November 2010

The Foundation
for AIDS Research
Rolling Back Funding to FY 2008 Levels:
Impact on the Domestic and Global AIDS Epidemic
On September 8, 2010, House Minority Leader Rep. John
Boehner and other members of Congress announced a
proposal1 to reduce non-security-related government spending
for fiscal year (FY) 2011 to FY 2008 levels. This proposal is
also included in the House Republicans’ “Pledge to America”
legislative agenda.2
President Barack Obama’s FY 2011 federal budget request
included $1.128 trillion for discretionary spending. Boehner’s
proposal would reduce total discretionary spending for FY 2011
to $1.029 trillion (the FY 2008 level) while exempting all security
programs (defense, military construction/veterans affairs, and
homeland security) from cuts. This approach would leave $378
billion for all non-security-related discretionary programs in FY
2011 and is 21.7% less than the President’s request.3
Impact on Federal HIV/AIDS Programs
and Outcomes
To assess the impact of the Boehner proposal on HIV/AIDS
programming, amfAR made the assumption that allocations
would revert to actual FY 2008 funding levels for each budgeted
program. Where multiple programs are included in a single
budget item, it was assumed that all programs within that
budget line would be cut proportionately. Obviously Congress
will have a range of budgetary options at its disposal and may
choose to fund AIDS and other health programs at higher or
lower levels than those indicated below. The figures used here
are intended only to illustrate the possible impact of returning to
FY 2008 funding levels. If AIDS and other health programs are
spared the reductions indicated, deeper cuts would need to be
made in other non-security-related discretionary programs.
ISSUE BRIEF
Cuts of the magnitude proposed would inevitably lead to sharply
reduced efforts to prevent HIV infection in the U.S., risking
increased infection rates. Globally, they would lead to a surge
in the number of people being denied access to lifesaving AIDS
treatment and severe cutbacks in proven programs such as
prevention of mother-to-child transmission (PMTCT) services.
The outcomes would include increased infection and mortality
rates from a disease that we know how to prevent and treat.
Impact on the Response to the Domestic
HIV/AIDS Epidemic
Domestic HIV/AIDS prevention, treatment, and research
would be vulnerable to severe cuts under the Boehner proposal,
undermining implementation of the new National HIV/AIDS
Strategy, which has been carefully crafted to bring greater
coordination, effectiveness, and accountability to America’s
response to the epidemic at home.
HIV Prevention: More than 56,000 new HIV infections occur
in America each year – one every 9½ minutes. Domestic HIV
prevention currently receives only 3% of the federal HIV/AIDS
budget. Reverting to FY 2008 spending levels for HIV prevention
at the Centers for Disease Control and Prevention (CDC) would
reduce funding from $799 million to $732 million, an 8.3% cut in
our investment in preventing HIV infection in the U.S.

The Boehner proposal would have a devastating impact on

America’s ability to respond to its own domestic HIV/AIDS
epidemic or to sustain progress against the global epidemic.
A return to FY 2008 funding levels for HIV/AIDS programs
would mean a 9.6% reduction in overall discretionary HIV/AIDS
spending. Domestic HIV/AIDS discretionary programs would
be cut 6.5% (from $7.58 billion to $7.09 billion)4 while global
programs would face a cut of 13.1% (from $6.74 billion to
$5.86 billion).5

