House testimony on FY27 funding for domestic HIV and hepatitis programs

Testimony for the Record Submitted by Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute, for the House Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies

Regarding Fiscal Year 2027 Appropriations for HIV and Hepatitis Programs at the Department of Health and Human Services and its Centers for Disease Control and Prevention, Health Resources Services Administration, National Institutes of Health, and Substance Abuse and Mental Health Services Administration

The HIV+Hepatitis Policy Institute respectfully submits this testimony in support of increased funding for domestic HIV and hepatitis programs at the Department of Health and Human Services for FY 2027. Specifically, this testimony is in support of funding for the following initiatives, programs and divisions: Ending the HIV Epidemic Initiative – $395 million for the CDC Division of HIV/AIDS Prevention, $358.6 million for the HRSA Ryan White HIV/AIDS Program, $207.3 million for the HRSA Community Health Centers, and $52 million for the Indian Health Service; Ryan White HIV/AIDS Program – $3.13 billion; CDC Division of HIV Prevention – $822.7 million; CDC Division of Viral Hepatitis – $150 million; and the HHS Office of Infectious Disease and HIV/AIDS Policy – $7.6 million.  We also support maintaining funding for CDC’s Eliminating Opioid-Related Infectious Diseases Program and Division of Adolescent and School Health; the Minority HIV/AIDS Initiative; AIDS Research at the NIH; the Title X Family Planning Program; the Teen Pregnancy Prevention Program; and the SAMHSA Hepatitis C Elimination Initiative Pilot.

Testimony
1.2 million people in the United States are living with HIV, and in 2023, more than 39,000 new HIV cases were diagnosed.  Today’s prevention and treatment options provide us the opportunity to actually end the epidemic, with antiretroviral treatment that enables people with HIV to live healthier lives and reach viral suppression, and PrEP, the revolutionary pre-exposure prophylaxis medication that prevents HIV infection. In 2019, President Trump announced the Ending the HIV Epidemic initiative (EHE) which set the goal of reducing new HIV cases by 90% by 2030. EHE has demonstrated that the existing CDC prevention and HRSA treatment and care infrastructure can be scaled up to significantly reduce HIV transmission in areas of high HIV prevalence. Although transmissions have declined and viral suppression rates have increased in EHE areas, we remain far from its goals and will continue to fall short without increased funding. The administration’s proposal to dramatically reduce funding levels, including cutting HIV prevention from over $1 billion to just $220 million, will certainly not lead to the end of the HIV epidemic. The proposed reorganization and consolidation of HIV programs at HHS should be carefully considered and analyzed and include input from stakeholders and the authorizing committees of the Congress.

In communities across the nation, state and local health departments, community health centers and community-based organizations are doing the testing, linkage to care, linkage to PrEP services, surveillance, and rapid outbreak response, but they need more resources. Ending the HIV epidemic not only depends on prolific prevention programs, but also the linkage of people with HIV to treatment. While two-thirds of people in the U.S. with HIV are in treatment, one-third are not.  Closing this gap through testing, linkage to care, and providing access to treatment medication is integral to public health and for the nation’s fiscal health as well. Every dollar spent preventing a new HIV infection avoids an estimated $1.3 million in lifetime medical costs.

Our funding requests support increased investment – and certainly not cuts – in surveillance, education, prevention, and care and treatment that will lead to further progress in reducing HIV and viral hepatitis.

Ending the HIV Epidemic
Congress has supported EHE through appropriations that have enhanced prevention programs at the CDC and treatment programs at HRSA, with the goal of reducing new HIV cases to less than 3,000 per year.  The initiative, which is currently focused on jurisdictions representing about 50% of HIV diagnoses, has shown success by targeting funding to areas of higher HIV prevalence, supporting increased testing, expanding access to prevention medication and linking people with HIV to appropriate medical care.

