Federal HIV budget grows while states make big cuts
ADAP faces critical shortage, limits enrollment
The federal government’s FY 2003 budget provides modest increases in HIV prevention and care funding, but that additional money won’t meet drug treatment needs for the poor or offset significant cuts in state and city health budgets, experts say.
Congress increased funding for the Ryan White Comprehensive AIDS Resources Emergency Act by $96 million, bringing total spending under that bill to $2 billion. Nearly all the increase ($80 million) will go to the Ryan White AIDS Drug Assistance Program (ADAP) — about half of what AIDS organizations had requested.
The Centers for Disease Control and Prevention’s HIV, STD and TB prevention budget also was increased by $34.7 million for a total of $1.2 billion. And the Minority HIV/AIDS Initiative was increased $25 million, for a total of $406 million. An additional $14 million was earmarked for the Housing Opportunities for People with AIDS program.
Although President Bush’s budget for HIV care and treatment programs calls for a $100 million increase in ADAP, it assumes no increase in FY 2003 and delays the proposed increase until October, according to the San Francisco AIDS Foundation’s HIV Advocacy Network.
At least 13 state ADAPs have already either limited access to antiretroviral treatments or closed enrollment to new clients. An additional seven states have reported the potential need to implement restrictions in early 2003 based on current funding levels and projected trends in program utilization, the Gay Mens’ Health Crisis (GMHC) reports.
"Sadly, instead of confronting the issue head on, this President has chosen to tout illusory budget increases while actually cutting vital programs." says Ana Oliveira, executive director.
States facing difficult cutbacks
Faced with balanced-budget requirements and large declines in revenues, most states have had to cut health department programs. Massachusetts announced a $3 million cut in AIDS services, for example. The FY2003 funding cut combined with last year’s budget cuts of $12 million to mean a 30% reduction in the state’s HIV/AIDS program budget.
HIV care organizations say the reduced funding will interrupt care and support for even the most hard-core services, such as nutrition programs and home-care visits.
In California, Gov. Gray Davis’s proposed 2004 budget has spared most AIDS treatment programs and includes $9 million in additional funding for ADAP. However, $7.2 million of that will come directly from the new copayments.
AIDS activists say the increase won’t meet current needs and will require enrollment limits or removing drugs from the ADAP formulary. At the same time, Davis also has proposed cutting $1.25 million from HIV prevention efforts statewide and scaling back AIDS research at the University of California by $2.3 million.
Cities hit hard by AIDS, such as San Francisco and New York, face bigger problems. San Francisco’s budget crisis, exacerbated by the Internet technology bust and tourism declines, could result in up to 300 staff reductions at the city’s health department.
The head of the city’s health department, Mitch Katz, MD, presented an initial cut of $37.5 million now and another $28 million later if necessary. Reductions would include funds for the AIDS hotline and HIV/AIDS support groups.
"These cuts are painful, and they’re occurring in areas where there are currently unmet needs," Katz told reporters.
In cities across Texas, cuts have resulted in protests not seen in years. AIDS activists rallied this fall at the state capital to fight against the kind of cuts seen in San Marcos, where Community Action Inc., which received $66,000 in state funds in 2002, will receive no funds this year. Local health officials are calling for changes to ensure resources are funneled to areas with the highest rates of infection, such as Dallas and Houston.
The federal governments FY 2003 budget provides modest increases in HIV prevention and care funding, but that additional money wont meet drug treatment needs for the poor or offset significant cuts in state and city health budgets, experts say.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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