AIDS Funding for Federal Government Programs: FY1981-FY2009

AIDS Funding for Federal Government Programs:
FY1981-FY2009
Updated April 23, 2008
Judith A. Johnson
Specialist in Biomedical Policy
Domestic Social Policy Division

AIDS Funding for Federal Government Programs:
FY1981-FY2009
Summary
Federal government spending on HIV (the human immunodeficiency virus) and
AIDS (acquired immune deficiency syndrome) is estimated at $23.3 billion in
FY2008. Of the total, 63% is for treatment programs; research programs receive

13%; prevention programs receive 14%, and income support programs receive 10%.

The Administration’s government-wide request level for all HIV/AIDS programs in
FY2009 is $24.1 billion.
AIDS programs within the Department of Health and Human Services (HHS)
account for 66% of the total amount spent on HIV/AIDS by the federal government
in FY2008, a total of $15.2 billion for both discretionary and entitlement programs.
Within the HHS discretionary budget, funding for HIV/AIDS research, prevention,
and treatment programs has increased from $200,000 in FY1981 to an estimated
$6.586 billion in FY2008; the Administration’s request for FY2009 is $6.592 billion.
This report provides an overview of HHS spending on HIV/AIDS as well as
budget numbers for other federal government programs targeting HIV/AIDS. This
report is updated once per year to reflect the new budget figures.

Contents
In troduction ......................................................1
HHS Discretionary Funding: NIH, CDC, and HRSA......................3
NIH.........................................................3
CDC ........................................................4
HRSA .......................................................4
HHS Entitlement Funding: Medicaid and Medicare at CMS................5
Medicaid ....................................................5
Medicare ....................................................6
Funding for Other AIDS Programs....................................7
HIV/AIDS Minority Initiative....................................7
International HIV/AIDS Programs.................................8
List of Figures
Figure 1. Estimated Total Federal Spending on HIV/AIDS, by Function,
FY2008 .....................................................1
Figure 2. Estimated Total Federal Spending on HIV/AIDS, by Agency,
FY2008 .....................................................3
Figure 3. Estimated Federal Government Spending on HIV/AIDS
Treatment, FY2008............................................6
Figure 4. HHS Spending on HIV/AIDS Programs.......................14
Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a Percentage of
Total .......................................................14
List of Tables
Table 1. HIV/AIDS Minority Initiative.................................8
Table 2. HHS Discretionary Funding for HIV/AIDS.......................9
Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency ...........10
Table 4. Total Federal Government Spending on HIV/AIDS, by Function....11
Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009....12
Table 6. Federal Government Spending on International HIV/AIDS Programs,
by Function.................................................15

AIDS Funding for Federal Government
Programs: FY1981-FY2009
Introduction
Untreated HIV infection leads to a gradual deterioration of the immune system
and leaves affected individuals susceptible to the opportunistic infections and cancers
that typify AIDS. Since 1981, a cumulative total of 1,014,797 AIDS cases in the
United States and dependent areas have been reported to the Centers for Disease¹
Control and Prevention (CDC). Of this total, 448,871 persons were reported to be
living with AIDS as of the end of December 2006. In addition to the total number
of people living with AIDS, another 233,079 persons were known to be infected with
HIV (does not include data from five states and the District of Columbia; these areas
have not been reporting name-based HIV infection case numbers to CDC since at
least 2003).
Figure 1. Estimated Total Federal Spending on HIV/AIDS,
by Function, FY2008

Research

13%

Prevention

14%

TreatmentIncome
63%Support

10%

^Source:^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008}.
¹ Data in this paragraph are from Table 3, p. 13 and Table 12, pp. 24-25 of the CDC,
HIV/AIDS Surveillance Report, 2006, vol. 18, at [http://www.cdc.gov/hiv/topics/
surveillance/resources/reports/].

Federal government AIDS spending is estimated at $23.3 billion in FY2008 (see
Table 5). The Bush Administration request for FY2009 is $24.1 billion. Of the total
amount spent by the federal government on HIV/AIDS in FY2008, the majority
(63%) of funding is for treatment programs; funding for research receives 13% of the
total (see Figure 1 and Table 4). The remaining amounts are for prevention
programs (14%) and income support for persons with AIDS (10%).
AIDS programs within HHS (Health and Human Services) account for 66% of
the total amount spent on AIDS by the federal government (see Figure 2). HHS
entitlement funding supports the treatment of HIV/AIDS patients through Medicaid
and Medicare, which are administered by the Centers for Medicare and Medicaid
Services (CMS). HHS discretionary funding supports AIDS research and prevention
programs, as well as treatment programs. Table 2 provides a history of HHS
discretionary funding for HIV/AIDS from the beginning of the epidemic in FY1981
to the present.
Funding for HIV/AIDS programs within HHS has increased markedly over the
past 15 years as measured in constant 2000 dollars, shown in Figure 4 near the end
of this report. Even though HHS has revised its estimates of spending by Medicaid
for FY2007 through FY2009, Figure 4 still shows that most of the overall rise can
be attributed to increased spending on Medicaid, Medicare, and treatment programs
in the discretionary budget, largely through the Ryan White program administered by
the Health Resources and Services Administration (HRSA). The increase in
HIV/AIDS research and prevention programs has been much less pronounced, and
their portion of the total amount spent by HHS on HIV/AIDS has declined over the
past 15 years (see Figure 5). For example, in FY1992 HIV/AIDS research and
prevention programs at HHS accounted for 51% of the total amount spent by HHS
on HIV/AIDS; by FY2008, such programs were about 27% of the total amount spent
by HHS on HIV/AIDS, reflecting the growing amounts spent on treatment services
under Medicaid and Medicare.

Figure 2. Estimated Total Federal Spending on HIV/AIDS,
by Agency, FY2008

VeteransOther

2%2%

HHS
DiscretionaryState Dept.

