Yes we can? Obama's win brings hope to HIV/AIDS groups

Election raises optimism for more funding

Next month a new administration will usher in great expectations with regard to how President-elect Barack Obama will fund a variety of domestic programs, including HIV/AIDS prevention and medical care.

But the big question is whether even a Democratic administration and Congress can satisfy eight years of pent-up needs when there also loom two costly wars and the biggest economic meltdown since the Great Depression.

"We are optimistic that with the new president and new Congress that the kinds of flat funding and reductions in funding that we've experienced will be reversed," says Ronald Johnson, deputy director of AIDS Action in Washington, DC.

"We are confident that the new Congress and president will have a leadership that is much more mindful of the crisis of HIV/AIDS that we still face in this country," Johnson says.

"President-elect Obama, as a candidate, has fully endorsed a national AIDS strategy that calls for resources that are targeted and designed to end this epidemic," he adds.

Obama's stated national strategy toward the HIV/AIDS epidemic are better than those that were proposed by his opponent Sen. John McCain, so his presidency is seen as possibly bringing a major change to funding for HIV/AIDS programs, AIDS advocates say. (See Obama's HIV/AIDS strategy summary.)

"The democratic Congress will certainly try to make up for some of the funding shortfalls that we've had to deal with," says Bill Arnold, director of the ADAP Working Group in Washington, DC.

This is particularly true because the Hispanic caucus and Congressional black caucus are expected to make the HIV/AIDS epidemic a more visible priority, Arnold adds.

Still, there will be major challenges: "The fiscal constraints are going to be very difficult, anyway," Arnold says.

Any hope HIV/AIDS advocates feel is tempered by nearly a decade of disappointments.

"It's been a rough eight years," says Marie Saint Cyr, executive director of the New York AIDS Coalition in New York, NY.

HIV/AIDS programs essentially have been flat-funded because even when the government dollars rise a little, they are off-set by the increasing number of people living with HIV/AIDS, Cyr says.

"We also are dealing with increases in [HIV infection among] communities of color, and we're seeing a wide range of ages," she says.

"We've been really disappointed in the lack of funding increases in all parts of the domestic portfolio," says Carl Schmid, director of federal affairs for The AIDS Institute in Washington, DC.

"We thought with the democrats coming in two years ago we would have seen some major increases in the domestic portfolio," Schmid notes. "But we've really been disappointed in the area of prevention spending, which has gone down."

This year, the final bill for Ryan White appears to contain a $100 million increase on the House side and a paltry $6.5 million on the Senate side, Schmid says.

Demand expected by many groups

So even with more democrats in Congress and an Obama administration, AIDS groups will have to fight for increases because there will be so many other federal funding demands, Schmid predicts.

The current global economic crisis is propelling the nation into a recession that will increase public assistance needs among people living with HIV/AIDS, Cyr notes.

"Unless we see a major turnaround [financially], we're looking at more gaps and more cuts in the future," Cyr says.

AIDS organizations already are dealing with dwindling resources, so any further cuts will be hard to take, Cyr and others say.

"It's all a matter of priority," Schmid says.

So far, domestic AIDS programs have not been a political priority, he adds.

"Is this going to be a priority for president-elect Obama?" Schmid says. "We hope it will be."

An Obama administration probably will provide a national AIDS plan fairly quickly, Arnold says.

"At least in terms of what people say and reading between the lines, I think it's highly likely we'll be in better shape, and we will get steps in the right direction," Arnold adds. "We may even get the Ryan White Care Act extended three, maybe four years with very minor changes."

Arnold says the advocacy community would prefer an extension to having to undergo a full-scale reauthorization process.

Directors of HIV/AIDS service organizations say any positive funding change will be a welcome change.

AIDS service organizations (ASOs) across the nation have dealt with funding cuts and fiscal constraints for years, and this year's budget was no improvement.

For instance, the city and state of New York are under such budget constraints that there will be $5 million in cuts to services impacting people living with HIV/AIDS, Cyr says.

The HIV programs slated for cuts include programs for education and prevention for older HIV patients, programs targeting communities of color and HIV-positive persons who use crystal methamphetamine, a hepatitis C public education campaign, and housing for people living with HIV/AIDS, Cyr says.

"We see this is an extremely urgent situation, and we are meeting with the governor's office and will meet with the mayor's office," Cyr says. "In many ways, these cuts will have a long-term impact in the city."

All of these cuts could lead to increased infection rates, she notes.

"If you lose programs that help prevent infection and which educate people and pull them into services, then you will end up having a greater number of at-risk people and a greater number of HIV infections," Cyr says.

Even though the United States has made some major strides in combating the epidemic, challenges remain, Cyr says.

"We have major issues down the road," she explains. "We have a new Ryan White Care Act, which needs to be revised, and we have Medicaid policies that have been in moratorium, and so we're looking for a new administration to hopefully prioritize health and HIV as an epidemic."

Time to just say no to abstinence funding

One of the campaign promises Obama has made is that he will eliminate government programs that do not work and improve funding for those that have long-term consequences.

AIDS advocates suggest that abstinence-only funding programs should be cut given that criteria.

"I venture to say that the current presidential administration has done damage to HIV prevention in terms of values-based, rather than evidenced-based, programs," Cyr says. "It's a contradiction that we're promoting evidenced-based strategies when we're promoting abstinence-only."

The Obama administration should cut all of the discretionary funds for abstinence-only education, which has been the centerpiece of the Bush administration, Schmid says.

Some of the abstinence-only program funding is mandatory as part of Medicaid legislation, but the discretionary funding easily could be cut, he adds.

"Abstinence-only is purely ideological and is playing to Bush's base," Schmid says. "Right now the discretionary part is $113 million, and it could be put right into HIV prevention."

To fully fund HIV prevention, according to recent research numbers supplied by the Centers for Disease Control and Prevention in Atlanta, GA, would cost $4.8 billion more than currently is being spent, Schmid notes.

"We need more money," he says. "It's difficult, but it's all priorities, and it's our job to make HIV funding a priority since there will be more people out there needing our services, especially in an economic downturn."

Despite the challenges ahead, these are the days for some glimmer of hope, AIDS advocates say.

"We're optimistic and hopeful, as so many people in the country are, as we're on the door of what may well be a new day in this country — not only for HIV/AIDS, but in general," Johnson says.