Proposed 2001 AIDS budget falls short

Critics: Prevention funding lacks financial muscle

The Clinton administration still hasn’t made HIV prevention a high enough priority, despite recent evidence that the epidemic increasingly is spreading among women, youths, and minorities, AIDS advocacy groups say.

President Clinton’s proposals would increase prevention funding for the Centers for Disease Control and Prevention (CDC) in Atlanta by $39 million, for a total of $734.3 million. The amount of the requested increase is close to the $37.5 million that was appropriated as an increase in the fiscal year 2000 final budget. By contrast, the president proposed a $105 million increase in AIDS research, bringing its total to $2.111 billion. (See FY 2001 Appropriations chart, inserted in this issue.)

"While we note that the president’s request for 2001 is significantly higher than his requested increase last year, this still is well below the need," says Ronald Johnson, associate director of the Gay Men’s Health Crisis in New York. Johnson notes that Congress added more money to the 2000 budget’s prevention spending than what the president had requested.

While a $734 million prevention budget appears to be a lot of money, it won’t be enough to stop the disease’s spread, says Julio Abreu, director of government affairs department for AIDS Action in Washington, DC.

"I think with 40,000 new infections every year, and half are young people under age 25, we need a serious investment in HIV prevention, along the scales of investments going into research and care, to make a dent in new infections," Abreu says. "And $40 million is not an investment that is going to get us to reduce those new infections every year."

The National Alliance of State and Territorial AIDS Directors (NASTAD) of Washington, DC, had asked the administration to provide $160 million in additional funding in fiscal year 2001 for prevention efforts.

Additional funding sought from Congress

On Dec. 3, 1999, NASTAD executive director Julie M. Scofield stated in a letter to the Executive Office of the White House that if the nation truly wants to turn the corner on the HIV epidemic, the government would need to spend an additional $1.4 billion on prevention efforts. To reach even the estimated 300,000 people who are unaware that they are HIV-infected, the government would need to spend an additional $300 million per year, Scofield said.

NASTAD also requested an increase of $100 million to support states and local health departments in their efforts to target HIV counseling and testing efforts to minority communities, gay men of color, injection drug users, women, and high-risk youths.

NASTAD intends to lobby Congress for the additional HIV funding because the president’s proposal falls short of the organization’s request, a NASTAD official says.

While AIDS research and drug assistance funding provide short-term benefits, the positive benefits of prevention investments are not as tangible and can be viewed only in the long term, which is why prevention is a lower priority, says Nguru Karugu, MPH, coordinator of the New York State Black Gay Network in Peekskill, NY.

In the long run, prevention could save the government millions of dollars in the cost of caring for HIV patients. For instance, estimates now place the annual cost of care for an HIV patient at $18,000, Abreu says.

"So at a time when resources are tight, an investment in HIV prevention is a sound one," he adds.

Prevention efforts also need to be targeted more effectively, Karugu and Johnson say.

"What’s disturbing is that in some populations, including women, adolescents and young adults, and gay men of color, the HIV infection rate is actually going up, which heightens the need for more intensive and more targeted programs," Johnson says.

"We are concerned about insufficient amounts of money coming to New York to target communities of color," Karugu says. "The prevention resources have not been enough."

Abreu notes that all of the previous decades’ prevention messages are not as effective in reaching the groups of people who now are at highest risk of becoming infected. Prevention strategies need to be retooled, and this includes starting a media campaign that encourages people to be tested, he adds.

NASTAD suggests specific funding for these four prevention strategies:

• The alliance asks for $15 million more to enhance partner counseling and referral services, which focus on early identification of HIV-infected people through counseling and referrals.

• The alliance proposes a $20 million increase to assist state and local health departments with forming HIV prevention community planning groups. Such groups prioritize HIV-infected people for targeted prevention interventions with the goal of helping them adopt and maintain behavior changes to avoid infecting others.

• The alliance calls for $15 million more for programs that help increase minority access to effective prevention and treatment services. This is especially important in rural southern states that have a high rate of HIV prevalence.

• The alliance asks for $10 million in additional money for state and local health departments to implement new testing technologies, such as oral testing that reportedly is better accepted among minority communities and people who are reluctant to be tested for HIV because of the use of needles to draw blood.

AIDS Action suggests more money should be put into the "Know Your Status" campaign, which targets at-risk people who may be infected but are unwilling to be tested or lack information about why they should be tested.

While most AIDS organization leaders were concerned about prevention funding, NASTAD also had requested greater spending in the Ryan White CARE Act Title II grants than what the president proposed for 2001.

NASTAD asked for an increase of $175 million over fiscal year 2000 spending, and the president’s request called for increases of $14 million in care services and $26 million in AIDS Drug Assistance Program (ADAP) funding.

In her letter to the White House, Scofield said state HIV/AIDS care programs continue to receive inadequate financial support in their attempt to match the demand for treatment and service. "As a result, states continue to report increasing difficulty in providing the level of support necessary to attract and maintain low-income individuals with HIV/AIDS in primary medical care services through Title II core funding," she wrote.

Scofield also said NASTAD’s average cost per client through ADAP is $9,314, and there has been a 24% increase in the number of clients served by ADAPs nationwide between June 1998 and June 1999. NASTAD estimates the states will serve an additional 14,000 people in fiscal year 2001, which means they’ll need another $130 million in ADAP funding.