President’s FY’16 Budget: HIV/AIDS

Copies of President Barack Obama’s proposed 2016 budget are displayed for sale at the Government Printing Office in Washington February 2, 2015

Editor’s Note: President Obama released his fiscal year 2016 budget proposal. The White House issued this fact sheet to highlight the budget’s investment in domestic HIV/AIDS activities across federal departments and agencies.

Middle Class Economics: Enhancing the Lives of Americans Living with HIV/AIDS, and Fighting the HIV/AIDS Epidemic

The President’s 2016 Budget is designed to bring middle class economics into the 21st Century. This Budget shows what we can do if we invest in America’s future and commit to an economy that rewards hard work, generates rising incomes, and allows everyone to share in the prosperity of a growing America. It lays out a strategy to strengthen our middle class and help America’s hard-working families get ahead in a time of relentless economic and technological change. And it makes the critical investments needed to accelerate and sustain economic growth in the long run, including in research, education, training, and infrastructure.

These proposals will help working families feel more secure with paychecks that go further, help American workers upgrade their skills so they can compete for higher-paying jobs, and help create the conditions for our businesses to keep generating good new jobs for our workers to fill, while also fulfilling our most basic responsibility to keep Americans safe. We will make these investments, and end the harmful spending cuts known as sequestration, by cutting inefficient spending and reforming our broken tax code to make sure everyone pays their fair share. We can do all this while also putting our Nation on a more sustainable fiscal path. The Budget achieves about $1.8 trillion in deficit reduction, primarily from reforms to health programs, our tax code, and immigration.


Continuing to Support the National HIV/AIDS Strategy (NHAS) and Expanding Access to HIV/AIDS Treatment, Care, and Prevention. The Budget expands access to HIV/AIDS prevention and treatment activities and supports the goals of the National HIV/AIDS Strategy to reduce HIV incidence; increase access to care and optimize health outcomes for people living with HIV; and reduce HIV-related health disparities. By providing resources for Affordable Care Act implementation, the Budget will support increased health coverage for thousands of people living with HIV/AIDS and expand access to HIV testing for millions of Americans. The Budget makes smarter investments by prioritizing HIV/AIDS resources within high-burden communities and among high-risk groups, including gay and bisexual men, African Americans and Latino Americans. Compared to 2015, the Budget increases domestic discretionary Health and Human Services (HHS) HIV/AIDS by $118 million, including a doubling of funds for the Office of Women’s Health. Overall, total U.S. Government-wide spending on HIV/AIDS increases by nearly $1 billion from $30.7 billion in FY15 to $31.6 billion in FY16.

Supporting the Ryan White HIV/AIDS Program. The Budget invests $2.3 billion in the Ryan White HIV/AIDS Program to provide treatment and care completion services for people living with HIV, and includes $900 million for the AIDS Drug Assistance Program to ensure that people living with HIV have access to life-saving antiretroviral (ARV) treatments. By helping people living with HIV remain in care and on their medications, the Ryan White program plays a critical role in preventing the spread of the HIV epidemic, as recent research has shown that ARV treatment reduces HIV transmission by 96 percent.

Increasing Funding for HIV/AIDS Prevention and Service Integration. The Budget invests $799 million, an increase of $12.6 million, for Centers for Disease Control and Prevention (CDC) to continue implementing the goals of the National HIV/AIDS Strategy by preventing HIV/AIDS among high-risk communities using evidence-based interventions. The increase will be directed to those most at risk for acquiring HIV including youth, high risk HIV negative persons, and persons at risk for transmitting HIV, particularly those not engaged in care. CDC will continue to align prevention activities with the National HIV/AIDS Strategy and to promote high-impact prevention by focusing resources on effective, scalable, and sustainable prevention strategies along the HIV continuum of care for persons living with HIV and populations at highest risk for HIV. Part of the increase will support efforts to better link persons diagnosed and living with HIV to appropriate care and examine how new biomedical interventions are being used. Additionally, investments will be used to improve HIV prevention activities with school-aged youth. The Budget dedicates approximately $2.5 million to support States in developing integrated HIV plans to include prevention, care and treatment, and other supportive services such as substance abuse treatment and housing. This effort will help ensure that State and local health departments develop systems of prevention, care and treatment that are responsive to the needs of persons at risk for HIV infection and persons living with HIV, while also continuing the Administration’s commitment to streamlining and reducing reporting burden. The Budget also doubles funding for viral hepatitis to prevent deaths due to viral hepatitis, reduce hepatitis C among young people, and reduce mother-to-child transmission of hepatitis B.

Supporting Housing Assistance for People Living with HIV/AIDS. The Budget provides $332 million for Department of Housing and Urban Development’s (HUD) Housing Opportunities for Persons with AIDS (HOPWA) program to address housing needs among people living with HIV/AIDS and their families. The program provides States and localities with the resources to create comprehensive strategies for providing housing assistance that gives patients the stability needed for effective treatment. In partnership with Federal agencies through the HIV Care Continuum, HUD is working to improve outcomes that promote greater achievements in viral suppression through the coordination and alignment of housing support with medical care. The Administration is also proposing legislative reforms that would update HOPWA’s grant formula to distribute funds based on more robust CDC data on persons living with HIV, rather than the cumulative number of HIV cases.

Supporting Research at the National Institutes of Health (NIH). To address the critical AIDS research priorities, the Budget requests $3.1 billion for trans-NIH AIDS research, an increase of $100 million above the FY 2015 level. The Budget request reflects several shifts of funds to address the many new and exciting scientific opportunities in AIDS research, including etiology and pathogenesis that provides the underlying foundation for all HIV research; development of vaccines and microbicides; and new and innovative approaches for research toward a cure.

