The Indiana State Department of Health recently cut gay white men as an HIV/AIDS funding priority. African-American and Hispanic men who have sex with men are still included as priority populations. The decision was made by the department's advisory Community Planning Group (CPG).
The CPG is a Center for Disease Control (CDC) mandated process for funding HIV/AIDS prevention and treatment programs in the states; it aims to be politics-free and representative of the community. The Indiana State Department of Health (ISDH) administers CDC HIV/AIDS prevention funds. Indiana health activists charge that the Group ignored the CDC's criteria for defining community priorities.
This CPG defines the priority populations that the Indiana State Department of Health (ISDH) must use to solicit HIV/AIDS service providers for HIV prevention project proposals. The State of Indiana's 2008 Epidemiology Report shows that the number of cases as well as number of new diagnoses for White men having sex with men (MSM) continue to outnumber combined African-American and Hispanic MSM cases two to one.
So why aren't white gay men included as a community priority? According to Tri-State Alliance spokesperson Gary Essary, "The criteria for Community Planning Groups to set community priority populations include Prevalence (absolute number of HIV/AIDS cases in a target population) as well as Incidence (rate of HIV/AIDS cases within a target population). The CPG ignored these recommendations, basing their decision solely on Incidence."
"No one disputes that African-American and Hispanic MSM should be a priority. According to the State of Indiana's 2008 Epidemiology Report, the HIV/AIDS incidence rates for African-American and Hispanic MSM in Indiana (379 and 132 per 100,000 male population, respectively) are higher than for White MSM (111 per 100,000). However, prevalence shows 3,063 White MSM living with HIV/AIDS, more than double the combined African-American MSM (1024) and Hispanic MSM (216)," he said in an e-mailed statement.
The Community Planning Group also removed Hispanic women from the targeted heterosexual women demographic. Current targeted populations are:
- People living with HIV/AIDS
- Men Having Sex With Men (African-American/Hispanic)
- Heterosexual Women (African-American)
- Youth (Aged 13-24)
- Intravenous Drug Users
The CDC mandates that people with HIV/AIDS always be the number one priority.
"Only a Recommendation"
Indiana State Department of Health HIV Prevention Director Sarah Renner downplayed the changes. She was not at the CPG meeting and does not serve on the planning group's board. "According to the CDC guidance tool, the CPG makes a recommendation that we include in any planning documents. It's a recommendation. That's it," Renner told me.
The Dept of Health uses the CPG recommendations to encourage groups to apply for state funding by issuing a Request For Proposals (RFP). RFPs are driven from a methodology that allows people to use localized information.
Renner stressed that while the five groups were given a priority status, that doesn't mean no one else will be included. "Key is what defines a risk. Race doesn't define risk itself. There is so much fascinating data that folks can use to look at a population," she said.
"Don't think of it as 'What's up with white gay men in Indiana?' Think of it as 'How can we reach and define that community and how they're being infected?' Behavior is the primary function we look at," she continued. Renner stressed that prevalence and incidence were not the only source of epidemiological data used to determine rankings.
Critics charge, however, that when ISDH sends out the request for proposals, white gay men will not be listed as a priority; therefore, agencies applying for funding are much much less likely to target white gay men for HIV prevention services.
"...the practical impact of omitting White MSM as a priority in the Requests for Proposal is an overt discouragement for a service provider to write a proposal that includes White MSM. Those that do will be more likely to de-emphasize it. As a direct result, a population clearly in need of HIV prevention services will see fewer resources in their community, and the HIV cases and rates among White Gay males will surely increase," Essary said.
Personal Greed or Intractable Agencies?
While critics insinuate that the board voted along demographic lines to push funding towards their personal communities, others speculated that the issue stemmed from agencies angry at being forced to change their grant proposal process.
"As far as I know this is the first time we've used an RFP model for prevention funding so people will have to go through an application process. This is different from other times," Renner said. "The funding is driven by an RFP process that makes the algorithm very public as to how many apply, what type of intervention they apply for, how the scoring occurs and we report back who gets what type of funding."
"The process will be different so it really depends on our grant applicants writing qualified RFPs. It will be a new type of writing for some grantees. One of the targets is 'Individuals living with HIV.' White gay men fit that criteria," she said.
Indiana spends between $2-3 million dollars annually on HIV prevention. ISDH is currently waiting on a cost extension after the Indiana state legislature failed to pass a budget. Lawmakers will convene a special legislative session to pass a budget soon as per state law. Indiana spends approximately $35 million dollars annually on HIV/AIDS and STD issues.
Indiana publishes its 2008-2010 HIV Prevention Plan online. It also publishes the Community Planning Group's meeting minutes.