28%20%

USAID

Social
Security

HHS
Entitlement

38%

^Source:^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^No^te:^USA^I^{D, U.S. A}^g^en^cy^f^o^r^Iⁿ^terⁿ^atioⁿ^a^{l Dev}^e^lo^p^m^en^{t. See}^Ta^ble⁴^.
About 90% of FY2008 HHS discretionary funding for HIV/AIDS is allocated
to three HHS agencies: the National Institutes of Health (NIH), which supports
HIV/AIDS research; CDC, which supports HIV/AIDS prevention programs; and,
HRSA, which administers the Ryan White program, an HIV/AIDS treatment
program (see Table 3 and Table 4). The budgets and activities of these three
agencies are briefly described below, followed by a discussion of entitlement
program spending on HIV/AIDS.
HHS Discretionary Funding: NIH, CDC, and HRSA
NIH
NIH is the principal agency of the federal government charged with the conduct
and support of biomedical and behavioral research. NIH conducts research at its own
27 institutes and centers and supports more than 200,000 scientists and research
personnel working at over 3,100 U.S. institutions. NIH funding for FY2008 was
provided in P.L. 110-161 (H.R. 2764), and NIH estimates FY2008 funding for AIDS
research at $2.913 billion. The Administration’s request for FY2009 is $2.913

billion.² Funding for AIDS research is distributed among the NIH institutes in
accordance with the scientific priorities identified in the annual comprehensive plan
for AIDS research developed by the institutes along with the Office of AIDS
Research (OAR).
OAR was established in statute by the National Institutes of Health
Revitalization Act of 1993 (P.L. 103-43) and given substantially enhanced authority
and responsibility beyond the office NIH had established under the same name.
Congress appropriated funds to OAR in FY1995. However, since FY1996, Congress
has not provided a direct appropriation for the OAR (aside from amounts identified
for the operations of the office itself). For FY2008, the House and Senate do not
specify a funding amount for AIDS research at NIH. Instead, funding for AIDS
research is included within the appropriation for each Institute/Center/Division of
NIH, with decisions as to specific projects to fund and levels of funding left to the
Director of NIH and the Director of OAR.
CDC
CDC works with community, state, national, and international public health
agencies to prevent HIV infection and reduce AIDS-associated morbidity and
mortality through its information and education programs. CDC also supports
research, surveillance, and epidemiology studies on HIV/AIDS. CDC distributes
much of its HIV funds to state and local agencies through cooperative agreements,
grants, and contracts. CDC funding for FY2008 was provided in P.L. 110-161 (H.R.
2764). According to the HHS Budget Office, CDC will be spending $872 million on
HIV/AIDS activities in FY2008; the Administration’s request for FY2009 is $871
million.³
HRSA
The HIV/AIDS Bureau within HRSA administers the Ryan White program, a
four-part federal grant program designed to provide emergency relief and essential
health care services to patients infected with HIV. The program funds hundreds of
grantees that serve 531,000 people each year. The Ryan White HIV/AIDS Treatment
Modernization Act of 2006 (P.L. 109-415, H.R. 6143) reauthorized the Ryan White
program through September 30, 2009.
HRSA funding for FY2007 was provided in P.L. 110-161 (H.R. 2764).
According to the HHS Budget Office, HRSA will be spending $2.170 billion on
Ryan White program activities in FY2008. The Administration’s request for FY2009

² For additional information on OAR budget and research activities for FY2009, see
“Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates
for Appropriations Committees, National Institutes of Health, Volume I, Overview,” pp. 1-

17, at [http://officeofbudget.od.nih.gov/ui/2008/OAR.pdf].

³ For further information on the CDC HIV/AIDS budget and program activities, see
“Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates
for Appropriations Committees, Centers for Disease Control and Prevention,” pp. 61-78, at
[ h t t p : / / www.cdc.go v/ f mo/ PDFs/ FY09_CDC_CJ _ Fi nal .pdf ] .

is $2.171 billion.⁴ (For further information on the Ryan White program, see CRS
Report RL33279, The Ryan White HIV/AIDS Program, by Judith A. Johnson.)
HHS Entitlement Funding:
Medicaid and Medicare at CMS
Medicaid
Medicaid is a federal-state matching entitlement program that provides medical
assistance for eligible low-income persons and families and certain aged, disabled,
and medically needy individuals. In order to obtain Medicaid coverage, persons must
belong to one of the categories of persons who can qualify for coverage (such as
families with children and disabled persons) and have low income or deplete their
income on the cost of their care. Medicaid has played an important role in needed
health care for persons with HIV and AIDS because of its coverage of prescription
drugs.
Within broad federal guidelines, each state designs and administers its own
Medicaid program, resulting in wide variations among the states in coverage, benefits
offered, and payment for services. The portion of a state’s Medicaid budget provided
by the federal government varies from 50% in relatively affluent states to 80% in
poorer states. Medicaid is one of the largest source of federal funding for AIDS
treatment and health care services (see Figure 3).
For FY2008, the federal share of Medicaid spending on AIDS treatment is
estimated at $4.1 billion, and for FY2009, the federal share estimate is $4.4 billion.
Total FY2008 federal and state Medicaid spending for AIDS treatment will be an
estimated $7.2 billion ($4.1 billion federal and $3.1 billion state).⁵ CMS analysts
have significantly lowered their estimate of the federal share of Medicaid spending
on AIDS treatment due to two factors: (1) the impact of Medicare Part D prescription
drug coverage and (2) lowered per capita health care costs based on internal CMS
data and external data.⁶ However, a study by analysts outside of CMS found that
although “implementation of Medicare drug benefit resulted in a major shift of
prescription drug spending from Medicaid to Medicare ... spending for antiretroviral
medications decreased by a much smaller percentage than did spending for many

⁴ For more information on the HRSA Ryan White budget and program activities, see
“Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates
for Appropriations Committees, Health Resources and Services Administration,” pp. 163-

193, at [ftp://ftp.hrsa.gov/about/budgetjustification09.pdf].

⁵ Estimate based on average federal Medicaid assistance percentage (FMAP) for the nation
as a whole.
⁶ Personal communication, HHS Budget Office, April 17, 2008.

other classes. People with HIV and AIDS continue to depend heavily on Medicaid
to pay for their health care, as most do not qualify for Medicare.”⁷
Figure 3. Estimated Federal Government Spending on HIV/AIDS
Treatment, FY2008

VAOther

3%3%

Medicaid

28%State Dept.

