AIDS United Fiscal Year 2026 Testimony prepared for the House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Dear Chairman Cole and Ranking Member DeLauro:
As the subcommittee continues its important deliberations on the Fiscal Year (FY) 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill, we again thank you for your commitment to ending the HIV epidemic in the United States. We request that you increase the federal government’s financial commitment to meeting the goals of the Ending the HIV Epidemic Initiative and reaffirm your support for the safety net programs that protect the health and wellbeing of all Americans living with and affected by HIV. Our scientific knowledge of HIV treatment, prevention and epidemiology has never been stronger, but our recent progress in preventing new transmissions of the virus and providing care for those living with HIV, is in grave danger. Without swift action from Congress, that progress won’t just halt, but could be reversed altogether.
Over the past few months, actions taken by the current administration to place blanket freezes on federal funding, abruptly cancel millions of dollars worth of lifesaving HIV prevention, treatment, and research grants, and lay off thousands of dedicated public servants who coordinate our nation’s HIV programming have led to significant disruptions within our sector. Already, we are seeing HIV service organizations in the United States being forced to lay off critical front line staff, reduce the scope of their work, and turn patients away from the essential care that they otherwise would have been able to access.
Robust resources are needed to deliver HIV treatment and prevention services, to sustain HIV programs, and to maintain the hardworking staff at health departments and local organizations who provide healthcare services to their communities. Without adequate funding and support from our public health partners within the federal government, these lifesaving programs and services will come to a halt, resulting in devastating consequences for the communities we serve.
For people living with HIV, it is critical to have continued access to HIV treatment without any pauses or disruptions, so they can maintain viral suppression and prevent future HIV transmissions. Unfortunately, the resources allocated to programs supporting people living with HIV and the base HIV programmatic spending in recent years have failed to meet the levels needed to address the true needs of people living with and impacted by HIV.
We urge Congress to capitalize on the medical and scientific advancements made in the HIV sector and adequately equip our public health infrastructure, so we can continue our country’s progress in ending HIV, both domestically and abroad. Ending HIV is absolutely possible, but only through targeted and sustained investment.
Below are detailed domestic HIV and related funding requests that we join our coalition partners in the Federal AIDS Policy Partnership in urging the committee to include in the FY2026 appropriations bills.
We urge Congress to include clear and instructive language to appropriations legislation for all of the programs listed below to ensure that this funding is being allocated in line with Congressional intent. A chart detailing each request as well as previous fiscal year funding levels for each program is available here:
http://federalaidspolicy.org/fy-abac-chart/
Ending the HIV Epidemic Initiative
Since its inception in the first Trump Administration, Congress has appropriated additional funding for the Ending the HIV Epidemic (EHE) Initiative, which has the goal of reducing new HIV transmissions by 90% by 2030.
We ask Congress to increase funding in FY2026 for the Ending the HIV Epidemic Initiative by at least the amounts listed below in the following divisions:
- $395 million for CDC Division of HIV/AIDS Prevention for testing, linkage to care, and prevention services, including pre-exposure prophylaxis (PrEP) (+$175 million);
- $358.6 million for HRSA Ryan White HIV/AIDS Program to expand comprehensive treatment for people living with HIV (+$193.6 million);
- $207 million for HRSA Community Health Centers to increase clinical access to prevention services, particularly PrEP (+$50 million)
The Ryan White HIV/AIDS Program
For more than thirty years, the Ryan White HIV/AIDS Program has provided comprehensive care to populations disproportionately impacted by the HIV epidemic. The Program has over 561,000 clients and nearly two-thirds live under the federal poverty level. With 90% of Ryan White HIV/AIDS Program clients achieving viral suppression, which means a person can live a longer and healthier life and cannot transmit HIV, the program is a model for a successful public health response to an infectious disease.
Though the Ryan White HIV/AIDS Program is a payer of last resort, it provides services critical to managing HIV, often inadequately covered by insurance, including case management, mental health and substance use services, adult dental services, and transportation, legal, and nutritional support services. Many Ryan White HIV/AIDS Program clients live in states that have not expanded Medicaid and they must rely on the Ryan White HIV/AIDS Program as their only source of HIV/AIDS care and treatment. While increasingly, clients have access to insurance, patients still experience cost barriers, such as high premiums, deductibles, and other patient cost-sharing. The Ryan White HIV/AIDS Program, particularly the AIDS Drug Assistance Program (ADAP), assists with deferring these costs.
