Aligning resources to fight HIV/AIDS in the United States: Funding to states through the US department of health and human services

Background: In response to the first U.S. National HIV/AIDS Strategy released in July 2010, we assessed how HIV/AIDS funding is spent by the Department of Health and Human Services (HHS) and how these resources align geographically with the HIV/AIDS epidemic according to various measures. Methods: Estimated FY2010 spending information was gathered from HHS agencies, including state/territory-level spending by prevention, care, and treatment services of the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA)-as well as Centers for Medicare and Medicaid Services (CMS). HHS funding is presented descriptively by state in the context of living HIV and AIDS case numbers and rates. Results: Nearly US$16 billion went to discretionary and entitlement spending, 77% of which supported or provided care and treatment by CMS (Medicare, Medicaid) and HRSA; the remainder to research, prevention, and other activities. For states and territories overall, funding was highly correlated with living AIDS case numbers (R ² =.88) as well as living HIV case numbers (R ² =.84); funding was far less correlated with case rates (per 100,000 population) for AIDS (R2 =.35) or HIV (R2 =.42). Conclusions: HHS HIV/AIDS funding, overall, is well correlated with the number of HIV/AIDS cases in each state/territory. Future assessments should capture information on who is being served, where, and how.