Increasing Support for Our Veterans Living with HIV/AIDS. The Budget includes $1.15 billion within the Department of Veterans Affairs (VA), including a $62 million increase for medical care, to ensure that veterans living with HIV/AIDS receive high quality, comprehensive clinical care, including diagnosis of their infection and timely linkage to medical care. Additionally, VA promotes evidence based HIV prevention services and is implementing its plan to meet the goals outlined in the President’s National HIV/AIDS Strategy.

You can also download this as a PDF fact sheet “Enhancing the Lives of Americans Living With HIV/AIDS, and Fighting the HIV/AIDS Epidemic



Dramatic Decline in Risk for Heart Attacks Among HIV-Positive Members of Kaiser Permanente in California

OAKLAND, Calif. — Previously reported increased risk of heart attacks among HIV-positive individuals has been largely reversed in recent years for Kaiser Permanente’s California patients, according to a study published in the current online issue of Clinical Infectious Diseases.

“Our findings lend support to the concept that increased heart attack risk for HIV patients is largely reversible with continued emphasis on primary prevention in combination with early initiation of anti-retroviral therapy to preserve immune function,” said lead author Daniel B. Klein, MD, chief of Infectious Diseases for Kaiser Permanente San Leandro.

The adjusted risk ratio for heart attacks among HIV-positive study participants went from an 80 percent increased risk in 1996 to no increased risk in 2010-2011. The study population included 24,768 HIV-positive and 257,600 demographically matched HIV-negative subjects from Kaiser Permanente Northern California and Kaiser Permanente Southern California.

Noting that the study participants are members of a large integrated health care setting, the investigators say these results may be explained by access to care and broadly disseminated cardiovascular risk-reduction efforts. These include the implementation of health prompts that appear during all clinic visits in the electronic medical record with reminders for cholesterol and blood pressure monitoring, diabetes follow-up and smoking cessation.

One of the first reports documenting an increased risk of cardiovascular disease was conducted among Kaiser Permanente HIV patients and led by Dr. Klein. That early awareness within the Kaiser Permanente health care system may have resulted in enhanced attention to cardiovascular risk reduction and interventions in this population. Over the 16-year study period, HIV-positive subjects had similar increases in the use of lipid-lowering and hypertension therapy compared with HIV-negative subjects.

In addition, in accordance with national treatment guidelines mirrored within Kaiser Permanente, patients are being started on antiretroviral treatments earlier and being prescribed less toxic combination therapies.

“Such early and sustained improvements in care would have been necessary to achieve not only a reduction in risk of heart attack but a virtual leveling of risk between HIV-positive and HIV-negative individuals,” said senior author Michael J. Silverberg, PhD, MPH, a senior research scientist with the Kaiser Permanente Division of Research. “The takeaway from this study is that the well-established higher risk of a heart attack in HIV patients may be reversible. With better HIV treatments, and more attention to traditional cardiovascular risk factors, the difference in risk by HIV status has been diminished or even eliminated.”

Other authors on the study include Wendy A. Leyden, MPH, Leo B. Hurley, MPH, Julia L. Marcus, PhD, MPH, Charles P. Quesenberry, Jr., PhD, Division of Research, Kaiser Permanente Northern California, Oakland, California; Lanfang Xu, MS, and Chun R. Chao, PhD, Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; Michael A. Horberg, MD, MAS, Mid-Atlantic Permanente Research Institute, Rockville, Maryland; and William J. Towner, MD, Division of Infectious Diseases, Department of Internal Medicine, Kaiser Permanente Los Angeles.

About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, the Division’s 550-plus staff are working on more than 350 ongoing research studies in behavioral health and aging, cancer, cardiovascular and metabolic conditions, health care delivery and policy, infectious diseases, vaccine safety and effectiveness, and women’s and children’s health. For more information, visit

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 9.5 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to

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Condoms and gay men


“How effective are condoms for gay men?” Read the pithy report on a recently published CDC study at While condoms used during anal sex can prevent 70% of HIV infections, “Notably, the study observed low rates of consistent condom use. Only 16% of participants reported ‘always’ using condoms during anal sex with male partners (of any HIV status) throughout the entire study period, despite having received sustained behavioral interventions.”

OHSU’s Louis Picker homes in on HIV’s hidden sanctuary

Dr. Louis Picker, the Oregon Health & Science University scientist who is working on an HIV vaccine, has reached a breakthrough an another front in the battle against AIDS.

While Picker’s previous research centered on preventive vaccines that could be given to healthy people, this latest research takes aim at finding a cure for those already infected.

It’s a much tougher challenge, he said.

“What we’ve identified is a barrier to a cure that needs to be overcome,” said Picker, associate director of the OHSU Vaccine and Gene Therapy Institute. “The approaches needed to cure it, No. 1, is to figure out where and how it’s hiding and what’s a possible approach to get to its hiding place.”

Picker found through research on nonhuman primates that the virus hides in a biologic sanctuary that can’t be destroyed by even the most effective killer T cells. Someone infected with HIV has “a lot of residual virus,” a kind of reservoir, Picker said.

“They hide from the police, the killer T cells,” Picker said. “I think of it like the church in old Western movies, the hideout from the federales.”

In monkeys with the primate form of HIV (called SIV) who were on anti-retroviral medications, residual, low-level virus remained mostly in the same B cell follicles, suggesting that therapeutic vaccines designed to rid the body of SIV will fail until the sanctuary is breached.

Picker said while discovery of this barrier may seem like bad news, it’s actually a positive.

“You need to know your enemy, then you can work to find a way to get around it,” he said. “We’ve identified the barrier, which gives us a clear path. It’s still a long path.”

Picker’s latest research was published in the journal Nature Medicine