President Seeks to Increase ADAP,
Decrease Prevention Funding

For the first time since becoming president, George W. Bush has proposed a significant funding increase for the AIDS Drug Assistance Program (ADAP) beginning in fiscal 2004. Unfortunately, the president also proposed reducing funds available for domestic HIV prevention services and providing no funding increases for essential medical and social services through the Ryan White CARE Act.

"We commend the president for recognizing the essential role of ADAP to the health and well-being of thousands of low-income and uninsured Americans," said David Munar, associate director at the AIDS Foundation of Chicago (AFC). "However, funding cuts for HIV prevention programs do our nation a disservice. We need to increase not decrease our efforts in prevention. And we need to ensure that AIDS-related medical and support services remain available for all who need them."

With the notable exception of ADAP, which would receive a $100 million increase, the budget plan provides no funding increases for the various programs of the Ryan White CARE Act. This is the president's third consecutive budget to recommend level funding for medical and other essential services of the CARE Act as well as for the AIDS Education and Training Centers. The proposed increase for ADAP would put the program's total appropriation at $739 million, which is still at least $200 million short of the estimated amount needed for the program nationwide. Because the House and Senate are currently negotiating final appropriations for fiscal 2003, which began October 1, Congress could decide soon to appropriate the full $739 million for ADAP in FY03.

The president's FY04 proposal reduces funding for the Centers for Disease Control and Prevention (CDC) for domestic HIV prevention programs by $858,000, for a total appropriation of $690 million. However, a budget description by the U.S. Department of Health and Human Services (HHS) indicates that domestic HIV prevention services would be level-funded. According to HHS's "Performance and Management Assessments," the department determined that CDC's domestic HIV prevention programs have "not demonstrated" results and therefore recommends "level funding to continue to address the estimated 40,000 new infections." The detailed budget posted online by the CDC shows a net decrease for domestic HIV prevention services of $858,000.

Housing Opportunities for People with AIDS (HOPWA), an emergency housing assistance program, received a $5 million increase in the president's plan, raising the total request to $297 million. While the increase is commendable, AFC remains concerned that it will be insufficient to accommodate all areas, including Chicago and Illinois, that are eligible for HOPWA funding. Having safe and affordable housing is essential to the health of HIV-positive people.

AFC is also concerned that the administration's plans to "revamp" Medicaid will give states incentives to reduce benefits or limit eligibility to the program, which could dramatically affect the availability of healthcare for HIV-positive people on Medicaid. The budget plan proposes giving states broad flexibility to alter benefits for nearly one-third of current recipients, including people living with HIV. Significant changes to Medicaid, the largest single payer of HIV/AIDS services, could have a negative impact on healthcare availability for low-income people with disabilities.

On a positive note, the budget plan does offer important increases for global AIDS relief, which was among the core items raised in the president's January 28 State of the Union address. Global AIDS advocates are now requesting the U.S. to spend at least $3 billion of the proposed five-year $15 billion commitment in FY04. The FY04 budget, however, commits only about $2 billion to global AIDS relief, with less than $1 billion in new funding.

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The AIDS Foundation of Chicago (AFC) is Illinois' principal advocate for people living with and at risk for HIV disease. Established in 1985 to provide central leadership in the fight against the epidemic, AFC promotes sound HIV/AIDS public policy, funds HIV/AIDS care and prevention projects, and through its Service Providers Council, helps to coordinate the delivery of essential HIV/AIDS services.