by Craig Vincent-Jones

On July 28th, Governor Schwarzenegger shocked the HIV/AIDS community when he used his veto authority to cut $59.1 million in state funds from HIV/AIDS programs. The Governor’s line-item reductions were made in addition to HIV/AIDS program cuts already included in the budget package approved by the legislature.

In all, the 2009/2010 California Office of AIDS (OA) general fund budget was reduced by approximately $82 million. While there are still many unanswered questions regarding how these cuts will translate to direct programs, it is clear that a budget reduction this severe will dismantle the effective and responsive system of HIV/AIDS care, prevention and treatment services upon which thousands of Californians rely.

The final State 2009/2010 budget approved by the legislature and signed by the governor eliminates state funding for all OA-managed programs except the AIDS Drug Assistance Program (ADAP) and core surveillance. Here’s a look at the programs and their status:

AIDS Drug Assistance Program (ADAP): ADAP provides prescription medications to people with incomes less than $50,000 annually, and was fully funded in the 2009/2010 budget.

Surveillance and Epidemiologic Studies: OA coordinates core statewide HIV/AIDS reporting that is so critical to understanding the HIV epidemic and on which federal agencies base their funding awards (e.g., Ryan White funds) for the state and locally. There was a $1 million cut for non-core surveillance activities.

Early Intervention Programs (EIPs): All state general funds ($7.4 million) were cut from EIPs—comprehensive HIV-specific ambulatory medical programs to enroll patients and provide them with care, treatment, support, and referral services.

Testing and Counseling: All State general funds ($8.2 million) were cut for HIV/AIDS screening, testing and counseling services. Several recent studies indicate that HIV is being spread by those who do not know they are infected.

Education and Prevention: All state general funds ($24.6 million) were cut for the state’s education and prevention programs including risk reduction, social marketing and other HIV prevention activities in local health jurisdictions.

Therapeutic Monitoring Program (TMP): All funds ($8.0 million) were eliminated for TMP, which provides laboratory test vouchers (e.g., genotype, phenotype and viral load) statewide that providers use to monitor which medications and treatment plans will be the most effective for individual patients. Viral load testing, for instance, is one of the most important tools doctors use to monitor an individual’s HIV status.

Home and Community Based Care: All state general funds ($6.3 million) were cut from the state’s HIV Case Management Program (CMP) and HIV/AIDS Medi-Cal Waiver program, which provide in-home case management and support services to severely ill patients with HIV/AIDS. These services are provided as cost-effective alternatives to skilled nursing home placements—some of which are not equipped to handle AIDS patients.

Housing Services: All state general funds ($1 million) were cut for OA housing programs that help coordinate local housing and referral systems.

Statewide, the cuts are devastating and threaten to dismantle an entire safety net of care and treatment services for our state’s most vulnerable and disenfranchised residents with HIV/AIDS. The state’s public health response to prevent and slow the spread of HIV has been decimated and will lead to more HIV cases and further cost burdens on the State’s and local health systems.

A lot of counties throughout the state don’t have money for HIV services at all. Their only funding may be through state funds. For those counties, the cuts could mean an end to specialized HIV prevention, care and treatment services, or they could leave service delivery at such low levels that it would be rendered completely ineffective. For instance, a person with HIV/AIDS would have to go to a clinic that treats the general population instead of a clinic that understands HIV medicine.

Although the circumstances for those counties are dire, the funding scenario for L.A. County may even be in worse shape.

For counties like Los Angeles and San Francisco that are more heavily burdened by HIV/AIDS, state general funds have represented cornerstone resources in the tapestry of prevention, care and treatment responses to the epidemic. The absence of the general funds threatens to unravel complex service delivery linkages and networks—along with wholesale elimination of some services—leaving significant gaps in effective service delivery that cannot be filled by additional local or federal resources.

While HIV/AIDS stakeholders around the State are waiting for OA to announce its plans detailing how it will be implementing the budget cuts, L.A. County officials estimate that, at a minimum, the cuts will result in the loss of close to $15 million in prevention, care and treatment services. All of L.A. County’s HIV prevention organizations and county-contracted HIV medical clinics will experience serious budget and possibly service reductions, along with numerous other human and social service organizations that provide services to patients/clients with HIV/AIDS.

L.A. and other counties will not ultimately know the direct impact of the cuts until OA’s implementation plan has been finalized—promised shortly. [As Frontiers in L.A. goes to press, OA had not issued its implementation plan.] There is significant concern that OA intends to penalize L.A. County and other local areas that receive direct federal funding for HIV services. Reasoning that those areas receiving direct grants have more resources and do not need additional state resources, OA is considering re-directing the balance of its funding away from L.A. and San Francisco.