We urge Congress 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, distributed in the following manner: Part A: $751.4 million, Part B (Care): $520 million, Part B (ADAP): $968.3 million, Part C: $231 million, Part D: $85 million, Part F/AETC: $58 million, Part F/Dental: $18 million, Part F/SPNS: $34 million, EHE Initiative: $358.6 million
CDC Division of HIV Prevention
Increasing funding for high-impact, community focused HIV prevention services has proven to result in a strong return on investment. Not only are these prevention tools effective at halting new HIV transmissions, but in the long term they result in decreased lifetime medical costs that are associated with HIV treatment.
The
CDC’s Division of HIV Prevention is the federal leader in creating innovative strategies for HIV prevention. Through partnerships with state and local public health departments and community-based organizations, the CDC has expanded targeted, high-impact prevention programs that address racial and geographic health disparities. Funding supports expanded, targeted programs, including non-traditional HIV testing such as at-home testing to reduce stigma. Effective prevention strategies include testing, linkage to care, condom distribution, syringe service programs, and PrEP, with jurisdictions employing a combination of these approaches to combat HIV transmission.
We urge you to fund the CDC Division of HIV Prevention at $822.7 million in FY2026, an increase of $67 million over FY2024. This is in addition to the $395 million for EHE Initiative work within the Division.
Federal Overdose Crisis and Infectious Disease Response
Thanks to sustained investment from Congress and a whole-of-government approach prioritizing evidence-based approaches to substance use issues, we are finally turning the tide on the overdose epidemic. The most recent national data shows there were roughly 87,000 drug overdose deaths from October 2023 to September 2024, a nearly 24% decrease from 114,000 overdose deaths we saw the previous year. We can continue to bend the curve on overdose deaths in this country and prevent new HIV transmissions among people who inject drugs, but only through significant and sustained support for evidence-based drug user health interventions.
This is especially true for support for Syringe Services Programs (SSPs), who are the first responders to the overdose and infectious disease crisis and essential to helping prevent drug overdoses and new HIV and hepatitis transmissions. Beyond providing access to sterile syringes, SSPs prevent overdose, connect people to substance use treatment, HIV and hepatitis testing, and other supportive services. The CDC’s Opioid Related Infectious Diseases program is best situated to support harm reduction programs and spearhead funding a syndemic approach to ending the overdose, HIV and viral hepatitis crises.
We urge you to fund the CDC’s Infectious Diseases and Opioid Epidemic program in FY2026 at the $150 million, an increase of $127 million over FY2024. We also urge you to remove all restrictions on federal funding for syringe service programs in those jurisdictions that are experiencing - or vulnerable to - a significant increase in HIV or hepatitis transmissions due to injection drug use.
Pre-Exposure Prophylaxis (PrEP)
PrEP is a medication that effectively prevents HIV transmission when taken as prescribed. The first PrEP medication was approved by the FDA 13 years ago, and now there are multiple medications available, including generic medications and a new long-acting injectable version. Increasing access to PrEP has been a key strategy in ending the HIV epidemic, yet progress must be made more equitably.
Currently, only about one in three people who need PrEP have a prescription. In 2022, only 13% of Black individuals, 24% of Hispanic individuals, and 15% of women assessed to be most in need of PrEP had a prescription. We ask that Congress prioritize reducing these disparities as we work to expand PrEP use.
As Congress moves through the regular appropriations cycle, we urge you to support funding for new and innovative programs to expand PrEP access, and ensure that those who want PrEP can easily access the medication without cost or other barriers.
Minority AIDS Initiative (MAI)
Racial and ethnic minorities in the U.S. are disproportionately impacted by HIV/AIDS. African Americans, more than any other racial/ethnic group, continue to bear the greatest burden of HIV in the U.S. Three out of four new HIV transmissions occur among people of color.
The
Minority HIV/AIDS Initiative (MAI) supports cross-agency demonstration initiatives to support HIV prevention, care and treatment, and outreach and education activities across the federal government.
MAI programs at the Substance Abuse and Mental Health Services Administration (SAMHSA) target specific populations and provide prevention, treatment, and recovery support services, along with HIV testing and linkage to services when appropriate, for people at risk of mental illness and/or substance abuse.
We urge you to fund the Minority HIV/AIDS Initiative at $105 million, and SAMHSA’s MAI program at $160 million in FY2026, an increase of $48 million and $41 million over FY2025 levels, respectively. We also urge you to fund Minority AIDS Initiative programs across HHS agencies at $610 million in FY2026.
We thank you for your continued leadership and support of these critical programs for so many people living with and vulnerable to HIV, and the organizations and communities that serve them nationwide.
Please do not hesitate to be in touch for more information regarding HIV appropriations with Drew Gibson, our Director of Advocacy, at dgibson@aidsunited.org.
Sincerely,
Carl Baloney, Jr.
CEO-Elect
AIDS United
