Statement to the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Written Statement of Carl Schmid, Deputy Executive Director,the Aids Institute to the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies House Committee on Appropriations.
April 12, 2010

Dear Chairman Obey and Members of the Subcommittee:

The AIDS Institute, a national public policy research, advocacy, and education organization, is pleased to comment in support of critical HIV/AIDS and Hepatitis programs as part of the FY2011 Labor, Health and Human Services, Education and Related Agencies appropriation measure. We thank you for your support of these programs over the years, and trust you will do your best to adequately fund them in the future in order to provide for and protect the health of many Americans.
 
HIV/AIDS
HIV/AIDS remains one of the world’s worst health pandemics in history. According to the CDC, 583,298 people have died of AIDS in the U.S. In 2008, the CDC announced that its estimate of new infections per year is now 56,300, which is 40 percent higher than previous estimates. That translates into a new infection every 9 ½ minutes. At the end of 2007, an estimated 1.1 million people in the U.S. were living with HIV/AIDS.

Persons of minority races and ethnicities are disproportionately affected by HIV/AIDS. African Americans, who make up 12% of the US population, account for half of the HIV/AIDS cases. HIV/AIDS also disproportionately affects the poor, and about 70 percent of those infected rely on publicly funded health care.

The U.S. government has played a leading role in fighting HIV/AIDS, both here and abroad. The vast majority of the discretionary programs supporting HIV/AIDS efforts domestically are funded through your Subcommittee. The AIDS Institute, working in coalition with other AIDS organizations, has developed funding request numbers for each of these domestic AIDS programs. We ask that you do your best to adequately fund them at the requested level.

We are keenly aware of budget constraints and competing interests for limited dollars. Unfortunately, despite the growing need, domestic HIV/AIDS programs have experienced only very minor increases in recent years. We are pleased that President Obama continues to focus on domestic HIV/AIDS programs and has proposed increases for prevention and treatment. We hope you will support the President’s desire and increase funding for these important public health programs.  Federal funding is particularly critical at this time since state and local budgets are being severely cut during this economic downturn.  Many states and local governments have greatly cut their HIV prevention and HIV/AIDS care programs at the very same time demand for services are escalating. 

Below are The AIDS Institute’s program requests and supporting explanation:

Centers for Disease Control and Prevention-HIV Prevention and Surveillance
FY2010:                $728 million
FY2011 Community Request:    $1,606 million    

As stated above, the CDC has increased the estimate of people infected each year by 40 percent. New infections are particularly occurring in certain populations, including African-American men and women and men who have sex with men.. In order to address the specific needs of these populations and the increased number of people infected, CDC is going to need additional funding. Currently, the United States spends only about 4 percent of its domestic HIV/AIDS spending on prevention. 

 The AIDS Institute is extremely supportive of President Obama’s budget request to “begin a focused initiative to prevent HIV through holistic and integrated approached to protect the health of gay, bisexual, and other MSM.”  We congratulate the President for proposing additional funding and for focusing it on gay men, which represent a majority of HIV cases in the U.S and is the only group in which the rate of infection is growing.

Unfortunately, the $31 million increase for FY11 requested by the President is far from what is needed to significantly reduce the number of new HIV infections.  According to the CDC’s professional judgment budget, an additional $878 million for each of the next five years is necessary to improve HIV prevention efforts and reduce HIV transmission in the United States. Therefore, The AIDS Institute supports an increase for CDC HIV prevention funding by $878 million in FY11.

This additional funding would be targeted toward: 1) Increasing HIV testing and the number of people who are reached by effective prevention programs; 2) developing new tools to fight HIV with scientifically-proven interventions; and 3) improving systems to monitor HIV and related risk behaviors, and to evaluate prevention programs.

Investing in prevention today will save money tomorrow. Every case of HIV that is prevented saves, on average, $1 million of lifetime treatment costs for HIV. The CDC estimates that the cost of treating the estimated 56,300 new HIV infections in 2006 will translate into $9.5 billion in annual future medical costs.

In order to implement the goals and objectives that will be contained in the National HIV/AIDS Strategy, which will be released by the President this summer, additional resources will be necessary.  At a time when state and local HIV prevention budgets are being cut, just to keep at the current funding levels will require a level of resources greater than what has been proposed. 

The AIDS Institute is concerned about any effort that would actually reduce the level of HIV prevention dollars at the state level.  That is why we are opposed to language requested by the Administration that would allow states to move up to 10 percent of its CDC funding, including HIV funding, to address the top six leading causes of death. 

Ryan White HIV/AIDS Programs
FY2010:                $2,290.9 million
FY2011 Community Request:    $3,101.5 million    

The centerpiece of the government’s response to caring and treating low-income people with HIV/AIDS is the Ryan White HIV/AIDS Program. Ryan White currently serves over half a million low-income, uninsured, and underinsured people each year.  In FY10, the Program received an increase of $53 million, or just 2.3 percent. This increase does not even cover the rate of inflation. The AIDS Institute urges you to provide substantial funding increases to all parts of the Ryan White Program. Consider the following:

1) Caseload levels are increasing. People are living longer due to lifesaving medications; there are over 56,000 new infections each year; and increased testing programs, according to the CDC, will identify 12,000 to 20,000 new people infected with HIV each year. With rising unemployment, people are losing their employer-sponsored health coverage.

2) State and local budgets are experiencing cutbacks due to the economic downturn.  A recent survey by the National Alliance of State and Territorial AIDS Directors found that state HIV/AIDS funding reductions totaling more than$170 million occurred in 29 states during FY09.  The situation for this year and next will be even worse. Thirty-three states who participated in the survey anticipate a decrease in state funding this year.

