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I’d really like to see a breakdown of how these dollars are being spent, not just for the HIV/AIDS category, but also for the other wild outliers, breast cancer, and (on a per patient basis) West Nile virus. And I’d like to see the whole federal government funding picture, not just “NIH research dollars” for the other diseases, not just the outliers. I suspect the ratio between total federal funding and NIH funding is especially outrageous for AIDS, because of a massive number of politically-motivated “educational” programs (some of which boil to down to titillating sessions with graphic instruction in how to have lots and lots and lots of sex while sorta kinda hopefully minimizing your chance of catching or transmitting HIV) and disability payments to AIDS patients (I doubt that the total funding chart you linked to includes the disability payments).

Many years ago, I had a passing acquaintance with an HIV+ friend of a friend. This young man was getting a huge housing voucher (I believe it was directly from New York State or New York City, but a good chunk may have been ultimately coming from federal funds), sufficient to pay the full cost of a comfortable apartment, based on his “disability”, and also some sort of cash welfare payments (I think at least partly federal) and food stamps, while he attended a “job training” program in “Landscape Design”. Mind you there was no way he had the qualifications or connections to get any sort of employment in actual landscape *design*, and the program sounded like it was actually preparing people to doing mowing/mulching/hedgetrimming type work — in other words, manual labor that couldn’t possibility be performed by anyone who had a legitimate physical disability, and that is normally done by people with no formal training. The fellow was out partying 7 nights a week and didn’t show the slightest sign of illness. He also seemed to have plenty of spare cash, since he shared his excitement over the new piercings he’d gotten in unspeakable places, with accompanying little bits of gold jewelry. I’d guesstimate, translated into today’s dollars, that he was directly receiving about $30,000 a year in cash, housing vouchers, and food stamps, plus Medicaid, plus the “job training” program was covered, so altogether probably over $75,000/year to the taxpayers. This was for an “AIDS” patient who wasn’t even sick yet, and if his infection continued to develop slowly, would likely survive another 15-20 years, with gradually decreasing ability to work (hardly relevant, since he wasn’t working and had no real intention of working) and gradually increasing annual medical care costs. The final tab for that particular patient probably came in at over $1 million, and I have no reason to think he was an unusual case.

Looking at NIH funding alone doesn’t give a clear picture for other diseases either, since they vary tremendously in what type of research is suited to the disease. West Nile looks like a far more insane outlier in that table than AIDS or breast cancer, but there’s probably very little federal spending related to WNV other than NIH research and some data-gathering/processing by the CDC. And there would probably be little funding at the state level, except for seasonal spraying in certain areas, and breast cancer probably only gets a bit more non-NIH federal funding than WNV, through Medicare and Medicaid (for both screening and treatment). On the other hand, as noted above, NIH-funding is probably a tiny drop in the bucket when considering the total federal taxpayers’ bill for HIV/AIDS. WNV is clearly a real public health issue, which emerged rather suddenly, creating a need for a burst of research to find out how big a threat it really is, and for which research is appropriately done under the auspices of a federal agency, and drawing on resources from other federal agencies with expertise in entomology, local/regional weather patterns, local/regional wetlands geography, immigration/customs, etc. Breast cancer, however, is suited to having a lot of research done out of large hospitals, and with a lot of private funding — not much the federal government can really add other than cash.