20%

Ryan
White
Medicare15%

31%

^Source:^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^No^tes:^Oth^e^rⁱⁿ^clu^d^es^th^e^f^o^llowⁱⁿ^g^:^Su^bs^tan^{ce A}^b^u^s^{e an}^{d Men}^t^{al Health}^{; P}^u^{blic Health}^Em^erg^eⁿ^c^y
^F^uⁿ^d^;^D^e^part^m^eⁿ^t^of^D^e^f^eⁿ^s^e;^Bu^reau^of^Pri^s^on^s^;^F^e^deral^Em^pl^oy^{ee H}^eal^t^h^Ben^e^fⁱ^t^s^Prog^ram^;^G^l^obal
^A^I^D^S^T^r^ust^Fund^.^Se^e^Ta^ble³^.
Medicare
Medicare is a federal health care insurance program for the elderly and certain
disabled persons. In general, in order to qualify for coverage under Medicare, a
person must be age 65 or older, disabled, or suffering from kidney failure (end-stage
renal disease or ESRD). According to one estimate, about 80% of beneficiaries with⁸
HIV/AIDS that qualified for Medicare did so because of a disability, the remainder
⁷ Brian K. Bruen and Laura M. Miller, “Changes in Medicaid Prescription Volume and Use
in the Wake of Medicare Part D Implementation,” Health Affairs, January/February 2008,
v. 27, pp. 196-202.
⁸ An HIV-positive individual must have a recognized AIDS-defining illness in order to meet
the disability classification.

were eligible because they were 65 or older or had ESRD.⁹ The elderly qualify the
month they turn 65, and those with ESRD qualify within three months of being
diagnosed with irreversible kidney disease requiring dialysis or a kidney transplant.
However, disabled people, including those with AIDS, must wait for a total of 29
months after a determination that they are disabled before they become eligible for
Medicare coverage.¹⁰
Early in the epidemic, few individuals with AIDS survived the long waiting
period. With improved drug therapies, the life expectancy of individuals with HIV
has increased, and it is expected that the number able to qualify for Medicare
coverage will continue to rise.¹¹ The Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (P.L. 108-173) provided for the implementation of a
prescription drug program, often called Medicare Part D, which became effective
January 1, 2006. CMS analysts have adjusted their estimate of Medicare spending
on AIDS treatment based on two factors: (1) the impact of Medicare Part D
prescription drug coverage and (2) lowered per capita health care costs based on
internal CMS data and external data.¹² For FY2008, funding for the care of persons
with HIV/AIDS under Medicare is estimated to be $4.5 billion, and the estimate for
FY2009 is $4.8 billion.
Funding for Other AIDS Programs
HIV/AIDS Minority Initiative
In 1998 the White House announced a series of initiatives targeting appropriated
funds for HIV/AIDS prevention and treatment programs in minority communities.
The Congressional Black Caucus worked with the Clinton Administration to
formulate the approach. For FY2008, a total of $403 million is provided to continue
these activities. For FY2009, the Administration has requested $387 million. See
Table 1 below for further details.

⁹ Nancy Fasciano et al., Profile of Medicare Beneficiaries with AIDS: Application of an
AIDS Case Finding Algorithm, Executive Summary, October 14, 1999. Submitted by
Mathematica Policy Research, Inc.
¹⁰ Disabled people begin collecting Social Security disability cash benefits five months after
a determination that they are disabled and then must wait an additional 24 months for a total
of 29 months before becoming eligible for Medicare.
¹¹ Combination drug therapies do not work for everyone with HIV. However, for individuals
who are successfully treated, the drug therapies will keep them healthy longer, thereby
preventing some from qualifying for disability.
¹² Personal communication, HHS Budget Office, April 17, 2008.

Table 1. HIV/AIDS Minority Initiative
($ in millions)
^Program^FY²⁰⁰⁵^FY²⁰⁰⁶^FY²⁰⁰⁷^FY²⁰⁰⁸^FY²⁰⁰⁹
^H^R^S^A^$129^$129^$131^$135¹³⁹
^C^D^C⁹⁴⁹⁶⁹⁶⁹⁶⁷⁶
^S^A^MH^S^A¹¹²¹¹²¹¹¹¹¹²¹¹²
^Min^o^r^ity^Co^m^m^uⁿ^{ities Fu}ⁿ^d⁵²⁵²⁵²⁵¹⁵²
^Of^fⁱ^{ce o}^f^Min^o^r^ity^Health⁸¹⁰⁹⁷⁷
^Of^fⁱ^{ce of}^W^o^m^eⁿ^’^s^Health¹¹¹²¹
^T^o^tal^,^Mⁱⁿ^o^ri^{ty HI}^V^/^A^I^D^S^Iⁿⁱ^tⁱ^a^ti^ve³⁹⁷³⁹⁹⁴⁰⁰⁴⁰³³⁸⁷
^Source:^T^a^{ble prepared by}^th^{e C}^oⁿ^g^r^es^sⁱ^on^{al R}^e^s^earch^(C^R^S^{) bas}^e^{d on}^an^aly^s^is^f^r^om^th^{e HHS}
^Bu^dg^et^O^f^fⁱ^{ce, F}^e^bru^a^ry^{15, 2008.}
^No^tes:^T^o^t^a^l^s^m^a^yⁿ^o^t^{add du}^{e t}^o^rouⁿ^dⁱⁿ^g^.^F^Y^{2009 i}^s^bas^e^{d on}^t^h^e^A^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^’^s^bu^dg^et^requ^es^t^.
International HIV/AIDS Programs
In January 2003, President Bush announced in the State of the Union speech a five-
year $15 billion program, the President’s Emergency Plan for AIDS Relief
(PEPFAR).¹³ The five-year program targets countries with a very high prevalence
of HIV infection; its goals are to prevent 7 million new infections, provide treatment
to 2 million HIV-infected people, and provide care for 10 million HIV-infected
individuals and AIDS orphans.
The Global Fund to Fight AIDS, Tuberculous and Malaria, was first proposed
at the July 2000 G-8 Summit in Okinawa.¹⁴ Its purpose is to attract, manage and
disburse funding through a public-private partnership dedicated to the reduction of
infections, illness and death caused by these three diseases in countries in need. It
was established in January 2002 as a charitable foundation in Geneva, Switzerland;
the first round of grants was approved in April 2002. U.S. support of the fund occurs
through USAID and HHS.
As indicated in Table 6, federal government spending on international
HIV/AIDS programs in FY2008 is $5.8 billion; the Administration’s request for¹⁵

FY2009 is $5.9 billion.
¹³ The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (H.R.