EHE’s impact on HIV in this country has been noteworthy. From 2017 to 2022, in jurisdictions receiving EHE funding, new HIV cases decreased 21%, compared to a 6% decrease in non-EHE jurisdictions, largely due to increased access to PrEP. With EHE funding, CDC grant recipients have tested over 1,000,000 people for HIV, delivered 600,000 self-tests, and connected 61,000 people to PrEP.  In 2024, HRSA-supported community health centers provided PrEP services to 60,854 people, and 406 community health centers conducted more than 4.3 million HIV tests, substantially increasing the proportion of their patients aware of their HIV status.

Notwithstanding EHE’s demonstrated successes, without an infusion of new resources to accelerate our efforts, we will continue to fall short of the intended goals even though we have the tools to achieve them.  We simply need Congress to provide the resources.  For FY 27, we urge the Subcommittee to fund EHE activities at the levels outlined below to accelerate our efforts to end HIV in the prioritized jurisdictions:

• $395 million for the CDC Division of HIV/AIDS Prevention for testing, linkage to care, and prevention services, including PrEP (+$175.0 million);
• $358.6 million for the HRSA Ryan White HIV/AIDS Program to expand comprehensive care and treatment for people living with HIV (+$193.6 million);
• $207.3 million for the HRSA Community Health Centers to increase access to prevention services, particularly PrEP (+$50.0 million); and
• $0 million for the Indian Health Service to address the disparate impact of HIV and hepatitis C on American Indian/Alaska Native populations (+ $47.0 million).

HIV
HRSA’s Ryan White HIV/AIDS Program (Ryan White) is the payer of last resort for people living with HIV, providing medications, medical care, and essential support services to more than 600,000 low-income, uninsured, and/or underinsured individuals.  Nearly 60% of Ryan White clients are living at or below the Federal Poverty Level.  The program continues to be a critical pillar in the federal response to HIV, providing treatment and care to more than 50% of people diagnosed with HIV in the U.S. More than 91% of Ryan White clients have achieved viral suppression, compared to just 67% of all people diagnosed with HIV nationwide.

People living with HIV who are in care and on treatment are far more likely to be virally suppressed, leading to reduced transmission of the virus. This program is especially important in many states that have not expanded Medicaid, particularly in the South, where there are large healthcare coverage gaps. Despite this progress, approximately 40% of people with HIV in the U.S. are either undiagnosed or not receiving regular care, contributing to most new HIV cases. Addressing these gaps is essential to achieving the goal of ending the epidemic, and Ryan White plays a pivotal role in supporting communities most severely affected by HIV through its distribution of funds to grantees.

Upcoming changes in Medicaid eligibility and increasing premiums in health marketplaces are expected to result in more people moving into discretionary safety net health programs, including the under and uninsured seeking treatment through the Ryan White HIV/AIDS Program.  Of particular concern this year is the Ryan White Program’s AIDS Drug Assistance Program (ADAP). In FY 2027, 19 states anticipate ADAP funding shortages due to an increasing number of people with HIV enrolling in ADAPs, people losing access to Medicaid and other health care coverage due to higher premiums, and rising costs. As of February 2026, five states have already changed ADAP income eligibility requirements, disenrolling patients. Without additional funding, more states are expected to take similar actions. We are urging Congress to increase ADAP funding, which has remained at $900 million since 2013, by $175 million. We also ask the Subcommittee to reject the administration’s proposed elimination of Part F of the Ryan White HIV AIDS Program, which funds dental reimbursements, clinical training, and community-driven research.

We urge the Subcommittee to fund the Ryan White HIV/AIDS Program at a total of $3.130 billion in FY27, an increase of $559.4 million over FY26 (+$193.6 million for the EHE initiative and +$175 million for AIDS Drug Assistance Programs).

