The CDC is redirecting funds to states with high infection rates—and eliminating programs that actually promote health
Look no further than the cuts to HIV funding announced yesterday in Massachusetts: one quarter of the state's HIV/AIDS prevention budget ($4.3 million) has been eliminated. What this means is that outreach to gay and bisexual men, black and Latino men and women, and intravenous drug users--the populations most vulnerable to infection--will be cut entirely or dramatically slashed.
These cuts are being driven by two things: steep reductions in federal spending on HIV/AIDS mandated by the budget deal, and new restrictions stipulating that federal prevention dollars must be directed to clinical settings that emphasize HIV testing and prevention in clinical settings rather than in the community.
Our experience at AIDS Action Committee of Massachusetts shows that it is easier and cheaper to do prevention and sexual health counseling with those living with HIV in comfortable community settings, led by peers with whom they identify. Our experience also shows that we cannot ignore people who are HIV-negative--and we are much more likely to reach those people with prevention messaging in community settings rather than clinical ones. We prioritize people at high risk by providing services they need in order to change behaviors and stay negative: clean needles, referrals to housing and substance abuse programs, financial assistance so people will not have to sell sex on the streets. These programs prevent new infections.
Eliminating these counseling and treatment programs seems like a nonsensical strategy, given the large (and frighteningly increasing) number of people affected by HIV in the minority community and the low number of those people now represented in the health care system--not to mention the time pressures under which doctors and nurses must already work. When was the last time your primary care doctor had time to discuss your sexual behavior? Or even asked you about it?
The CDC claims that given its limited resources, it must redirect funds to states with the highest concentration of HIV infections. But if the goal is to save billions of dollars in health care expenditures, then we should be investing in programs that keep people healthy. In Massachusetts, the state's long-term investment in finding ways to reduce the transmission of HIV resulted in a 60 percent drop in new diagnoses from 1998 to 2008. All of which will save the state more than $1.6 billion in health care costs.
In 2008 and 2009, I worked closely with a coalition of AIDS service organizations to help the Obama administration develop its National HIV/AIDS Strategy. That strategy, which marked the first time that any presidential administration had created a national plan to end the domestic AIDS epidemic, called for accountability and measurable outcomes. That's exactly what Massachusetts has been delivering. Our funding strategies demand results: a reduction in new infections, which saves health care costs and lets us direct scarce dollars to care for those who are already HIV-positive.