CDC funding will end June 30 for two-thirds of the community-based HIV-prevention programs currently receiving that support. The Centers for Disease Control and Prevention (CDC) announced its latest round of grant decisions May 21, the grants are renewable for up to five years.
The controversial Stop AIDS Project in San Francisco is among those that will lose their funding. In fact, no program providing prevention programs aimed at gay white men will be funded in that city.
When asked to comment on that fact, National Association of People With AIDS (NAPWA) executive director Terje Anderson replied with the cynical question, 'Is that part of their epidemic?'
In a telephone news conference announcing the awards, Robert Janssen, the director of CDC's HIV prevention programs, said, 'CDC's longstanding partnerships with community groups are key in reducing the estimated 40,000 new HIV infections that occur each year in the United States.'
The agency will distribute $49 million to 142 organizations across the country, with the typical grant averaging $345,000. The number of grants is down from 189 in the last cycle while their average size is up from about $200,000.
Programs directed toward people living with HIV and their partners, and those at very high risk for infection will receive $23 million; voluntary counseling and testing with referral to medical care will receive $14 million; while $12 million will go to targeted outreach, education and risk reduction.
Janssen said the new programs 'focus especially on the HIV prevention needs of communities of color,' which will receive 82% of the total dollars.
He outlined the procedures used to insure that the process was 'objective and open.' Community-based organizations (CBOs) were evaluated on the quality of the application; a proven track record at providing HIV prevention services; capacity to carry out the proposed activities; regional AIDS incidence; and specific HIV prevention needs in the city or region the organization serves.
Janssen said there was no pressure from the Department of Health and Human Services not to fund particular controversial organizations. The reason that they were not funded was, 'They didn't score high enough on the objective review panel.'
Anderson buys that explanation but added, the political decisions were 'laid out was in shaping the call for applications in the first place. There is less emphasis on doing direct risk reduction behavioral intervention,' so there is less opportunity to fund those types of programs.
CBOs submitted 537 requests and approximately 235 of them scored high enough to be awarded funding. Janssen called the process 'highly competitive, and CDC was not able to fund every qualified applicant.' It funded only 60% of those that qualified.
When asked whether total funding for the program is adequate for the prevention needs, Janssen toed the administration line and declined to say that more money was needed. The CDC essentially has not received any increase in funding over the last three budgets. He did say a congressionally passed rescission to the 2004 budget reduced HIV prevention funding 'by about $6 million.'
Estimates are that about 45% of new transmissions are by people who know they are infected, which explains the CDC's new focus on prevention for positives. He said that when a person learns their HIV status through counseling and prevention 'there is a 68% reduction in risk behavior.'
'We applied funding preferences based upon the last three years of AIDS incidence by region. We tried to track the epidemic based upon the population that these organizations provided services for,' Janssen said. That resulted in more funding for organizations in the South and decreased funding in some areas such as New England.
It had the perverse effect of penalizing programs, populations, and regions for success in reducing the rates of new infections.
One reporter quoted CDC official Ron Valdiserri, Janssen's superior, as saying in an earlier news conference with regard to new HIV infections, 'When we look by year, the only risk group for which we see an increase is men who have sex with men.'
The reporter asked why CBOs serving men who have sex with men (MSM) are not getting more of the funding. Janssen maintained that the MSM programs are getting larger grants and the total dollars allocated mirror the infected populations.
AIDS advocates tread gingerly, not wanting to pit one organization against another. They praised the grants as adapting to the changing face of the epidemic while worrying about the groups with proven prevention track records that were not getting funded.
'We've got more questions than answers,' said NAPWA's Anderson. He would like a better sense of what target populations and strategies will be used.
'What happens in those communities that are losing their funding?' he asked. 'You don't just take away a quarter of a million dollars in grant funding in a community and assume that it gets replaced somewhere else. So if there are good functioning prevention programs operating, what happens to the people they were doing prevention work with? '
He mentioned the STOP AIDS program in San Francisco and the African Services Committee that works with African immigrants in New York City, which is a high-risk population, as solid programs that will no longer be supported.
STOP AIDS spokesman Jason Riggs minced no words; 'The new initiative has the effect of dismantling HIV prevention work across the country.' Groups receiving funding for the first time had a more positive reaction.
'This is $70 million, why don't you talk about the other 90%' of the CDC HIV prevention budget, 'what are they doing with that?' said Marsha Martin, executive director of the AIDS Action Council. 'The truth is, they have never been held accountable for the entire portfolio. What does the demographic profile look like there? And then I can put the $70 million into a context.'
The Illinois grants (followed by their target populations) were:
Access Community Health Network, Chicago, Black, Heterosexuals.
Better Existence with HIV, Chicago, Black, Heterosexuals.
CALOR, a division of Lester & Rosali, Chicago, Hispanic, MSM.
Chicago House and Social Services Agency, Chicago, Black, MSM.
HIV Care Program, Chicago, Black, MSM
Midwest Hispanic Health Coalition, Chicago, Hispanic, Heterosexuals.
Roseland Christian Health Ministries, Chicago, Black, Heterosexuals.
South Side Help Center, Chicago, Black, IDU (IV drug users), Heterosexuals.