1298, P.L. 108-25), signed into law on May 27, 2003.

¹⁴ Fact Sheet, Office of the Spokesman, U.S. Department of State, December 13, 2002, at
[ ht t p: / / www.st at e.gov/ r / pa/ pr s / ps/ 2002/ 15583.ht m] .
¹⁵ For additional information, see CRS Report RL33771, Trends in U.S. Global AIDS
Spending: FY2000-FY2008, by Tiaji Salaam-Blyther; CRS Report RL33485, U.S.
International HIV/AIDS, Tuberculosis, and Malaria Spending: FY2004-FY2008, by Tiaji
Salaam-Blyther; CRS Report RL31712, The Global Fund to Fight AIDS, Tuberculosis, and
(continued...)

Table 2. HHS Discretionary Funding for HIV/AIDS
($ in thousands)
^{$ I}ⁿ^creas^e^over^{% I}ⁿ^creas^e^over
^Yea^r^F^unding^p^rⁱ^o^{r year}^p^rⁱ^o^{r year}
^F^Y¹⁹⁸¹^$200^—^—
^F^Y¹⁹⁸²^5,555^$5,355^2,678%
^F^Y¹⁹⁸³^28,736^23,181^417%
^F^Y¹⁹⁸⁴^61,460^32,724^114%
^F^Y¹⁹⁸⁵^108,618^47,158^77%
^F^Y¹⁹⁸⁶^233,793^125,175^115%
^F^Y¹⁹⁸⁷^502,455^268,662^115%
^F^Y¹⁹⁸⁸^962,018^459,563^94%
^F^Y¹⁹⁸⁹^1,304,012^341,994^36%
^F^Y¹⁹⁹⁰^1,592,756^288,744^22%
^F^Y¹⁹⁹¹^1,891,232^298,476^19%
^F^Y¹⁹⁹²^1,963,414^72,182^4%
^F^Y¹⁹⁹³^2,079,591^116,639^6%
^F^Y¹⁹⁹⁴^2,568,682^489,091^24%
^F^Y¹⁹⁹⁵^2,700,498^131,816^5%
^F^Y¹⁹⁹⁶^2,897,923^197,425^7%
^F^Y¹⁹⁹⁷^3,267,220^369,297^13%
^F^Y^{1998 3,536,519}^269,299^8%
^F^Y¹⁹⁹⁹^4,094,489^557,970^16%
^F^Y²⁰⁰⁰^4,546,326^451,837^11%
^F^Y²⁰⁰¹^5,225,645^679,319^15%
^F^Y²⁰⁰²^5,788,553^562,908^11%
^F^Y²⁰⁰³^6,093,846^305,293^5%
^F^Y²⁰⁰⁴^6,242,501^148,655^2%
^F^Y²⁰⁰⁵^6,279,141^36,640^0.6%
^F^Y²⁰⁰⁶^6,235,251^-^43,890^-⁰^.7%
^F^Y^{2007 6,357,719}^122,468^2%
^F^Y²⁰⁰⁸^6,586,086^228,367^4%
^F^Y^{2009 R}^e^qu^es^t⁶^,592,399⁶³¹³^0.1%
^Source:^T^a^{ble prepared by}^th^e^C^oⁿ^g^r^es^sⁱ^on^al^R^e^s^earch^Serv^ice^(C^R^S^{) bas}^e^{d on}^an^aly^s^is^f^r^om^HHS
^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^No^te:^F^Y^{2009 i}^s^bas^e^{d on}^t^h^{e A}^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^’^s^bu^dg^et^requ^es^t^.

¹⁵ (...continued)
Malaria: Background, by Tiaji Salaam-Blyther; CRS Report RL34192, PEPFAR: From
Emergency to Sustainability, by Tiaji Salaam-Blyther; CRS Report RL32001, HIV/AIDS in
the Caribbean and Central America, by Mark P. Sullivan; and CRS Report RL33584, AIDS
in Africa, by Nicolas Cook.