On the surface, those decisions may seem justified. However, when resources are limited most for HIV/AIDS services, funds should be allocated to the areas impacted most and with the greatest HIV burden—namely those jurisdictions that receive additional, supplementary federal funding.

Even with additional federal funding, for example, L.A. County only spends 71¢ per person (risk-adjusted) for HIV prevention services, compared to the risk-adjusted per capita expenditure of $3.97 for the rest of California’s counties. Redirecting the remaining, federally-funded state HIV resources away from L.A. County would reduce per capita expenditures in L.A. County by over 50%.

L.A. County’s Office of AIDS Programs and Policy (OAPP) and Commission on HIV are struggling with determining how to make such significant budget reductions with as little disruption to patient/client services as possible. The HIV Commission (an open, public meeting) is meeting on August 13 to determine how to implement the budget cuts locally. Collaboratively, the two county entities are developing plans that — barring any unforeseen circumstances — will begin in mid-August. Similarly, AIDS service organizations are all modifying their programs and services to accommodate budget and contract cuts that will be beginning shortly.

HIV/AIDS organizations and stakeholders throughout the State have called for the governor to restore the funding he cut from the Office of AIDS, but it is an uphill battle now that the budget has been passed.

The state legislature could override the governor’s budget vetoes with a two-thirds vote, but it is unlikely given that the governor’s party [Republicans] will not support such a vote. In addition, legislative Democratic leaders may legally challenge the governor’s authority to veto items in a budget “reduction” bill.

Although federal agencies in Washington, D.C. have expressed concern and alarm about California’s budget woes and their impact on health and human services, few solutions have been offered. While California—as the world’s eighth largest economy—may be overcome by its fiscal challenges, the Obama administration and California’s congressional representatives have declined to propose strategies for federal assistance or aid. And while numerous commercial interests [such as banks] have benefitted from hundreds of billions of dollars in direct federal grants and loans—all based on the theory that “they’re too big to fail”—states facing almost insurmountable budget problems, like California, have received little or no federal assistance and/or attention.

In spite of the bad news this year, we must also prepare to fight even more sobering challenges in next year’s state budget.

Already projecting a $7-8 billion budget deficit in FY 2010-2011—even with the current cuts—HIV/AIDS services may face even worse conditions next year. With state general funding removed from all but the AIDS Drug Assistance Program (ADAP) and surveillance, the Governor and Legislature may turn to those programs for further cuts. Discussions earlier this year included reducing eligibility and available medications on ADAP’s formulary—changes that may be raised next year in the state’s bleak financial scenario. We must begin now to stop further cuts in forthcoming months.

Californians’ voices are the most important to these issues. Decision-makers need to hear from you and be held accountable by you.

Join the protest vigil and march on Tuesday, August 11, 2009 in downtown L.A. to demand restoration of HIV/AIDS funding and stop further cuts to vital HIV/AIDS programs. The candlelight vigil will begin at 7 p.m. in Pershing Square. For more information and to stay updated on future protests, visit stoptheHIVcuts.com.

Contact (e-mail, call, fax and/or write) Dr. Mark Horton, Director, California’s Department of Public Health at cdph.ca.gov/services/contact/Pages/default.aspx or 916.558.1700 to let him know that OA options to divert state funding away from the most impacted counties are unacceptable.

Contact (e-mail, call, fax and/or write) your state (Assembly and Senate) representatives to remind them of the value of these services to people with HIV/AIDS (look up your State representatives at legislature.ca.gov/port-zipsearch.html) and urge them to take whatever measures necessary to restore HIV/AIDS funding, and to pressure the Department of Public Health and OA to distribute remaining funding to those areas with the greatest HIV burden.

Demonstrate your outrage by reminding the governor how appalled you are by his state funding cuts for HIV/AIDS programs. Contact the governor at: State Capitol Building, Sacramento, CA 95814; Tel. (916) 445-2841; Fax. (916) 558-3160).

Call, write and visit your Congressional representatives (in particular, the Speaker of the House, Nancy Pelosi; Congressman Henry Waxman; Senators Boxer and Feinstein; and your personal House representative) and participate in their health reform town halls to urge their support for federal intervention (e.g., loans, direct assistance, bail-outs) in California’s health and human service crisis while they are in their districts this month (look up Congressional contact information at takeaction.lwv.org).

Remember, your voice is the most powerful and compelling tool that we have to inform sound decision-making. Don’t be afraid to use it. Share your personal experiences and stories, and let our leaders know how their decisions will significantly impact your lives.

Craig Vincent-Jones is the executive director of the L.A. County Commission on HIV. Visit hivcommission-la.info