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AIDS Hits Federal Budget Shoals

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No increases seen for major federal programs that bolster states’ HIV efforts

In his State of the Union address on February 2, Pres. George W. Bush said that funding for AIDS services and HIV prevention is important because the disease “brings suffering and fear into so many lives.”

Five days later, when the president released his 2006 budget, the federal government’s main HIV/AIDS prevention and treatment programs took an effective per-patient cut when it became clear that the White House had requested no increase in funding.

AIDS advocates are accusing Bush of saying one thing and doing another.

Under the president’s proposed budget, the Housing Opportunities for People Living with AIDS (HOPWA) program would be cut by about five percent, reducing it to $268 million, the same amount as when Bush took office in 2001. The Ryan White CARE Act, the government’s main assistance block grant program for state and municipal programs, would stay essentially flat-funded at approximately $2.1 billion.

The AIDS Drug Assistance Program (ADAP), which is part of the Ryan White allocation and provides support for state programs for uninsured and underinsured people not on Medicaid, would be increased by $10 million—a fraction of the $100-200 million advocates say it needs to support current program growth rates as more Americans survive and live longer with AIDS.

“These programs are bursting at the seams with new infections and old patients who are living longer,” said Rep. Barney Frank, a Massachusetts Democrat, who is gay.

The federal budget squeeze is bound to trickle down to the states and municipalities which will be forced to either make up the difference or cut services. But after four years of flat and declining funding under the Bush administration, many states, facing their own budget shortfalls, say they are at the outer limits of their ability to finance any increased efforts on AIDS.

Frank said that declining funding for HIV/AIDS is just one of many cuts to domestic spending and social programs in the president’s proposed budget.

“It’s an indication of the president’s turning his back on social concerns in the country. His priorities are the war in Iraq and major tax cuts,” said Frank.

The president’s proposed $2.5 trillion budget, for enactment at the beginning of the fiscal year in October, is a blueprint for the federal government’s spending priorities. The proposed budget is merely that—a proposal that still faces intense congressional scrutiny and politicking.

Frank said that it’s possible some Democrats might force some changes to the budget, but he views as unlikely any spending additions on domestic spending as long as Bush’s tax cut proposals remain in effect.

AIDS advocates say that the budget proposal shows a disregard for the needs of Americans suffering with AIDS.

“I think it has to do with the target population,” said Ernest Hopkins, head of federal affairs for the San Francisco AIDS Foundation. “An epidemic that’s primarily affecting gay men, gay men of color and injecting drug users—those are not the populations that this president has shown he cares about.”

Despite Bush’s pledge to “focus our efforts on fellow citizens with the highest rates of new cases—African-American men and women,” in his State of the Union Address, the Minority AIDS initiative, the main federal program targeting infections in the black community, is also facing flat funding.

Advocates say that the most crying need for increases is in the ADAP program, which provides critical support for people who might otherwise have to reduce their income and/or spend down their assets to qualify for Medicaid. The president’s critics charge that by limiting access to the program or the full range of drugs available, the federal government down the line will have bigger medical bills to cover.

Some states established waiting lists for their ADAP programs last summer, but an emergency $20 million funding measure by the Bush administration just prior to the November election eliminated those lists—for now.

Some states significantly subsidize their ADAP programs. In California, for example, Gov. Arnold Schwarzenegger included about $100 million in state money in this year’s budget to augment federal funding and prevent a waiting list for ADAP. New York also maintains a generally well-funded ADAP program.

But some states use other means to keep the cost of ADAP down, either refusing to pay for expensive new protease inhibitors or by limiting access to only the poorest of the poor. In North Carolina, if a family of four earns over $23,000, they are bumped from the program.

Medicaid is also slated to be cut by at least $45 to 60 billion over the next 10 years, according to New York’s Gay Men’s Health Crisis, with potentially dire consequences for people living with AIDS.

While the Centers for Disease Control is slated to lose about $4.5 million of its $662.2 million HIV prevention budget, abstinence-only educations programs got a $38 million boost.

According to the Human Rights Campaign, a nationwide LGBT lobbying group, a recent study at Texas A&M University showed that teenagers in such abstinence only programs became more sexually active, not less. The programs normally do not include information about how HIV is transmitted.

CDC spokeswoman Cathy Harben said that her agency’s cut would be absorbed by savings it has managed in consolidating its data processing operations.

“Penny-wise and pound-foolish,” said Darryl Cummings who is the chief of staff with the Los Angeles Gay and Lesbian Center, which along with San Francisco AIDS Foundation and New York’s Gay Men’s Health Crisis, is a leading advocate for HIV and AIDS funding at the federal level.

Cummings vowed to fight for more funding along with other AIDS advocacy groups like the AIDS Action Council.

Cummings said that effective cuts by inflation to Ryan White’s community health programs would end up costing more in the future. Programs like those run by the Callen-Lorde Community Health Center in New York are relatively cheap compared to hospital treatment.

“This proposal is economically foolish as well from many years of doing this work,” he said, warning that if people “develop full-blown AIDS and show up in the emergency room—that’s a very costly proposition.”

The White House press office did not return a telephone call seeking comment.

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Updated 5:17 pm, July 20, 2018
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