CRS-10
Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency
($ in thousands)
^en^cy^FY²⁰⁰⁰^FY^{2001 FY}²⁰⁰²^FY²⁰⁰³^FY²⁰⁰⁴^a^FY²⁰⁰⁵^a^FY^{2006 FY}²⁰⁰⁷^FY²⁰⁰⁸^FY²⁰⁰⁹
^A^$76,317^$75,818^$75,818^$72,830^$73,⁸⁴⁷^$87,661^$88,758^$90,563^$94,425^$95,369
^S^A^1,599,231^1,815,000^1,917,200^2,024,962^2,066,861^2,075,296^2,064,⁷⁰⁵^2,141,195^2,170,192^2,171,312
^S³^,770^3,810^3,886^3,940^4,⁰¹³^4,074^4,261^4,437^4,587^3,629
^C^687,164^859,045^931,141^936,426^862,⁸⁵⁴^855,535^838,225^879,241^872,427^871,314
^H²^,004,428^2,247,015^2,499,458^2,716,218^2,849,952^2,920,551^2,901,⁸⁵⁹^2,905,788^2,913,345^2,913,345
^MH^S^A^110,347^156,677^169,034^170,614^171,²⁰⁵^173,024^171,872^171,545^172,226^172,907
^R^Q^1,787^3,381^2,913^1,825^2,⁰¹⁷^1,088^2,750^2,800^2,800^2,800
^63,282^64,899^64,103^67,681^62,637^62,712^63,821^63,150^61,325^61,723
ⁱ^{ki/CRS-RL30731}^A^I^D^S^T^r^u^s^t^F^uⁿ^d^—^—^125,⁰⁰⁰^99,350^149,115^99,200^99,000^99,000^294,759^300,000
^g/w^tal^$4,546,326^$5,225,645^$5,788,⁵⁵³^$6,093,846^$6,242,501^$6,279,141^$6,^235,251^$6,357,719^$6,586,086^$6,592,399
^s^.or
^le^ak^T^a^bl^{e prepared by}^t^h^{e C}^oⁿ^g^r^es^sⁱ^on^al^R^e^s^earch^S^e^rvⁱ^{ce (C}^R^S^{) bas}^e^{d on}^an^al^y^sⁱ^s^f^r^om^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^://wiki^F^Y^{2009 i}^s^bas^e^{d on}^t^h^{e A}^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^’^s^bu^dg^et^requ^es^t^.^FDA:^F^{ood an}^{d D}^r^u^g^A^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^;^H^R^S^A^:^Health^R^e^s^o^u^r^ces^an^{d Serv}^ices^A^d^mⁱⁿⁱ^s^t^ration^;^I^H^S^:^In^dian^Health
^h^ttp^ice;^CDC:^C^eⁿ^t^ers^f^o^{r Dis}^eas^{e C}^oⁿ^t^{rol an}^{d P}^r^ev^en^tion^;^NIH:^Natioⁿ^a^{l I}ⁿ^stitu^{tes o}^f^Health^;^SAM^H^SA:^Su^bs^tan^ce^A^b^u^s^{e an}^{d Men}^t^{al Health}^Serv^ices^A^d^mⁱⁿⁱ^s^t^ration^;^AHRQ^:
^cy^f^o^r^Health^car^{e Resear}^ch^an^d^Qu^ality^;^OS^:^Of^fⁱ^{ce of}^th^{e Secretary}⁽ⁱⁿ^c^lu^des^th^{e Of}^fⁱ^{ce of}^HIV/A^I^{DS P}^o^lic^y^,^O^f^fⁱ^c^e^fo^r^Ci^vi^l^Ri^ght^s,^O^ffi^c^e^of^Miⁿ^o^ri^t^y^H^eal^t^h^{, O}^f^fⁱ^{ce o}^f
^m^eⁿ^’^{s Health}^an^d^th^{e P}^u^b^{lic Health}^an^d^So^{cial Ser}^v^{ices Em}^er^g^eⁿ^c^y^Fuⁿ^d^/Mⁱⁿ^o^r^ity^Co^m^m^uⁿ^{ities Fu}ⁿ^d⁾^;^G^l^o^b^a^l^{Aids Trust}^F^und:^W^h^{ile b}^u^d^g^etedⁱⁿ^NI^{H, HHS co}ⁿ^t^rⁱ^b^u^tioⁿ^s
^{e Glo}^b^a^{l Fu}ⁿ^d^to^Fig^h^t^HI^V/A^I^{DS, Malar}ⁱ^{a, an}^d^T^u^b^e^r^c^u^l^o^s^is^{are n}^o^{t ref}^l^{ected in}^th^{e NIH HIV/A}^I^{DS s}^p^en^din^g^fⁱ^g^u^r^es^{, bu}^{t are}^accouⁿ^t^{ed f}^o^{r s}^e^parately^.
^{C r}^e^p^o^r^t^e^d^fundⁱ^{ng fo}^r^H^I^V^/^A^I^D^S^e^x^p^e^ndⁱ^t^u^r^e^{s ha}^ve^b^e^eⁿ^c^o^m^p^arably^adj^u^s^t^{ed dow}ⁿ^w^{ard to ref}^l^{ect th}^{e n}^e^w^bu^dg^{et s}^t^ru^ctu^r^{e at}^C^D^C^th^{at ex}^clu^d^es^admⁱⁿⁱ^s^t^rativ^{e an}^{d m}^aⁿ^a^g^e^m^eⁿ^t
^cos^t^s^.^T^h^{e FY2004 adj}^u^s^t^m^eⁿ^t^w^a^s^abou^{t $68 m}^illioⁿ^,^an^{d th}^{e FY2005 adj}^u^s^t^m^eⁿ^t^w^a^s^abou^{t $74 m}^illion^.

