online column that appears weekly. Got a tip on queer news? Contact John Ferrannini at [email protected]
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