June 28, 2021 | Funding the Fight


House Appropriations Subcommittee Budget Proposal Provides Just 20% of Funding Increase Needed to End AIDS by 2030

Jessica Bassett (Health GAP): +1 518-593-7628| jessica@healthgap.org

A Decade of Chronic Underfunding and COVID-19 Pandemic Mean a Minimum $750 million Increase is Needed to Put the US Global HIV Response Back on Track


The House Appropriations Subcommittee on State, Foreign Operations, and Related Programs (SFOPs) tonight agreed on its Fiscal Year 2022 Appropriations Bill, including funding for the President’s Emergency Plan for AIDS Relief (PEPFAR), the main source of funding for programs that test for, treat, and prevent HIV around the world. Representative Barbara Lee, the SFOPs chair, requested only a $150 million increase for PEPFAR in FY22.


Matthew Rose, Health GAP Director of U.S. Policy and Advocacy, said: “PEPFAR has been chronically underfunded for the last decade, so while the $150 million increase proposed today is heading in the right direction, the global HIV budget is still very far from where it needs to be for the U.S. to meet its obligation to people living with HIV and people at risk of HIV infection.”


A $750 million increase is needed this year to put PEPFAR back on track. PEPFAR has been virtually flat funded over the last decade, equivalent to a funding decrease when accounting for medical cost inflation. PEPFAR country teams have never been able to fully build out the robust programs needed to achieve epidemic control in all PEPFAR countries, and now the COVID-19 crisis has set progress back even further. A $750 million increase is the minimum needed in FY22 to begin to expand life-saving treatment access to all who still lack access; implement adult and point of care pediatric testing so all people can know their status immediately and are immediately linked to care; to support and expand highly effective strategies like multi-month dispensing of antiretroviral medicines; expand prevention and treatment for key populations; and to invest in more robust healthcare workforce in places where increased staffing is urgently needed. Without this necessary increase, people around the world will continue to be relegated to second-class care rather than benefiting from life-saving scientific innovation. 


Activists expressed disappointment in the Subcommittee’s failure to increase the allocation offered by Chairwoman Lee during tonight’s markup of the proposed bill. They called on Congress to pass an FY22 bill 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.


“During the recent UN High-Level Meeting on HIV, Secretary of State Blinken and various government officials continuously called for bold action and global leadership to end AIDS. Now is the time for Congress to show bold U.S. leadership promoting justice in global health, not scarcity,” said Asia Russell, Health GAP Executive Director. “We cannot resign ourselves to incrementalism as people are dying from lack of access to life-saving HIV treatment and COVID-19 is devastating the healthcare workers who are on the front lines of the HIV pandemic. In this moment of crisis, Congress can and must do more.”   


In the wake of the COVID-19 pandemic:

  • HIV testing has reduced nearly 40% compared to 2019;
  • Some countries have seen a 25% decline in the number of HIV positive pregnant women accessing services to prevent perinatal HIV transmission;
  • HIV treatment initiation has dropped by 25% across many age groups;
  • Voluntary medical male circumcision (VMMC) over one year fell 74% and there are similar declines in prevention for adolescent girls and young women, such as PEPFAR’s DREAMS program.


Health GAP welcomed the announcement that the bill included language to remove the Helms amendment restrictions that have prohibited the use of U.S. funding to provide safe abortion care as part of comprehensive sexual and reproductive healthcare services and to permanently end the deadly Global Gag Rule. Activists encouraged Congress to ensure both provisions are included in the final budget and signed into law by the president as critical steps toward decolonizing the U.S. role in promoting global health.