CRS-11
Table 4. Total Federal Government Spending on HIV/AIDS, by Function
($ in millions)
^FY^{2007 A}^c^t^u^a^l^FY^{2008 E}ⁿ^a^c^t^e^d^F^Y^{2009 Pr}^e^s^id^eⁿ^t^’^s^B^u^d^g^e^t
^In^com^e^In^com^e^In^com^e
^en^cy^/^D^ep^artm^en^t^Research^P^reven^t^T^reatm^t^s^uppor^t^T^o^t^a^l^R^e^s^e^a^r^c^h^P^r^e^v^eⁿ^t^T^r^e^a^t^m^t^s^uppor^t^T^o^t^a^l^R^e^s^e^a^r^c^h^P^r^e^v^eⁿ^t^T^r^e^a^t^m^t^s^uppor^t^T^o^t^a^l
^$91^—^—^—^$91^$94^—^—^—^$94^$95^—^—^—^$95
^—³^2,138^—^2,141^—³^2,167^—^2,170^—³^2,168^—^2,171
¹³^—^—⁴¹³^—^—⁵¹²^—^—⁴
^—⁸⁷⁹^—^—⁸⁷⁹^—⁸⁷²^—^—⁸⁷²^—⁸⁷¹^—^—⁸⁷¹
^2,906^—^—^—^2,906^2,913^—^—^—^2,913^2,913^—^—^—^2,913
^—⁴⁰¹³¹^—¹⁷²^—⁴⁰¹³²^—¹⁷²^—⁴⁰¹³³^—¹⁷³
^Q³^—^—^—³³^—^—^—³³^—^—^—³
^—¹¹^—^—¹¹^—¹⁰^—^—¹⁰^—¹⁰^—^—¹⁰
^e^r^ge^nc^y^fund^—³⁷¹⁵^—⁵²^—³⁶¹⁴^—⁵¹^—³⁷¹⁵^—⁵²
^a^{l A}^I^{DS tr}^u^s^{t f}^uⁿ^d⁵⁰⁵⁰⁹⁹¹⁴⁷¹⁴⁷²⁹⁵^—¹⁵⁰¹⁵⁰^—³⁰⁰
^di^s^c^retⁱ^oⁿ^a^ry^$3,001^$1,024^$2,333^—^$6,358^$3,⁰¹²^$1,114^$2,460^—^$6,586^$3,013^$1,114^$2,465^—^$6,592
ⁱ^{ki/CRS-RL30731}^—^—^3,900^—^3,900^—^—^4,100^—^4,100^—^—^4,400^—^4,400
^g/w^—^—^4,200^—^4,200^—^—^4,500^—^4,500^—^—^4,800^—^4,800
^s^.or^al^{, H}^H^S^$3,001^$1,024^$10,433^—^$14,458^$3,012^$1,114^$11,060^—^$15,186^$3,013^$1,114^$11,665^—^$15,792
^le^ak^rity^{— DI}^—^—^—^$1,450^$1,450^—^—^—^$1,484^$1,484^—^—^—^$1,519^$1,519
^rity^{— SSI}^—^—^—⁴²⁰⁴²⁰^—^—^—⁴⁷⁹⁴⁷⁹^—^—^—⁴⁹⁰⁴⁹⁰
^://wiki^aⁿ^s^A^f^f^a^ir^s⁵³⁵⁴⁶⁵^—⁵⁰⁵⁵³⁵⁵⁰⁰^—⁵⁴⁰^$3^$35^$607^—⁶⁴⁵
^h^ttp^s^{e Dep}^a^rtm^eⁿ^t^.²⁶¹⁰⁵⁸^—⁹⁴³⁰¹⁸⁵⁸^—¹⁰⁶²³¹⁰⁵⁸^—⁹¹
^cy^f^o^{r In}^{t. Dev}^.^—⁴⁶⁶¹²⁴^—⁵⁹⁰^—³⁷¹^—^—³⁷¹^—³⁴²^—^—³⁴²
^u^reau^of^P^r^is^on^s^—²¹⁹^—²¹^—²¹⁹^—²¹^—²¹⁹^—²¹
^eⁿ^t^—^1,147^2,101^—^3,248^—^1,645^3,017^—^4,662^—^1,626^3,153^—^4,779
^e^part^m^eⁿ^t^—^—^—^—^—^—^—^—^—^—^—^—^—^—^—
ⁿ^Dep^t^.^—^—^—^—^—^—^—^—^—^—^—^—^—^—^—
^—^—^—²⁸⁶²⁸⁶^—^—^—³⁰⁰³⁰⁰^—^—^—³⁰⁰³⁰⁰
^FEHB^—^—¹⁰⁷^—¹⁰⁷^—^—¹¹⁴^—¹¹⁴^—^—¹²³^—¹²³
^t^{al, No}ⁿ^-^HHS^$31^$1,660^$2,874^$2,156^$6,721^$35^$2,071^$3,708^$2,263^$8,077^$26^$2,015^$3,959^$2,309^$8,310
^,^fed^eral
^m^eⁿ^t^$3,032^$2,684^$13,307^$2,156^$21,179^$3,047^$3,¹⁸⁵^$14,768^$2,263^$23,263^$3,039^$3,130^$15,624^$2,309^$24,102
^T^a^bl^{e prepared by}^t^h^{e C}^oⁿ^g^r^es^sⁱ^on^al^R^e^s^earch^S^e^rvⁱ^{ce (C}^R^S^{) bas}^e^{d on}^an^al^y^sⁱ^s^f^r^om^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^:^HHS^{: Dep}^a^r^t^m^eⁿ^t^o^f^He^a^lth^an^d^Hu^m^aⁿ^Ser^v^ices;^CM^S^{: C}^eⁿ^t^ers^f^o^{r Medicare an}^{d Medicaid Serv}^ices^;^DI^{: Disab}^ility^Iⁿ^su^r^aⁿ^ce;^HUD^:^D^e^part^m^eⁿ^t^of^H^o^u^sⁱⁿ^g^an^{d U}^r^ban
^e^lo^p^m^en^t;^SSI^{: Su}^p^p^l^em^en^{tal Secu}^r^ity^Iⁿ^co^m^e^;^OPM^-^FE^HB^{: Of}^fⁱ^{ce of}^P^e^rs^onⁿ^e^{l Man}^a^g^e^m^eⁿ^t^-^F^{ederal Em}^ploy^ees^Health^B^eⁿ^e^f^its^.

CRS-12
Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009
($ in millions)
^HHS
^SS^DOJ^-^OPM^-^CM^S
^r^VA^Defense^A^ID^Pri^s^on^s^S^tate^L^a^b^o^r^H^UD^FE^HB^E^d^u^c^ati^oⁿ^T^otal^Dis^cretionary^M^e^dica^id^M^e^dica^re^DI^SSI
^$6^—^—^—^—²^—^—^—^—^—^—^—^—^$8
^$29¹⁰^—^—^—⁵^—^—^—^—^—^—^—^—^$44
^$60³⁰^—⁵¹⁷^—^—^—^—^—^—^—^—^$103
^$109⁷⁰⁵¹⁰³⁸^—^—^—^—^—^—^—^—^$205
^$234¹³⁰⁵³⁰⁵²⁰⁷⁹^—^—^—^—^—⁵^—^$508
ⁱ^{ki/CRS-RL30731}^$502²⁰⁰¹⁵⁵⁵¹⁵⁵¹⁷⁴^—¹^—¹^—⁸^—^$922
^g/w
^s^.or^$962³³⁰³⁰⁹⁵²⁰⁷⁸⁵³³⁰¹^—¹¹¹³¹^$1,615
^le^ak^$1,304⁴⁹⁰⁵⁵¹⁵⁰³⁵¹³⁶⁸⁶⁴⁰²¹¹^—²²^—^$2,322
^://wiki^$1,592⁶⁷⁰¹¹⁰¹⁸⁴⁵⁵²²⁰¹²⁴⁷¹⁵¹¹^—³⁷^—^$3,070
^h^ttp^$1,891⁸⁷⁰¹⁸⁰²⁶⁶⁹⁵²⁵⁸¹²⁷⁷⁸⁵¹¹^—⁶¹^—^$3,833
^$1,967⁸⁰⁰⁴⁰⁰³⁷²¹⁵⁰²⁷⁹¹²⁵⁹⁴⁵¹¹⁴⁸¹⁰³^—^$4,345
^$2,079^1,000⁶⁰⁰⁴⁸¹²⁰⁰²⁹⁹¹⁵⁵¹¹⁷⁵¹¹¹⁰⁰¹⁷⁵^—^$5,213
^$2,569^1,300⁸⁰⁰⁵⁶⁸²⁵⁰³¹²¹²⁷¹¹⁵⁶¹¹¹⁵⁶¹⁹³^—^$6,398
^$2,700^1,500^1,000⁶³¹²⁵⁰³¹⁷¹¹⁰¹²⁰⁶¹¹¹⁷¹²¹²^—^$7,019
^$2,898^1,800^1,100⁶⁸⁴²⁵⁰³³¹⁹⁸¹¹⁵⁶^—¹¹⁷¹²²⁶^—^$7,680
^$3,267^2,200^1,300⁷³⁸²⁷⁵³⁵⁰⁸⁴¹¹⁷⁷^—²¹⁹⁶²⁴¹^—^$8,777
^$3,537^2,600^1,400⁷⁸⁷³⁰⁵³⁷⁸⁹⁵¹²¹⁷^—²²⁰⁴²⁵³^—^$9,689

