annually; (5) ensure that approval of specific projects and ongoing operation remain with the individual institute, center, and division directors; and (6) include a full range of research (including basic, applied, intramural, extramural, investigator-initiated, NIH-directed, and behavioral and social science research). This comprehensive plan is meant to be the basis for developing the annual budget requests for AIDS research.

Beginning in FY 1995, when AIDS funds are appropriated to NIH by Congress they will go directly to the director of OAR. The director will allocate to the individual institutes, centers, and divisions all of the funds received in accordance with the previously approved comprehensive plan for expenditures and appropriations.


The specific funding of ADAMHA and NIH AIDS activities over time has taken place within the larger context of the overall federal budget process and has been directly affected by it. Appreciating the length and complexity of the budget process is critical for understanding the problems faced by rapidly changing and expanding research areas such as AIDS and by organizations that are in the process of restructuring, as were ADAMHA and NIH during the course of this study.

At any one point in time, an institute (whether at ADAMHA or NIH) must consider its research program in relation to three separate budgets. For example, at the end of calendar year 1993, an institute would have been in the midst of utilizing its current funds (which were allocated through September 30, 1994), presenting and defending its next year's (FY 95) budget to reviewers ranging from HHS and the Office of Management and Budget (OMB) to various congressional committees and interest groups, and planning the subsequent year's (FY 96) budget request.

NIAAA, NIDA, and NIMH joined in the FY 1994 NIH budget process after the major internal HHS decisions already had been made about the NIH AIDS budget, although they still were affected by those decisions. In FY 1994, as in all preceding years, once the institute received its budget allocation, the determination of the specific projects to fund was mostly a function of the grant review process.

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