CHICAGO — The White House budget proposal unveiled Feb. 1 will result in further reductions in HIV prevention and care services across the U.S. with scarcely any help from the federal government, AIDS advocates warn.
"Even with the nominal HIV funding increases proposed by the Obama Administration, fewer HIV prevention and care services will be provided across the country because of disastrous state budget cuts, which will only widen the gap in unmet need," said David Ernesto Munar, AIDS Foundation of Chicago ( AFC ) vice president.
As state and municipal governments continue to cut health and human services to address their budget shortfalls, the supply of HIV-related services continues to decline at a rapid pace. A September 2009 survey conducted by the National Alliance of State and Territorial AIDS Directors found that states had already reduced HIV and viral hepatitis budgets by more than $167 million. Funding cuts were concentrated in HIV prevention, the AIDS Drug Assistance Program ( ADAP ) , and public health services. Jurisdictions reported an average decrease in state funding of almost 11 percent in FY2009.
A discretionary spending cap proposed by President Barack Obama on all non-defense-related and entitlement spending may further erode nominal HIV funding increases as lawmakers begin the budget-making process. Efforts by some lawmakers to restore appropriations for favored programs will certainly force lower appropriations elsewhere.
"In the coming months, the White House will finalize a National HIV/AIDS Strategy which, under the terms of this budget, will be hard pressed to meet its stated goals of fewer HIV transmissions, more people received HIV-related case services, and less HIV-related inequality," said Munar.
According to the White House Office of National AIDS Policy, the president's request for the Centers for Disease Control and Prevention ( CDC ) includes an additional $1.8 million for viral hepatitis services, a $6.8 million increase for sexually transmitted disease ( STD ) services, and a $31 million increase for HIV prevention activities. Leveraging new and existing funds, CDC will launch a $26.93 million initiative to increase HIV awareness and testing among gay and bisexual men and transgender individuals. Another $10 million in new funds will be set aside for projects strengthening surveillance and an additional $10 million is requested for service integration across HIV, STD, hepatitis, and tuberculosis programs.
Despite White House efforts to expand HIV testing, investments in corresponding HIV care would increase only slightly under the president's budget plan. The president's request seeks a $20 million increase for ADAP, which is significantly lower than the community request of $370.1 million to address waiting lists and unmet service need for medication assistance across the country. The budget would also increase Ryan White Part B care services for states and territories by $10 million, Part C early intervention grants by $5 million, dental services by $1.8 million and AIDS Education and Training Centers by $2.6 million. Part A grants to cities would not see any funding increases under the president's plan.
The Housing Opportunities for People with AIDS ( HOPWA ) program would receive a $5 million increase and research activities at the National Institutes for Health, including HIV-related research, would increase by 3.2 percent. States would benefit from a six-month extension of enhanced Medicaid reimbursement rates next fiscal year.
"We can't fill in all the state budget cuts," said Jeff Crowley, White House National Office of AIDS Policy director said on a briefing call.
AFC joins other organizations across the country in urging Congress to appropriate higher amounts across the board to reverse escalating HIV and public health service cuts nationwide.
Founded in 1985 by community activists and physicians, the AIDS Foundation of Chicago is a catalyst for local, national, and international action on HIV/AIDS.
FROM A NEWS RELEASE
SAN FRANCISCO, CA Project Inform today thanked President Obama for providing increases to domestic HIV/AIDS and chronic viral hepatitis programs in a challenging economic environment. However, the organization expressed overall disappointment in his Fiscal Year 2011 budget. While the budget does call for minor increases to HIV care, treatment, prevention, housing, and other vital services, it does not match the President's goal of reinvigorating the fight against the domestic HIV epidemic. The budget also would make the President's goal of implementing a National AIDS Strategy more difficult, as it would not provide the resources necessary to achieve the objectives of reducing HIV incidence, increasing the number of HIV positive people who are accessing care, and reducing health disparities.
"We appreciate that President Obama has prioritized domestic HIV/AIDS programs in his budget," said Ryan Clary, Project Inform's Director of Public Policy. "However, this proposal falls far short of building a serious effort to help people learn their HIV status and enter care, while reducing new HIV infections. It would also fail to assist many states that are struggling to provide basic care and treatment services to low-income and uninsured people living with HIV. Congress must improve these funding levels as it develops the final spending bill."
The President also proposed a $1.8 million increase for viral hepatitis programs at the Centers for Disease Control and Prevention ( CDC ) , which currently receive only $19.3 million per year. While this is significantly higher than the President's request last year, it also falls far short of funding needed to improve the nation's hepatitis screening, testing, surveillance, and education programs. Nearly 5 million Americans have chronic hepatitis B and/or hepatitis C, with 75% not knowing their status. Many of them are co-infected with HIV.
"Two weeks ago, the Institutes of Medicine released a scathing report highlighting the federal government's failure to address the chronic hepatitis B and hepatitis C epidemics, which result in 15,000 deaths per year," continued Clary. "Congress must increase the President' funding request for viral hepatitis programs to demonstrate it is ready to lead a strong effort to fight these epidemics."
Project Inform will work with its national HIV and hepatitis advocacy partners to encourage Congress to provide adequate funding for these epidemics.
FROM A PROJECT INFORM NEWS RELEASE