CRS-13
^HHS
^SS^DOJ^-^OPM^-^CM^S
^r^VA^Defense^A^ID^Pri^s^on^s^S^tate^L^a^b^o^r^H^UD^FE^HB^E^d^u^c^ati^oⁿ^T^otal^Dis^cretionary^M^e^dica^id^M^e^dica^re^DI^SSI
^$4,094^2,900^1,500⁸²⁸³³⁰⁴⁰¹⁸⁶¹³⁹⁷^—²²²⁵²⁶⁶¹^$10,779
^a^$4,546^3,300^1,700⁸⁷⁰³⁷⁰³⁴⁵⁹⁷²⁰⁰⁸^—²²³²²⁷⁹¹^$12,025
^a^$5,226^3,700^1,900⁹¹⁹³⁴⁰⁴⁰⁵¹⁰⁸⁴³⁰¹⁵^—¹¹²⁵⁷²⁹²¹^$14,184
^$5,789^4,200^2,050⁹⁶¹³⁹⁰³⁹¹⁹⁶⁵¹⁰¹⁶^—¹¹²⁷⁷²⁹⁷^—^$14,988
^$6,094^4,800^2,400^1,019³⁹⁵³⁹⁶⁸²⁷⁷⁴¹⁷¹⁴¹¹¹²⁹⁰³²¹^—^$16,739
^$6,243^5,400^2,600^1,050⁴¹⁵⁴⁰²¹⁰⁵⁹⁶³¹⁷⁶³⁸¹¹²⁹⁵³⁴³^—^$18,481
^$6,279^5,700^2,900^1,250⁴⁵⁰⁴⁴⁵¹¹⁰⁶³³²⁰^1,376²²⁸²³⁷⁰^—^$19,817
ⁱ^{ki/CRS-RL30731}^$6,235^3,600^b^3,900^b^1,365⁴⁴⁰⁴⁶⁸¹⁰²⁶²¹²¹^1,977^—²⁸⁶¹⁰⁰^—^$19,116
^g/w^b^b
^s^.or^$6,358^3,900^4,200^1,450⁴²⁰⁵⁰⁵⁹⁴⁵⁹⁰²¹^3,248^—²⁸⁶¹⁰⁷^—^$21,179
^le^ak^$6,586^4,100^b^4,500^b^1,484⁴⁷⁹⁵⁴⁰¹⁰⁶³⁷¹²¹^4,662^—³⁰⁰¹¹⁴^—^$23,263
^://wiki^$6,592^4,400^b^4,800^b^1,519⁴⁹⁰⁶⁴⁵⁹¹³⁴²²¹^4,779^—³⁰⁰¹²³^—^$24,102
^h^ttp
^T^a^bl^{e prepared by}^t^h^{e C}^oⁿ^g^r^es^sⁱ^on^al^R^e^s^earch^S^e^rvⁱ^{ce (C}^R^S^{) bas}^e^{d on}^an^al^y^sⁱ^s^f^r^om^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^F^Y^{2009 i}^s^bas^e^{d on}^t^h^{e A}^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^’^s^bu^dg^et^requ^es^t^.^Mayⁿ^o^t^{add du}^{e t}^o^rouⁿ^dⁱⁿ^g^.^HHS^:^Dep^a^r^t^m^eⁿ^t^o^f^Health^an^d^Hu^m^aⁿ^Ser^v^{ices; Discr}^e^tioⁿ^a^r^y^A^I^DS^b^u^d^g^et;^CM^S:
^t^ers^f^o^{r Medicare an}^{d Medicaid Serv}^ices^;^SS:^{Social Secu}^rity^;^DI:^Disab^ility^Iⁿ^su^r^aⁿ^c^e^;^SSI:^Su^pplem^en^{tal Secu}^rity^In^com^e^;^VA:^Veter^aⁿ^s^A^f^f^a^ir^s;^AID:^{U.S. A}^g^en^cy^f^o^r
ⁿ^atioⁿ^a^{l De}^v^e^l^o^p^m^eⁿ^t^;^D^O^J-Pri^s^on^s^:^D^e^part^m^eⁿ^t^of^Ju^s^tⁱ^{ce, Bu}^reau^of^Pri^s^on^s^;^HUD:^D^e^p^a^r^t^m^e^nt^o^f^H^o^usi^{ng a}ⁿ^d^U^r^b^a^{n D}^e^ve^l^o^p^m^eⁿ^t^;^OPM^-^FE^HB:^O^ffi^c^e^o^f^P^e^r^s^o^nne^l
^a^g^e^m^eⁿ^t^-^F^{ederal Em}^ploy^ees^Health^B^eⁿ^e^f^its^.
^clu^d^es^{$75 m}^illion^f^o^{r th}^{e HR}^SA^Rⁱ^ck^y^R^a^y^Hem^oph^{ilia prog}^ram^,^an^{d FY2001 total in}^clu^d^es^{$580 m}^illion^f^o^{r th}^e^HRSA^Rick^y^Ray^Hem^o^p^h^{ilia p}^r^o^g^r^a^m^.
^{d Medicare am}^ouⁿ^t^s^h^a^v^e^been^revⁱ^s^e^{d du}^{e to th}^{e im}^{pact Medicare P}^a^{rt D pres}^criptio^{n d}^r^{ug c}^o^ve^r^a^ge^aⁿ^d^l^o^w^e^r^e^d^p^e^r^{capita h}^ealth^{care cos}^t^s^.

