Senate testimony on FY26 appropriations for HIV and hepatitis

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

Regarding Fiscal Year 2026 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, Substance Abuse and Mental Health Services Administration and the National Institutes of Health

On behalf of the HIV+Hepatitis Policy Institute, which promotes quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions, we respectfully submit this testimony in support of maintaining funding for domestic HIV and hepatitis programs in the FY 2026 Labor, HHS, Education, and Related Agencies appropriations bill. 

This Subcommittee has historically shown bipartisan leadership in supporting a public health infrastructure capable of combatting infectious diseases and ending epidemics. We as a nation have the tools to eliminate both HIV and viral hepatitis, but only if appropriate resources are allocated. Infectious diseases know no geographic borders, so even though municipalities and states throughout the country play pivotal roles in public health, it is essential that the federal government supports a strong infrastructure enabling them to implement innovative prevention strategies and effective treatment programs based on the latest scientific research.

We appreciate that over the past several years, the Subcommittee has sustained funding for domestic HIV and hepatitis programs. We urge you to continue to provide the resources for these programs that are supporting millions of people in need of treatment and protecting millions more from dangerous infectious diseases and related costly medical care.

As we make our requests for FY 2026, we must relay our deep disappointment with the administration’s decimation of many prevention programs. Specifically, we are troubled by the proposed elimination of the Centers for Disease Control and Prevention’s (CDC’s) HIV prevention and surveillance programs, a negligent and harmful proposal that will result in an increased number of HIV infections and higher healthcare costs in the future. Our nation’s essential prevention and surveillance functions cannot be conducted through the Ryan White HIV/AIDS Program which by law only supports treatment programs. We ask the Subcommittee to continue to fully fund domestic HIV prevention and surveillance programs.

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, and reject the proposed elimination of the Secretary’s Minority HIV/AIDS Fund and the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Minority HIV/AIDS Initiative programs.

The administration should not unilaterally eliminate critical prevention, treatment and research grant funding which Congress has appropriated and that states, local governments, and community-based organizations rely on to carry out their public health responsibilities to address HIV and other infectious diseases.  We also request that the Subcommittee urge the administration to immediately release appropriated FY 2025 funds for prevention that are now delayed, causing severe contracting issues and staffing disruptions.

As a nation, we are able to advance efforts to end the HIV and viral hepatitis epidemics. We possess proven prevention tools, including pre-exposure prophylaxis medication (PrEP), and effective treatments. We urge you to continue your historically strong commitment and leverage this pivotal moment to support the nation’s public health by comprehensively addressing these chronic diseases. Increased investment – and certainly not cuts – in surveillance, education, prevention, and care and treatment will lead to further progress in reducing HIV and viral hepatitis and allow us to continue to hold the promise of ending these epidemics.

The following is a description, including recommended funding levels, of the vital programs we urge you to support.

Ending the HIV Epidemic (EHE) Initiative
Congress has supported EHE through appropriations that have enhanced prevention programs at CDC and both treatment and prevention programs at the Health Resources Services Administration (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.  Between 2021-2023, more than 61,000 people were prescribed PrEP in the CDC EHE-funded programs, and HRSA-supported community health centers provided PrEP services to 183,000 patients. Also, under EHE, the Ryan White HIV/AIDS Program supported more than 22,000 clients new to care and re-engaged 19,000 clients, with 79.2% of those new to treatment achieving viral suppression in 2022. With EHE funding, 406 community health centers conducted a cumulative 7.2 million HIV tests, substantially increasing the proportion of their patients aware of their HIV status. Also, Indian Health Service EHE-supported sites have performed over 20,000 HIV tests. 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.

While the administration’s FY2026 budget proposal maintains funding for EHE, it also eliminates nearly $800 million in nationwide surveillance, testing, education and outreach programs. Continuing EHE, which currently only focuses on 57 distinct geographic areas, while eliminating the entire nation’s prevention and surveillance, would result in a failure of the EHE initiative, as its implementation depends upon existing program resources that would be cannibalized to fill the void left by the eliminated foundational CDC prevention programs.

For FY 2026, we urge the Subcommittee to fund EHE activities at the following levels:

• $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 is the payer of last resort for people living with HIV, providing medications, medical care, and essential support services to more than 576,000 low-income, uninsured, and underinsured individuals.  More than 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. 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. More than 90% of Ryan White clients have achieved viral suppression, compared to just 65% of all people diagnosed with HIV nationwide.

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. Ryan White can play a key role in bringing the approximately 400,000 people living with HIV in the U.S. who are not engaged in care into care and treatment.  Addressing these gaps is essential to achieving the goal of ending the epidemic, and Ryan White is an essential program in communities most severely affected by HIV through its distribution of funds to grantees. Proposed changes in Medicaid eligibility and the ACA in the budget reconciliation bill could force many more people with HIV into Ryan White coverage, further straining the program’s limited resources. We urge the Subcommittee to fund the Ryan White HIV/AIDS Program at a total of $3.024 billion in FY2026, an increase of $453.4 million over FY2025 (+$193.6 million for the EHE initiative and +$68 million for AIDS Drug Assistance Programs).

