President's HIV funding proposal is dead on arrival, HIV advocates say
President's HIV funding proposal is dead on arrival, HIV advocates say
Congress likely will decide spending in 2009
HIV/AIDS advocates say President Bush's FY 2009 appropriations for federal HIV/AIDS programs, which flat-funds HIV programs, is dead on arrival. They say it seals his legacy as being apathetic towards the domestic epidemic and science-based prevention interventions.
All signs point to a delayed budget battle, with Congress waiting to meet the next president before finalizing a budget, they say.
Meantime, the president's proposed budget changes no minds about Bush's attitude toward the HIV/AIDS epidemic in the United States.
"We were disappointed, to say the least, with the president's budget request for HIV/AIDS, particularly with the domestic programs," says Ronald Johnson, deputy director of AIDS Action of Washington. DC.
The president's proposed budget cuts $7.7 million from Ryan White Care Act, Title I, which would shortchange already hard-hit cities. (See AIDS Action's annual AIDS budget and programs.)
"Title I money goes to 51 metropolitan areas that are most impacted by HIV/AIDS," Johnson says. "The $7.7 million cut is what we consider a significant cut when one takes into consideration that caseloads are rising."
The president's proposed budget also flat-funds HIV prevention, even in light of the fact that many believe the next surveillance numbers coming from the CDC of Atlanta, GA, will show an increase in the number of new HIV infections, Johnson says.
"It just reflects the administration's continued retreat from responding to the domestic HIV/AIDS agenda," he adds.
The president's proposed budget requests a $28 million increase in abstinence education funding, a $27 million increase for community health centers, and $6 million more for the AIDS Drug Assistance Program (ADAP).
But this is part of the cards shuffle in which the areas that receive an increase do so at the expense of cuts in other areas, says Ryan Clary, director of public policy for Project Inform of San Francisco, CA.
For instance, the proposed budget calls for a $20 million increase in substance abuse block grant funding, but a $63 million decrease in funding for the Center for Substance Abuse Treatment and a $36 million decrease for the Center for Substance Abuse Prevention.
And some of the areas that are proposed to have increases this year were ones that were cut by those same amounts last year, Clary notes.
"An increase is great, but you can't have year after year, first a cut, then an increase, then a cut," Clary says. "The agencies can't do their planning if the money is fluctuating from year to year because they'll develop a program or increase their health care services, and then they'll have to decrease them."
While the proposed increase for ADAP is a step in the right direction, it is only a very tiny step when the need is considered, says Bill Arnold, director of the ADAP Working Group of Washington, DC.
"In a $1.4 billion program, a $6 million increase is small," Arnold says.
Beginning in April, existing ADAP funding will be released. The federal FY 2008 budget for ADAP of $808.5 million was a $19 million increase over the FY 2007 budget.
But it wasn't that increase that eliminated the ADAP waiting lists, Arnold says.
States came through where needed, and the Medicare Part D prescription drug money helped, he says.
Although Medicare Part D is a mixed bag and a moving target, it did help HIV patients who were eligible for its low income subsidy, Arnold says.
"The shifting around in the distribution of money and the new way the ADAP supplemental works have all conspired for the moment to make sure there are no waiting lists," he adds.
Bad publicity for states that have waiting lists also helps.
For example, South Carolina had a long waiting list last year, and while waiting for their HIV medications through ADAP, at least four people died, Arnold recalls.
"There are always other factors in the deaths, but the people were on an ADAP waiting list," Arnold says.
South Carolina received national negative publicity from these deaths, and activists protested at the state's capitol. As a result of the reauthorization of the Ryan Care Act bill, South Carolina began to receive more ADAP supplemental money, and so the waiting lists evaporated, Arnold says.
To keep HIV patients off the ADAP waiting lists, the program needs a $135 million increase this year, Arnold says.
But since this year's federal budget is expected to be delayed until after a new president takes the oath of office, ADAP really needs $55 million in emergency funding, Arnold says.
"What will we do if we don't get it?" he says. "Maybe some states will cough up a little more state money, but 30-odd states are projecting pretty severe budget crunches, and California is actively trying to cut money from the state ADAP appropriation as we speak."
If California is in such bad shape, where does that leave Arkansas or South Carolina, he asks.
International HIV/AIDS funding, which has been the president's focus all along, has fared well, but only for money spent in the President's Emergency Plan for AIDS Relief (PEPFAR), Johnson notes.
"The president does not propose an increase in the Global Fund, but he proposes a $4.1 billion increase that would be for the focus countries within PEPFAR," Johnson says.
President Bush's budget is more generous to PEPFAR and international funding, but there are problems with those proposals as well, says Kevin Frost, chief executive officer of amfAR of New York, NY.
"There still are some problems with this administration's response to the epidemic," Frost says. "There's still an extraordinary emphasis on abstinence, and there's still an ideological focus on abstinence even though there is no scientific evidence that it works."
Studies continue to show that abstinence-only programs, which are the only kind receiving funding in the president's proposed budget, do not reduce sexual activity among youths.1,2,3
Federal money put into abstinence-only programs could be put to more effective use elsewhere, Clary says.
"There you have the Bush administration's legacy on the domestic HIV program," Clary says. "In his final year as president, the largest increase is for abstinence-based education instead of for care and treatment for the poor and uninsured or for research or for testing or for science-based prevention efforts."
References:
- Ott MA, Santelli JS. Abstinence and abstinence-only education. Curr Opin Obstet Gynecol. 2007;19(5):446-452.
- Underhill K,et al.. Abstinence-only programs for HIV infection prevention in high-income countries. Cochrane Database Syst Rev. 2007;17(4):CD005421.
- Dworkin SL, Santelli J. Do abstinence-plus interventions reduce sexual risk behavior among youth? PloS Med. 2007;4(9):e276.
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