President Biden’s formal budget proposal for the U.S. government in the upcoming fiscal year has advocates in the fight against HIV/AIDS cheering over the commitment to increase funds to confront the domestic epidemic, although one group is criticizing the proposal for seeking to flat-fund international programs.

The fiscal year 2022 proposal, unveiled last Friday, would afford an additional $246 million for domestic HIV testing, prevention and treatment programs for the Ending the HIV Epidemic initiative, which seeks to end HIV by 2030, and would also provide a general boost of $46 million to Ryan White HIV/AIDS programs and $20 million for HUD’s Housing Opportunities for People with AIDS (HOPWA).

Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, said in a statement Biden is “demonstrating his commitment to ending HIV in the United States” in the budget request to Congress.

“While it falls short of what is needed and the community has requested, if this funding is realized it will continue the momentum already created and make further progress in ending HIV in the U.S. Efforts to end HIV will help eradicate an infectious disease that we have been battling for the last 40 years and help correct racial and health inequities in our nation,” Schmid said.

The total $670 million requested by the White House for the Ending the HIV Epidemic initiative breaks down as follows:

• Centers for Disease Control & Prevention:  $100 million in new money for a total of $275 million;
• Ryan White:  $85 million in new money for a total of $190 million;
• Community Health Centers for PrEP:  $50 million in new money for a total of $152 million;
• National Institues of Health:  $10 million in new money for a total of $26 million;
• Indian Health Services: $22 million in new money for a total of $27 million.

Counterinituitively, each of those numbers is actually below what the Trump White House proposed in the previous administration’s final budget request, with the exception of the proposed increase in money for Community Health Centers for PrEP and flat-lining for money for Indian Health Services.

The requested increase in funds for the Ending the HIV Epidemic was expected. Biden had signaled he’d seek the additional $267 million in funding in the “skinny budget” issued by the White House in February that preceded the more formal and detailed request to Congress last week.

Biden requests the increase in funds after he campaigned on ending the domestic HIV epidemic by 2025, an ambitious goal many advocates in the fight against HIV/AIDS were skeptical about achieving.

Nick Armstrong, the AIDS Institute’s manager of advocacy and government affairs and co-chair of the AIDS Budget & Appropriations Coalition, said in a statement the time to ramp up efforts against HIV has come as the nation emerges from the coronavirus pandemic.

“Public health departments have made herculean efforts to battle COVID over the past year,” Armstrong said. “But now it is time to reinvigorate neglected efforts to end the HIV, opioid, and viral hepatitis epidemics. Congress must go above and beyond what the president has proposed to bolster our critical public health infrastructure to protect Americans against infectious disease.”

The budget now goes on to Congress, which has authority on whether or not to appropriate funds consistent with the president’s request. Congress could either meet, short fund or even exceed in money the request by Biden as part of that process.

Schmid said via email to the Blade he’s optimistic about getting an agreement from Congress for an increase in funds to fight HIV/AIDS based on the “strong bipartisan support the proposal has enjoyed in the past.

“We still have work to do with the Congress due to so many demands on the budget but I am fairly confident Congress will support it, they have been anxious to see what the Biden administration does with the program in his budget and we have the answers now,” Schmid said. “The Biden-Harris administration firmly supports ending HIV.”

Although Biden was lauded for the increase in funds in domestic HIV programs, international programs are a different matter. The White House has essentially flat-funded programs designed to fight the global HIV epidemic, including the President’s Emergency Plan for AIDS Relief, or PEPFAR, or the Global Fund to Fight AIDS, Tuberculosis & Malaria.

Matthew Rose, director of U.S. Policy and Advocacy at the New York-based Health GAP, said in a statement Biden’s budget proposal “displays a lack of bold leadership motivated to end the HIV pandemic.”

“If the U.S. had continued fully funding PEPFAR since 2003 instead of letting funding levels slip into a flat-line for more than a decade, the HIV pandemic would look remarkably different today,” Rose said. “This is not a budget to end AIDS – and it could have been. This is not a budget to end the COVID-19 pandemic – and it could have been. The unconscionable lack of political will in recent years has created a world in which people cannot get access to the life-saving services they need.”

Health GAP is calling on Congress to approve a budget with at least a $750 million increase for PEPFAR and $2.5 billion in increased funding over the next four years to scale up HIV prevention and treatment and mitigate harms to the HIV response done by the COVID-19 pandemic, the statement says.

Additionally, Health GAP is calling on Biden to name “a highly qualified nominee” to serve as the U.S. Global AIDS Coordinator, the statement says.