Draconian CDC Cuts Will Cripple HIV Prevention in New York State
October 4, 2011
Recent changes to a major CDC prevention grant program have significantly altered the funding landscape in a way that some have hailed as an important step to advance the National HIV/AIDS Strategy (NHAS) and others have attacked as ill-conceived and poorly executed.
The CDC HIV prevention cooperative agreement has been in place for more than 20 years and for many states, territories and selected large cities is the major source of prevention funds. The situation in New York State is somewhat different since most financial support comes from state and NYC tax levy dollars.
When CDC released the funding opportunity announcement (FOA) in July for the five-year period covering Jan. 1, 2012 to Dec. 31, 2016, many states were shocked to see reductions of as much as 80 percent slated to take place in the first three years of the new grant cycle. The New York State Department of Health's AIDS Institute was one of those with a potential 80 percent cut. While some level of reduction was anticipated to address CDC's stated goal of moving their money to where the epidemic is (a strategy envisioned in the NHAS), few expected the magnitude of what was presented. Many said it seemed to be the gutting of a national HIV prevention program in order to devise a new one centered largely in a handful of metropolitan areas: New York City, Philadelphia, Baltimore, Atlanta, Fort Lauderdale, Miami, Chicago, Houston, Los Angeles, and San Francisco. There is talk of CDC carving out even more directly funded cities, which would additional budgetary pressures in order to provide them a formula-based award.
Although CDC did make a number of changes to the FOA after its initial release in July to address concerns raised from around the country (e.g., raising the minimum award levels and capping maximum annual cuts at 25 percent), a major redistribution of funds will begin in January 2012. In that year, the total awards for New York City and State could decrease between 3.5 percent and 13 percent since this area represents a decreasing percentage of HIV cases.
One key provision in the FOA is that it empowers states that have directly funded cities under the same grant to negotiate the most appropriate distribution of CDC prevention funds. This was of critical importance in New York where the state and city health departments both have large service portfolios and a longstanding history of cooperation in program planning. A letter of agreement has been executed between the two departments that will allow a more equitable sharing of resources. But this will still mean a significant cut to the state's CDC funding level, necessitating contract reductions and downsizing at the AIDS Institute. During the five years of the grant, the AIDS Institute will lose approximately $12 million, and the city health department will gain around $9 million. In other states with directly funded cities, it is unclear as to what arrangements are being made and what the impact of significant funding shifts from states to cities will be.
To accommodate the anticipated funding decrease, the AIDS Institute is moving ahead with staff cuts and is planning for the gradual phase-out the dozens of contracts it supports with CDC money in the five boroughs. The AIDS Institute, however, will continue to administer tens of millions of dollars in state-funded prevention and supportive services contracts in the city. The impact to the Institute's programs in other areas of the state will be less severe, but will still be felt. For instance, AI has already stated it will cut all CDC-funded 2012 contracts by 5 percent. New York City's Department of Health has not announced plans for what it will do with the increased funding it will see.
Additional funding challenges are looming as Congress seeks to address the much discussed national debt situation. The CDC absorbed massive cuts in 2011, but held its major HIV programs harmless. If additional reductions are levied, it is likely that the FOA will be funded at a lower level, leading to decreased awards to states and cities.
Another controversial aspect of the FOA was the creation of a $20 million competitive pool for special projects. Many states that are losing money have argued that these funds would be better utilized to address cuts to base programs, while the CDC says this part of the FOA will allow states a competitive chance to win back funds and to use them for innovative program purposes.
Besides the funding issues, there was also much interest in how CDC would address program priorities such as syringe exchange, interventions for MSM of color and women, perinatal prevention, PrEP and routine testing. As it turns out, the FOA requires that 75 percent of funds be used for prevention, HIV testing and linkage to care, condom distribution, and structural interventions. This prescriptive approach has its supporters, but others believe the lack of emphasis on such key areas as harm reduction for injection drug users and sexual health interventions for men who have sex with men may be a missed opportunity.
Terri Smith-Caronia is vice president for New York advocacy and public policy, Housing Works.
This article was provided by Housing Works. It is a part of the publication Housing Works AIDS Issues Update. Visit Housing Works' website to find out more about their activities, publications and services.
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