Prevention
HIV prevention methods, including PrEP, HIV testing and linkage to care, are more effective than ever.  CDC’s Division of HIV Prevention leads federal efforts in developing innovative prevention strategies, working closely with state, local, and community-based organizations to meet the disease prevention needs of their populations. Spearheaded by CDC’s prevention programs, between 2012 and 2022, 27,900 HIV cases were prevented which saved an estimated $15.1 billion in lifetime medical costs. This confirms that HIV prevention efforts are clinically and fiscally impactful. Increasing funding for high-impact, community-focused HIV prevention services through the CDC’s Division of HIV Prevention remains a priority and results in a strong return on investment. We urge you to support the CDC Division of HIV Prevention at $822.7 million in FY27 (+ $67.1 million).

PrEP
Increasing access to PrEP is the key to ending the HIV epidemic in the U.S. Long-acting PrEP options, including new long-acting agents, are expected to improve uptake and compliance, further advancing prevention objectives. The CDC estimates that 2.2 million people in the United States could benefit from PrEP; however, only 600,000 people are using PrEP. Expanding access to PrEP nationwide is imperative. Increasing CDC’s base HIV prevention and EHE funding, along with HRSA’s EHE funding for community health centers will help ensure PrEP activities are expanded, particularly for the uninsured.

Related Programs
A holistic response to the HIV epidemic also depends on maintaining and funding other priority programs at HHS, including the Secretary’s Minority HIV/AIDS Fund and the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Minority HIV/AIDS Initiative programs, which the administration’s proposed budget would eliminate. We also support maintaining funding for CDC’s Eliminating Opioid-Related Infectious Diseases Program and Division of Adolescent and School Health, AIDS Research at the NIH, the Title X Family Planning Program, and the Teen Pregnancy Prevention Program (TPPP).

Viral Hepatitis
We urge the Subcommittee to provide increased funding for viral hepatitis programs at CDC, which estimates that nearly 5 million people in the United States live with hepatitis B (HBV) or hepatitis C (HCV), and as many as 65% are unaware they are living with the disease. Left untreated, viral hepatitis results in significant costs to public health programs due to liver cancer and liver transplants. Liver transplants were estimated at over $800,000 per procedure in 2021, so, with approximately 1,500 liver transplants annually due to HCV, $1.2 billion avoidable medical costs are being incurred. The opioid epidemic continues to lead the increase in new viral hepatitis cases. SAMHSA’s Hepatitis C Elimination Pilot, currently funded at $100 million and slated for elimination in the President’s budget, is an integrated care model supporting 19 community-based organizations across the country in HCV testing, treatment and cure for people with risk factors for substance use, mental health challenges, and homelessness. There are several curative treatments available for HCV, but individuals must have access to screening and linkage to care. The administration’s proposed budget eliminates $46 million in dedicated funding for hepatitis prevention at the CDC and instead proposes a $300 million combined program that would include STD and tuberculosis prevention, totaling $70 million less than current funding. The proposed budget also ends the opioid-related infectious diseases program.  

The viral hepatitis programs at the CDC are severely underfunded, currently receiving only $46 million, far short of what is needed to build and strengthen our public health response to all forms of hepatitis. Increased investment would allow the CDC and the states to enhance testing and screening programs, conduct additional provider education, enhance clinical services specific to hepatitis at sites serving vulnerable populations, and increase services related to hepatitis outbreaks and injection drug use.

We urge you to provide the CDC Division of Viral Hepatitis with $150 million, an increase of $104 million over FY26 enacted levels, and provide funding to continue SAMHSA’s Hepatitis C Elimination Pilot.

Federal HIV & Hepatitis Coordination
In order to achieve successful implementation of the National HIV/AIDS Strategy (NHAS), EHE and viral hepatitis programs, resources are needed to strategically coordinate HIV and viral hepatitis activities across the federal government. We urge you to fund the HHS Office of Infectious Disease and HIV/AIDS Policy at $7.6 million.

While we recognize that many in Congress are looking to reduce government spending across the board, we urge you to consider that focused investment in public health programs provides long-term savings by addressing chronic disease and keeping people healthy. We respectfully urge the Subcommittee to continue its investment in our nation’s public health infrastructure specifically as it relates to addressing the ongoing HIV and hepatitis epidemics.