Prevention
HIV prevention, including PrEP, HIV testing and linkage to care, is 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, saving an estimated $15.1 billion in lifetime medical costs, and confirming 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. The administration’s proposed budget for FY2026 eliminates $793.7 million in HIV prevention activities at CDC. If enacted by Congress, this would be a devastating death knell to health departments and community-based organizations across the country. For FY 2026, we urge the Subcommittee to support the CDC Division of HIV Prevention at $822.7 million in FY2026 (+ $67.1 million) and include specific language in the bill directing the administration to preserve this function.

PrEP
Increasing access to PrEP is the key to ending the HIV epidemic in the United States. Long-acting PrEP options, including a six-month injectable, are expected to improve uptake and adherence, further advancing prevention objectives. A recent study published in the Annals of Epidemiology in June of 2025 estimates the number of people needing PrEP in the U.S. as being 2.2 million. Unfortunately, only one in five people at risk of acquiring HIV have access to PrEP.  Expanding access to PrEP nationwide is imperative and increasing CDC’s base HIV prevention and EHE funding, along with HRSA’s EHE funding for community health centers, will help ensure PrEP activities can be expanded, particularly for the uninsured. We urge the Subcommittee’s continued support for expanding PrEP access and advancing programs aimed at increasing PrEP uptake, which are driving factors in ending the HIV epidemic.

Minority AIDS Initiative and SAMHSA HIV Block Grant
Racial and ethnic minorities continue to be disproportionately impacted by HIV and represent the majority of new cases in the U.S. The Minority AIDS Initiative (MAI) was established to support community-based organizations that serve minority communities to help them develop capacity and implement culturally and linguistically appropriate services, with the Minority HIV/AIDS Fund specifically supporting cross-agency prevention and treatment initiatives. SAMHSA’s MAI program targets funding for prevention, testing, linkage to care, treatment and support services for individuals at risk of mental illness and/or substance abuse. These programs have been tremendously successful over the last two decades, and outcomes associated with them include an increase in people with permanent housing, a decrease in interactions with the criminal justice system of individuals who sustained no drug use, and a significant increase in the number of individuals sustained in community services. We urge the Subcommittee to reject the administration’s elimination of the MAI in its FY 2026 budget proposal and sustain and fund the MAI at $60 million in FY 2026. We also urge the Subcommittee to fund SAMHSA’s MAI programs at $160 million and include language that would modernize the way in which states qualify to be eligible for the HIV set-aside of the Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG). Instead of using the outdated measurement of AIDS cases for a state to qualify for the 5% HIV set-aside, the number of HIV cases should be used, which would expand the number of eligible states.

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 to an increase in new viral hepatitis cases. There are several curative treatments available for HCV, but individuals must have access to screening and linkage to care.

The viral hepatitis programs at the CDC are severely underfunded, receiving only $43 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. For FY 2026 we urge the Subcommittee to maintain the CDC Division of Viral Hepatitis by providing it with $150 million, an increase of $107 million over FY2025 enacted levels, and oppose efforts by the administration to combine hepatitis prevention into a block grant that would include STD prevention, tuberculosis prevention, and the Opioid-Related Infectious Diseases Program. While we support a coordinated approach to preventing the syndemic nature of these diseases, this block grant mechanism ultimately dilutes funding for each of these diseases and leaves states without policy leadership and guidance.

Federal HIV & Hepatitis Coordination
The HHS Office of Infectious Disease and HIV/AIDS Policy coordinates the implementation of the National HIV/AIDS Strategy, EHE and viral hepatitis activities across the federal government. We urge the Subcommittee to continue to support funding for these activities at $7.8 million and ensure that it includes funding to support the President’s Advisory Council on HIV/AIDS (PACHA).

NIH Office of AIDS Research
The administration’s shortsighted FY 2026 budget proposal cuts the NIH Office of AIDS Research budget by a shocking 42%, dramatically reducing support for research priorities, including vaccine, treatment and cure research.  In addition to advancing better drug therapies and prevention interventions, advances in HIV research have led to new vaccines, treatments and medication for other diseases, including cancer, Alzheimer’s, tuberculosis and COVID-19. We urge the Subcommittee to maintain funding and support the Office of AIDS Research.

Related Programs
A holistic response to the HIV epidemic also depends on maintaining other priority programs at HHS, and we wholeheartedly oppose the administration’s FY 2026 budget proposal which eliminates funding for: the Title X Family Planning Program, which funds health centers that provide contraceptive care, HIV and STD screening and treatment, cancer screening, and sexual health education; the Office of Adolescent Health, which provides funding to expand access in schools for health services and evidence-based health education to address the 20% of new HIV infections among people between the ages of 13 and 24; and the Teen Pregnancy Prevention Program, which supports initiatives to provide youth with evidence-based information to prevent unintended pregnancies, HIV and other STDs.  We urge the Subcommittee to reject the administration’s proposal to cut these programs, which ignores evidence-based, effective strategies to prevent and treat infectious diseases in vulnerable populations.

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.