D Gregory Smith

Feds' HIV Budget Rescues ADAP - But at a Price

Filed By D Gregory Smith | September 28, 2011 2:00 PM | comments

Filed in: Living
Tags: ADAP, Department of Health and Human Services, HIV/AIDS, infection, Kathleen Sebelius, low-incidence, Medicaid, rural, Ryan White, urban

In a move announced Monday, the Department of Health and Human Services will release 1.89 billion dollars to bring treatment and medication to over half a million people in the U.S. who are HIV-infected.

HIV medsEspecially welcome is the news that a significant part of this funding is expressly tagged to eliminate ADAP waiting lists for permanent medications - currently 8,785.

"These grants will help make a real difference in the lives of Americans living with HIV/AIDS, especially those in underserved rural and urban communities, ensuring they get access to quality health care and support systems," Secretary Kathleen Sebelius said. "The care and services these grants support will help Americans living with HIV/AIDS to live longer, healthier lives."

There are even more changes this funding cycle. The funding is becoming more directly proportional to the severity of infection rates in individual jurisdictions: "high incidence" states will get more; higher risk populations will get more; high incidence urban areas will get more; ADAP waiting lists will be shortened and eliminated.

This is good news - increased funding is great, the places and populations with higher incidence rates should get more funding - but it comes with a price. Maybe a heavy price.

Lower incidence states and programs will get less. In some cases, much less.

A prevention coordinator in one of the low-incidence states spoke to me this morning, saying:

Due to the fact that evidence-based funding is what CDC is using, they chose to take prevention funding from lower incidence states and give it to higher-incidence areas- they didn't just increase funding to high-incidence states and populations- they took it from lower.

I'm worried that our lower-incidence rating may not be able to be maintained without these prevention dollars. We will simply not be able to do what we have been doing- and that is often sometimes the bare minimum. We're not talking about stagnant infection rates either. People are still being infected here. Our message could be improved- but without this funding it's going to be very difficult.

And even with the added ADAP funding, low-incidence states are still receiving less this year on the whole than they ever have.

In order to stem the tide of new infections, prevention dollars have to be given wherever HIV lives. That just makes sense.

And if persons are still being infected - even in a low-incidence state - prevention dollars are obviously still needed. It doesn't make sense to cut them (almost) in half, as is the case with Montana. That kind of cutting and taking creates resentment. It doesn't address reality as much as it falsely creates distinctions. That may be something the Department of Health and Human Services doesn't quite get: the people in the rural areas matter just as much as the urban. Our lives are just as important. Our people are just as worthy of protection, prevention and treatment.

Maybe HHS doesn't see that this money grab denies that equality. Maybe they don't mean to say "just because you are at risk for HIV in Idaho you're not as important as someone at risk in Atlanta".

Maybe they don't mean to, but they are.

As long as people are still being infected - people everywhere - our work is not done. At least that's the way I see it. It's just going to be harder.

For some of us.

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