Figure 4. HHS Spending on HIV/AIDS Programs
¹⁶⁰⁰⁰
¹⁴⁰⁰⁰
¹²⁰⁰⁰
¹⁰⁰⁰⁰
⁸⁰⁰⁰
⁶⁰⁰⁰
⁴⁰⁰⁰
²⁰⁰⁰
⁰
¹⁹⁹²¹⁹⁹³¹⁹⁹⁴¹⁹⁹⁵¹⁹⁹⁶¹⁹⁹⁷¹⁹⁹⁸¹⁹⁹⁹²⁰⁰⁰²⁰⁰¹²⁰⁰²²⁰⁰³²⁰⁰⁴²⁰⁰⁵²⁰⁰⁶²⁰⁰⁷²⁰⁰⁸²⁰⁰⁹
^Dⁱ^s^c^r^e^tⁱ^ona^r^y^:^R^e^s^e^ar^c^h^Dⁱ^s^c^r^e^ti^oⁿ^a^r^y^{: P}^r^e^v^eⁿ^ti^oⁿ^Dⁱ^s^c^r^e^tⁱ^ona^r^y^:^T^r^ea^t^m^en^t^Me^dⁱ^c^aⁱ^d^M^edi^c^a^r^e
^Source:^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^No^te:^F^Y^{2009 i}^s^bas^e^{d on}^t^h^{e A}^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^’^s^bu^dg^et^requ^es^t^.
Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a
Percentage of Total

¹⁰⁰^%
⁸⁰^%
⁶⁰^%
⁴⁰^%
²⁰^%
^0%
¹⁹⁹²¹⁹⁹³¹⁹⁹⁴¹⁹⁹⁵¹⁹⁹⁶¹⁹⁹⁷¹⁹⁹⁸¹⁹⁹⁹²⁰⁰⁰²⁰⁰¹²⁰⁰²²⁰⁰³²⁰⁰⁴²⁰⁰⁵²⁰⁰⁶²⁰⁰⁷²⁰⁰⁸²⁰⁰⁹
^Dⁱ^s^c^r^e^ti^onar^y^:^R^e^s^ear^c^h^Dⁱ^s^c^r^e^ti^onar^y^:^P^r^ev^en^ti^on^Dⁱ^s^c^r^e^ti^onar^y^:^T^r^eat^m^e^nt^Me^dⁱ^c^aⁱ^d^M^edi^c^a^r^e
^Source:^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^No^te:^F^Y^{2009 i}^s^bas^e^{d on}^t^h^{e A}^d^mⁱⁿⁱ^s^t^ratⁱ^oⁿ^’^s^bu^dg^et^requ^es^t^.

CRS-15
Table 6. Federal Government Spending on International HIV/AIDS Programs, by Function
($ in millions)
^FY^{2007 A}^c^tu^al^FY^{2008 E}ⁿ^acted^F^Y^{2009 Pres}ⁱ^d^en^t’s^Bu^d^g^et
^ent^Res^e^arch^Prevent^T^reatm^ent^T^otal^Res^e^arch^Preven^t^T^reatm^ent^T^otal^Res^e^arch^Prevent^T^reatm^ent^T^otal
ⁿ^t^ers^f^o^{r D}ⁱ^s^eas^{e C}^oⁿ^t^rol^—¹²¹^—¹²¹^—¹¹⁹^—¹¹⁹^—¹¹⁹^—¹¹⁹
ⁿ^a^{l I}ⁿ^stitu^{tes o}^f^Health³⁶²^—^—³⁶²³⁶⁴^—^—³⁶⁴³⁶⁶^—^—³⁶⁶
^A^I^D^S^t^r^u^s^t^f^uⁿ^d^—⁵⁰⁵⁰⁹⁹^—¹⁴⁷¹⁴⁷²⁹⁵^—¹⁵⁰¹⁵⁰³⁰⁰
^b^t^o^t^a^l^,^HHS^$362^$170^$50^$582^$364^$266^$147^$777^$366^$269^$150^$785
^eⁿ^s^{e Dep}^a^rtm^eⁿ^t^—^—^—^—^—⁸^—⁸^—^—^—^—
^en^cy^f^o^{r In}^tern^ation^a^l
ⁱ^{ki/CRS-RL30731}^v^e^l^opm^en^t^—⁴⁶⁶¹²⁴⁵⁹⁰^—³⁷¹^—³⁷¹^—³⁴²^—³⁴²
^g/w^{e D}^e^part^m^eⁿ^t^—^1,147^2,101^3,248^—^1,645^3,017^4,662^—^1,626^3,153^4,779
^s^.or^o^r^Dep^a^rtm^eⁿ^t^—^—^—^—^—^—^—^—^—^—^—^—
^le^ak
^b^t^o^t^a^l^,^N^oⁿ^-^HHS^—^1,613^2,225^3,838^—^2,024^3,017^5,041^—^1,968^3,153^5,121
^://wiki
^h^ttp^tal^$362^$1,784^$2,275^$4,420^$364^$2,²⁹⁰^$3,164^$5,818^$366^$2,237^$3,303^$5,906
^T^a^bl^{e prepared by}^t^h^{e C}^oⁿ^g^r^es^sⁱ^on^al^R^e^s^earch^S^e^rvⁱ^{ce (C}^R^S^{) bas}^e^{d on}^an^al^y^sⁱ^s^f^r^om^H^H^S^Bu^dg^et^O^f^fⁱ^{ce, March}^{20, 2008.}
^M^a^y^no^t^a^d^d^d^u^e^t^o^r^o^undⁱ^ng.^HHS^:^Departm^eⁿ^t^of^Health^an^{d Hu}^m^aⁿ^Serv^ices^.