The Ryan White Program Is Vital to End the HIV Epidemic

In his second State of the Union address, President Trump called for an end to the HIV epidemic in the United States by 2030. To accomplish this goal, the president needs to support federal funding that goes toward the treatment of HIV among the nation’s most economically disadvantaged patients. The Ryan White Program, which provides federal funding for economically disadvantaged HIV patients, needs to be a vital part of the plan to end the epidemic. However, a review of the president’s budget requests for the Ryan White Program indicates that the president asked for significant funding decreases during his first two years in office (fiscal years 2018 and 2019) and has asked for only a small increase for fiscal year 2020.

The Ryan White Program (formerly the Ryan White Comprehensive AIDS Resource Emergency Act) was adopted in 1990 to treat low-income individuals affected by HIV.¹ In 2016, the program provided prevention and treatment services to more than 550 000 people living with HIV/AIDS.² The program provides support to more than half of the people with HIV/AIDS in the United States, with 63% of these patients having incomes below the poverty line.² From 2012 to 2016, the number of individuals diagnosed with HIV remained stable.³ However, new HIV diagnoses are increasing in Hispanic communities, and a majority of these new diagnoses are in economic disadvantaged communities in the South, which depend on services provided by the Ryan White Program.³

Even though his White House raised objections, President George H. W. Bush signed the legislation that created the Ryan White Program. Throughout Bill Clinton’s presidency, the program received sustainable funding increases.¹ The funding requests of President George W. Bush and President Barack Obama for the Ryan White Program often did not match their political discourse supporting the program.¹ President Bush and President Obama often called for small increases in funding.⁴

Building on my earlier work analyzing the Ryan White Program during the Bush and Obama administrations,¹ I analyzed the president’s budget requests for the program and the final appropriations by Congress. The budgetary request and appropriation data used in this analysis are available from the Health Resources and Services Administration and the Henry J. Kaiser Family Foundation. The National Alliance of State and Territorial AIDS Directors provided a comprehensive collection of data for the analysis.

Table 1 shows that, during his first two years in office, President Trump called for decreases in key parts of the Ryan White Program. The first budget request (fiscal year 2018) called for an overall decrease of $58.8 million. Most striking is how the president has asked Congress to defund the AIDS Education and Training Centers (AETCs). According to the Health Resources and Services Administration, funding for the AETC program supports a network of training centers that help train providers to prevent HIV and conduct other interventions to abate the epidemic.⁵ These centers and other parts of the Ryan White Program play an important role in providing education and prevention services to vulnerable populations. As mentioned, economically disadvantaged and minority communities are struggling to prevent the disease, and the HIV prevention pill (preexposure prophylaxis) is not reaching 1.1 million individuals, many of them people of color, who would benefit from the drug’s protection.⁶

TABLE 1—

President’s Budget Requests and Congressional Appropriations for the Ryan White Program: United States, Federal Fiscal Years (FYs) 2018–2020

Ryan White Program Component	President’s FY2018 Budget Request, $ Millionsa	FY2018 Final Appropriation, $ Millionsa	President’s FY2019 Budget Request, $ Millionsa	FY2019 Final Appropriation, $ Millionsa	President’s FY2020 Budget Request, $ Millionsa
Part A (Title I)	654.6 (−1.3)	655.9 (0)	655.9 (0)	655.9 (0)	. . .b
Part B (Title II)	413.9 (−0.8)	414.7 (0)	414.7 (0)	414.7 (0)	. . .b
ADAP	898.6 (−1.7)	900.3 (0)	900.3 (0)	900.3 (0)	. . .b
Part C (Title III)	204.6 (+3.5)	201.1 (0)	201.1 (0)	201.1 (0)	. . .b
Part D (Title IV)	75.1 (0)	75.1 (0)	75.1 (0)	75.1 (0)	. . .b
AETCs	0 (−33.6)	33.6 (0)	0 (−33.6)	33.6 (0)	. . .b
Dental	13.1 (0)	13.1 (0)	13.1 (0)	13.1 (0)	. . .b
Total funding	2260 (−58.8)	2319 (0)	2260 (−58.6)	2319 (0)	2389 (+70.0)

Note. ADAP = AIDS Drug Assistance Program; AETCs = AIDS Education and Training Centers.

^aFigures in parentheses are dollar changes from the previous year’s final appropriation.

^bAt the time this article was written, no information was available on the president’s FY2020 budget requests for Ryan White Program components.

On March 11, 2019, the current administration released the budget for fiscal year 2020. The president asked for an overall increase of $70 million in funding for the Ryan White Program, only a 3% increase in program funding. To end the HIV epidemic, the Ryan White Program will need to be a central part of the president’s plan.

First, the overall program needs significant rather than incremental funding increases. A majority of HIV patients in the United States receive some type of support from the Ryan White Program. The program serves economically disadvantaged groups that represent a majority of the new HIV diagnoses each year. Black and Hispanic patients account for 47% and 23% of the patients, respectively, receiving treatment through the program.⁷

Second, funding for AETCs and other efforts to prevent HIV/AIDS diagnoses needs to be expanded. Although in recent years the number of new diagnoses across the nation has remained stable, there are areas of concern. New diagnoses of HIV are increasing among Hispanics, and in certain areas of the US South there are concentrations of the disease and a risk of increases in diagnoses.

The president’s budget requests for the Ryan White Program do not support his call for ending the HIV epidemic. The first two budget cycles requested decreases in funding for the program, including elimination of AETCs, which play a crucial role in preventing the disease in poverty-stricken communities. In the fiscal year 2020 budget, which is intended to provide support for ending the HIV epidemic, the president asked for only a 3% increase in funding for the program. To end the HIV epidemic, the administration will need to significantly increase funding support for the Ryan White Program.