HIV Prevention, Treatment Hit By Local Funding Cuts

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Louie Jones can get you a syringe, a cooker for heroin, and a tourniquet for free. He can also give you a card with a special code that gets you off the hook if the police happen to notice your drug injection paraphernalia. This is because Louie Jones, coordinator of Voices of Community Advocates and Leaders (VOCAL), runs a needle exchange program, an important component of the effort to contain the spread of HIV in the city, as well as a publicly-funded support group for Hepatitis C sufferers. And although Jones is more familiar with certain drug dens in Brooklyn than the towers along Wall Street, he’s worried that fallout from the financial collapse may hurt his clients.

“Budget cuts kill,” he said, summing up the effect that he fears decreased services could have on his clients.

Jones was referring to the $600 million budget cuts imposed by Gov. David Paterson’s administration in August, of which $427 million have been enacted. As part of this effort to bring spending in line with decreased revenues, the governor asked for six percent across-the-board cuts in local assistance spending, which consists of aid to local governments and nonprofits and accounts for 70 percent of the state budget. This resulted in a $1 million cut to HIV services, including education and prevention; $390,000 less for the state’s first and only Hepatitis C initiative – a 50 percent reduction; $1.5 million less for New York’s AIDS Drug Assistance Program; and $500 million in cuts to Medicaid. These reductions come on the heels of $5.5 million in cuts to HIV/AIDS services and prevention by the city for fiscal year 2009.

With more than 100,000 New Yorkers living with HIV, the city has long been the center of the epidemic nationwide. But recent estimates by the city Department of Health and Mental Hygiene, using a new federal formula, amped up the urgency of these numbers: Local infection rates in 2006 were three times the national average. Infection rates were much greater in men than women, and particularly acute among blacks and men who have sex with men. And while anti-retroviral therapy, which prevents HIV from progressing to AIDS, has become widely available, 2,076 New Yorkers died from AIDS in 2006.

Worldwide, 40 million people are estimated to have contracted HIV, the human immunodeficiency virus, or to be suffering from the variety of AIDS symptoms that can take a decade to appear.

While acknowledging that the state is facing a fiscal crisis, HIV/AIDS advocates have been questioning the wisdom of these across-the-board local assistance cuts, particularly at a time when new HIV infections have been rising in the city among certain identifiable groups, such as young gay men. The New York City AIDS Housing Network (NYCAHN), a Brooklyn-based nonprofit, staged a protest outside Gov. Paterson’s Manhattan office early last month, demanding that he meet with them to discuss the impact of service cuts. NYCAHN also joined a rally and march across the Brooklyn Bridge a week later, on Sept. 18, calling on presidential candidates Sen. Barack Obama and Sen. John McCain to propose national AIDS-fighting strategies.
“Six percent may sound like a small number, but groups that depend on that funding may need to close their doors,” said Charles Long, NYCAHN’s development and communications director.

Sean Cahill, the managing director of public policy at Gay Men’s Health Crisis (GMHC), says these state cuts come just when GMHC is anticipating decreased support from private funders due to the economic downturn. While GMHC, which receives more than one-third of its funds from New York state, has felt the strain of decreased funding from federal sources since early 2007, Cahill is particularly worried that the recent state cuts will damage the city’s many smaller service organizations.

“We’ve already seen clients coming to us from smaller groups that have had to cut services,” he said, noting a recent increase in the number of HIV-positive clients seeking legal services at GMHC.

Some state agencies, however, such as ADAP, the AIDS Drug Assistance Program, which provides free anti-retroviral therapy to poor people living with HIV, and OASAS, the Office of Alcohol and Substance Abuse Services, whose programs include methadone and needle exchange, say they’ve been able to absorb the state cuts without damaging services – despite a cut to ADAP of $1.5 million, and to the OASAS Methadone Maintenance Program of $776,000. “Since the governor’s statement, we’ve been able to make reductions that will have no impact on patients, by making reductions in our general fund and looking for efficiencies,” said OASAS spokeswoman Dianne Henk. The city Health Department also was also able to absorb the cuts without any harm to services, according to department spokesperson Jessica Scaperotti.

Yet small organizations, like Louie Jones’, say they were forced to scale back services after the city’s cuts this summer. VOCAL’s Hepatitis C support group, for example, shrank from around a dozen members to three or four after Jones had to cancel their free transportation service.

“That is awful, to know that the need is great and we can’t provide the service,” he said, noting that untreated Hepatitis C can be fatal.

Terri Smith-Caronia, public policy director for Housing Works, an AIDS service organization, worries that it sets a bad precedent to cut programs that can provide a lifeline. “Once the state starts looking for spending cuts by diving into programs that provide actual medications, they’re going down a slippery slope,” Smith-Caronia said.

State officials acknowledge that Paterson’s cuts may be painful, but argue they are necessary to keep the state fiscally sound.

“There are many worthy programs that we simply can’t afford during these difficult fiscal times,” said state Division of the Budget spokesman Matt Anderson. The Citizen’s Budget Commission, a nonpartisan group dedicated to fiscal responsibility, has praised the governor for making tough decisions. However, the Commission questioned whether cuts to inefficient programs would have been wiser than across-the-board cuts.

“While the Governor’s proposed cuts in local aid may be admirably intended to spread the pain broadly,” the group said in a press release, “the CBC’s proposals to eliminate ineffective economic development programs and close unneeded prisons would save far more money with no harm to public services.”

Paterson called for a special session of the legislature Nov. 18 to ask for $2 billion in additional reductions. Asked whether these will include further cuts to HIV and AIDS service organizations, Anderson wouldn’t rule anything out. “The governor will continue to do whatever is necessary to protect the fiscal health of the state,” he said.

For his part, Cahill of GMHC suggested that the governor dip into a rainy day fund or cut other areas rather than burden local groups with more reductions. “There’s a disconnect between the epidemiology and how the government is responding,” he said. “If you cut HIV prevention when HIV is being transmitted at higher rates that we thought, at minimum we should be spending more. That we’re cutting prevention funds is crazy.”
Prof. Robert Fullilove, a minority health expert at Columbia’s Mailman School of Public Health, also worries that decreasing HIV services could have negative consequences. “If these cuts mean people get sub-optimal care,” he said, “if it means increased risk of people spreading the virus and getting non-treatable variants of HIV, then we will have lost more than we’ve gained over the last 10 to 15 years.”

As a longtime advocate for HIV services in the city’s underserved neighborhoods, Fullilove wonders whether nonprofits should diversify their funding, rather than relying solely on the government. “I have long thought that it’s a fundamental weakness to put all our eggs in one funding basket, because the government holds us hostage to their fortunes,” he said. “If they’re in trouble, so are we.”

As an alternative model, he pointed to Housing Works, an AIDS service organization that derives 34 percent of its revenue from its businesses, which include a bookstore and café in Soho, seven thrift stores around the city and a catering company.

In the meantime, groups like NYCAHN plan to continue pressing the governor to meet with them to discuss the likely impact of cuts on their clients. “To make a further broad, sweeping cut without considering the effects would be irresponsible,” said NYCAHN’s Long, “particularly when the problem is getting worse.”

– Alex Cotton