3) There are significant numbers of people in the U.S. who are not receiving life-saving AIDS medications. An IOM report concluded that 233,069 people in the U.S. who know their HIV status do not have continuous access to Highly Active Antiretroviral Therapy.
Specifically, The AIDS Institute requests the following funding levels for each part of the Program:
Part A provides medical care and vital support services for persons living with HIV/AIDS in the metropolitan areas most affected by HIV/AIDS. We request an increase of $225.9 million, for a total of $905 million.
Part B base provides essential services including diagnostic, viral load testing and viral resistance monitoring and HIV care to all 50 states, DC, Puerto Rico, and the territories. We are requesting a $55.9 million increase, for a total of $474.7 million.
The AIDS Drug Assistance Program (ADAP) provides life-saving HIV drug treatment to over 150,000 people, the majority of whom are people of color (59%) and very poor (74% are at or below 200% of the federal poverty level). Currently, ADAPs are experiencing unprecedented growth. The monthly growth of 1,271 clients is an increase of 80 percent from FY2008 when ADAPs experienced an average monthly growth of 706 clients.  Due to a lack of funding, states have instituted waiting lists and have reduced the number of drugs on their formularies, reduced eligibility and capped enrollment.  At the end of March, there were 777 people in eleven states on ADAP waiting lists.  In order to address the ADAP funding crisis, which will grow even worse in FY11, we are requesting an increase of $370.1 million for a total of $1,205.1 million.
Part C provides early medical intervention and other supportive services to over 248,000 people at over 380 directly funded clinics. We are requesting a $131 million increase, for a total of $337.9 million.
Part D provides care to over 84,000 women, children, youth, and families living with and affected by HIV/AIDS. This family-centered care promotes better health, prevents mother-to-child transmission, and brings hard-to-reach youth into care. We are requesting a $7.0 million increase, for a total of $84.8 million.
Part F includes the AIDS Education and Training Centers (AETCs) program and the Dental Reimbursement program. We are requesting a $15.2 million increase for the AETC program, for a total of $50 million, and a $5.4 million increase for the Dental Reimbursement program, for a total of $19 million.
For FY11, the President requested an increase of only $39.5 million, or just 1.7 percent, for the entire Ryan White Program and no increase for Parts A and D of the Program.  The AIDS Institute urges the Subcommittee to consider the growing needs of all Part of the Ryan White Program and provide the necessary resources it requires to meet the needs of people living with HIV/AIDS in the U.S.

National Institutes of Health-AIDS Research
FY 2010:                $3.1 billion
FY 2011 Community Request:    $3.5 billion

The NIH conducts research to better understand HIV and its complicated mutations, discover new drug treatments, develop a vaccine and other prevention programs such as microbicides, and ultimately develop a cure. The critically important work performed by the NIH not only benefits those in the U.S., but the entire world.

This research has already helped in the development of many highly effective new drug treatments, prolonging the lives of millions of people. As neither a cure nor a vaccine exists, and patients continue to build resistance to existing medications, additional research must continue. NIH also conducts the necessary behavioral research to learn how HIV can be prevented best in various affected communities. We ask the Committee to fund critical AIDS research at the community requested level of $3.5 billion.

Comprehensive Sex Education
President Obama and Congress took steps toward implementing comprehensive sexual education in FY10 by ending discretionary funded abstinence-only until marriage programs and creating the Teen Pregnancy Prevention Initiative.  We urge the Congress to continue no funding for abstinence only education programs.  Additionally, we believe the Teen Pregnancy Prevention Initiative should be expanded so that it addresses other aspects of sexual health, including HIV and STD prevention.

Syringe Exchange Programs
By eliminating the federal funding ban on syringe exchange programs in FY10, Congress allowed funding of a proven method to reduce the transmission of HIV and other infectious diseases. The AIDS Institute requests that you work to ensure that this ban is not reinstated.

Minority AIDS Initiative
The AIDS Institute supports increased funding for the Minority AIDS Initiative (MAI), which is funded by numerous federal agencies.  MAI funds services nationwide that address the disproportionate impact that HIV has on communities of color. We are requesting a $207.1 million increase across the MAI’s programs, for a total of $610 million.
 
Viral Hepatitis
The Institute of Medicine’s (IOM) recently released a report Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C.  It outlines a number of recommendations on how the incidence of Hepatitis B & C infections can be decreased. These recommendations include increased public awareness campaigns, heightened testing and vaccination programs, continued research, along with improved surveillance and other prevention programs. 

According to the IOM, 3.5–5.3 million people, or 1-2 percent of the US population are living with chronic Hepatitis B or C.  Because of their asymptomatic nature, the vast majority of infected people are unaware of their infection until they develop symptoms of cirrhosis or liver cancer.  There are an estimated 43,000 new acute Hepatitis B infections each year in the US.  The CDC estimates that 10 percent of people with Hepatitis B are co-infected with HIV and 25 percent of people with Hepatitis C are co-infected with HIV. 

Congress currently funds CDC’s Viral Hepatitis Division at only $19.3 million. Given the huge impact that Hepatitis B & C have on the health of so many people, and the large treatment costs, The AIDS Institute urges the federal government to make a greater financial commitment to Hepatitis prevention.  The AIDS Institute requests an increase of $30.7 million for the program, for a total of $50 million.

The AIDS Institute asks that you give great weight to our testimony as you deliberate over the FY2011 appropriation bill. Should you have any questions or comments, feel free to contact Carl Schmid, Deputy Executive Director, The AIDS Institute (202) 462-3042 or cschmid@theaidsinstitute.org.  Thank you very much.