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Treatment: HIV/AIDS treatment has improved, prolonged,
and saved hundreds of thousands of lives in the U.S., yet one-
third of people living with HIV/AIDS in America still are not in
care. More than 4,000 are now on waiting lists for the AIDS
Drug Assistance Program (ADAP), which funds treatment for
people living with HIV/AIDS who do not have health coverage.
Nearly all (87%) ADAP program expenditures support the
provision of lifesaving HIV/AIDS drugs. A roll-back in federal
ADAP spending to FY08 levels would cut AIDS prescription
drug funding by 7.1% (from $744 million to $691 million). ADAP
is a federal–state partnership. Unless the states make up
the shortfall, more than 4,300 people6 might need to be
removed from the ADAP program, putting their access to
lifesaving treatment in jeopardy.
Research: Investments in AIDS research have paid enormous
dividends in treating and preventing HIV/AIDS. AIDS research
has also led to major advances in the treatment and prevention
of a host of other diseases and conditions, including cancer,
heart attack, stroke, and Alzheimer’s. The proposed cuts would
slash AIDS research funding at the National Institutes of Health
(NIH) by 8%, from $3.18 billion to $2.93 billion, forcing the
NIH to make serious reductions in current research studies
and undermining American competitiveness in scientific
research and innovation.
Impact on the Global Response to HIV/AIDS
Launched by President George W. Bush, the President’s
Emergency Plan for AIDS Relief (PEPFAR) has proven to be one
of the most successful international aid programs in history,
saving millions of lives, preventing thousands of new HIV
infections, and providing desperately needed care for orphans
and other vulnerable children affected by the AIDS epidemic.
Even so, it is estimated that more than 9 million people in
low- and middle-income countries, including nearly one
million children, are in need of HIV/AIDS treatment but still
do not have access to it.7 Additionally, nearly 700,000 women
who need PMTCT services to reduce the likelihood of passing
HIV infection to their children do not have access to these
highly effective services.
Should federal discretionary funding return to FY 2008 levels,
bilateral HIV/AIDS programming would be reduced by 12.4%
(from $5.74 billion to $5.03 billion), substantially reducing the
availability of lifesaving treatment for people with HIV/AIDS,
pediatric services, and PMTCT programs.
Treatment: Based on FY 2009 budgets, 44.8% of PEPFAR
funding is dedicated to treatment, and, as of September 2009,
2.4 million men, women, and children depended on PEPFAR for
their AIDS treatment.8 A recent study from Stanford University
found that PEPFAR-funded treatment programs averted 1.2
million deaths in Africa and in only four years cut the HIV/AIDS
death toll by 10.5% in targeted countries.9 Funding cuts of the
magnitude proposed would seriously undermine capacity to
scale up treatment for people in the developing world whose
lives depend upon it. 
Pediatric and orphan services: Based on FY 2009 budgets,
14.2% of PEPFAR funding is dedicated to pediatric care,
support, and treatment services. As of September 2009, 3.6
million vulnerable children and orphans were receiving HIV-
related support and care services through PEPFAR. A return to
FY 2008 funding levels would likely require serious cutbacks in
services to children.
Prevention of mother-to-child transmission: Based on FY
2009 budgets, 6.9% of PEPFAR funding is dedicated to PMTCT
services. As of September 2009, PEPFAR-funded programs
had enabled nearly 340,000 babies to be born without HIV.10 A
return to FY 2008 funding levels would require cutbacks in this
extremely successful HIV prevention program for children.
A return to FY 2008 funding levels would erase our progress
in fighting the global HIV/AIDS epidemic, affecting the health
and wellbeing of millions of people around the world. Severe
cutbacks in PEPFAR would likely result in substantial reductions
in services to treat HIV/AIDS, provide for the needs of orphans
and other vulnerable children, and prevent mother-to-child
transmission of HIV infection. A more strategic approach to
HIV/AIDS in the U.S. through the National HIV/AIDS Strategy,
along with advances in global HIV prevention and treatment
delivery, presents an opportunity to change the trajectory of
the epidemic both at home and abroad. Funding cuts of the
magnitude proposed by Rep. Boehner would squander this
opportunity.
References and Notes
1 House Republican Leader John Boehner. BACKGROUND: House Republicans’ Plan for Immediate, Bipartisan Action
on the Economy. Available at: http://gopleader.gov/news/DocumentSingle.aspx?DocumentID=205301. Accessed
October 6, 2010.
2 A Pledge to America, page 21. Available at: http://pledge.gop.gov/resources/library/documents/pledge/a-pledge-
to-america.pdf. Accessed November 4, 2010.
3 Horney, JR, Greenstein R. Boehner Proposal Would Cut Non-Security Discretionary Programs 21 Percent, The
Deepest Such Cut in Recent U.S. History. Center on Budget and Policy Priorities. Available at: http://www.cbpp.org/
cms/index.cfm?fa=view&id=3286. Accessed October 6, 2010.
4 The total discretionary domestic funding figure for HIV/AIDS programs in FY 2008 assumes the Department of
Veterans Affairs number will be exempted from the roll back and set at the President’s FY 2011 request.
5 The total global funding figure for HIV/AIDS programs in FY 2008 assumes the Department of Defense number will
be exempted from the roll-back and set at the President’s FY 2011 request.
6 Assuming that all programs within ADAP would be cut proportionately, 87% of the total ADAP cut ($60.6 million)
would be a reduction in prescription drug funding. Taking this number ($52.7 million) and dividing it by the
estimated annual per client expenditures in 2009 ($12,034) yields the approximate number of clients (4,381).
7 World Health Organization (WHO), Joint United Nations Programme on HIV and AIDS (UNAIDS), United Nations
Children’s Fund (UNICEF). Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector.
Available at: http://www.who.int/hiv/pub/2010progressreport/en/index.html. Accessed October 18, 2010.
8 The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). 2009 Annual Report to Congress on PEPFAR
Program Results. Available at: http://www.pepfar.gov/documents/organization/138417.pdf. Accessed November 4,
2010.
9 Bendavid, E, Bhattacharya, J. The President’s Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes.
Ann Intern Med. 2009; 150:688-695. Available at: http://www.annals.org/content/150/10/688.long. Accessed
November 4, 2010.
10 The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Making a Difference: Funding (Updated October
2010). Available at www.pepfar.gov/press/80064.htm. Accessed October 18, 2010.
Sources
Data sources: Kaiser Family Foundation’s U.S. Federal Funding for HIV/AIDS: The President’s FY 2011 Budget Request
Fact Sheet, February 2010; National ADAP Monitoring Report Annual Report, April 2009; NIH Office of AIDS Research
FY 2011 Congressional Budget Justification, January 2010; U.S. President’s Emergency Plan for AIDS Relief’s Making a
Difference: Funding, October 2010; U.S. President’s Emergency Plan for AIDS Relief’s Sixth Annual Report to Congress
on PEPFAR Program Results, March 2010.