Testimony of AIDS United President and Chief Executive Officer Carl Baloney, Jr. on Fiscal Year 2027 HIV Appropriations

AIDS United Fiscal Year 2027 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 advances its work on the Fiscal Year (FY) 2027 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill, we thank you for your continued commitment to ending the HIV epidemic in the United States. In light of a rapidly shifting healthcare landscape, we urge you to increase the federal government’s investment in HIV prevention, care, and treatment, and reaffirm support for the safety net programs that protect the health and wellbeing of people living with and affected by HIV. Our scientific understanding of HIV treatment, prevention, and epidemiology has never been stronger. However, the systems required to translate that progress into sustained reductions in new transmissions and improved health outcomes are under significant strain. Over the past 15 months, HIV service organizations across the country have experienced unprecedented instability driven by federal action and inaction. Longstanding funding streams and coordinated public health systems that once operated in alignment with community-based efforts are being weakened or dismantled without clear replacement strategies. Recent developments include the cancellation of hundreds of millions of dollars in HIV prevention, treatment, and research funding and the loss of thousands of public health personnel critical to coordinating the national response. Changes to Medicaid and the failure to extend enhanced Affordable Care Act premium tax credits are creating significant gaps in coverage and access, placing unsustainable pressure on providers to serve more people with fewer resources. State-level actions further underscore these risks. In Florida, changes to the AIDS Drug Assistance Program (ADAP), including formulary restrictions and the elimination of premium assistance, have disrupted access to lifesaving medications for people living with HIV. While temporary funding has helped stabilize the program, these actions set a troubling precedent and signal a shift toward cost-containment strategies that undermine care systems. Without strong federal investment and oversight, similar approaches could emerge in other states, making Florida a warning sign of broader systemic erosion. As a result, HIV service organizations are being forced to lay off frontline staff, scale back programs, limit access to care, and in some cases close entirely. Without increased and sustained federal investment, these disruptions will continue to erode the infrastructure required to deliver lifesaving services. Uninterrupted access to treatment and care remains essential. Sustained viral suppression preserves the health of people living with HIV and prevents new transmissions. Yet current funding levels have not kept pace with need, leaving critical gaps in care and prevention. We urge Congress to build on the extraordinary scientific and medical progress achieved in the HIV response by strengthening the public health infrastructure that makes that progress possible. Ending the HIV epidemic is within reach, but only with targeted, sustained, and adequately resourced federal 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 FY2027 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 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 FY2027 for the Ending the HIV Epidemic Initiative by at least the amounts listed below in these divisions:

• $395 million for CDC Division of HIV/AIDS Prevention for testing, linkage to care, and prevention services, including pre-exposure prophylaxis (PrEP); 
• $358.6 million for HRSA Ryan White HIV/AIDS Program to expand comprehensive treatment for people living with HIV; 
• $207 million for HRSA Community Health Centers to increase clinical access to prevention services, particularly PrEP

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 91% 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. The Ryan White HIV/AIDS Program is a payer of last resort, providing services critical to managing HIV to the uninsured and underinsured, including case management, mental health and substance use services, adult dental services, and transportation, legal, and nutritional support services. Due to a confluence of factors including Medicaid cuts, the expiration of enhanced ACA tax credits, and rising medical costs, the burden on Ryan White providers is increasing substantially. Without increased investment in the program as a whole, and in the AIDS Drug Assistance Program in Part B in particular, thousands of people living with HIV will lose access to the medication and services they need to remain virally suppressed and stay alive. We urge Congress to fund the Ryan White HIV/AIDS Program at a total of $3.024 billion in FY2027, an increase of $559.4 million over FY2026, distributed in the following manner: Part A: $751.4 million, Part B (Care): $520 million, Part B (ADAP): $1.075 billion, 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 FY2027. 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 estimates there were roughly 71,500 drug overdose deaths from October 2024 to September 2025, a more than 36% decrease from the peak of the epidemic in 2022 and 2023. 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. We urge you to fund the CDC’s Infectious Diseases and Opioid Epidemic program in FY2027 at the $150 million. 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. Increasing access to PrEP has been a key strategy in ending the HIV epidemic, yet progress must be made more equitably. This is particularly true with the emergence of new long-acting injectable versions of PrEP that can significantly reduce barriers to medication adherence and access to previously hard to reach populations. Currently, only about one in three people who need PrEP have a prescription. In 2024, Black individuals only represented 15% of PrEP users despite representing 39% of all new HIV diagnoses in 2022. Similar discrepancies exist with Hispanic individuals and women, who both have PrEP usage rates that are significantly lower than their established need. 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 get 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 FY2027. We also urge you to fund Minority AIDS Initiative programs across HHS agencies at $610 million in FY2027. 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. 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. President and Chief Executive Officer AIDS United