HIV Policy Watch
San Francisco Watch
HIV Advocacy Network
Domestic AIDS Funding Increases Face Major Challenges as Global Funding Increases Fall Short of Stated Goal
Prior to the Congressional August recess, the Senate and House Appropriations Committees approved Fiscal Year (FY) 2004 funding levels for the Labor-Health and Human Services-Education Appropriations bill. The House cut or flat-funded virtually all domestic AIDS programs, except for a $38.9 million increase to the AIDS Drug Assistance Program (ADAP). Nationally, ADAPs need an additional $283 million in FY 04 to ensure treatment for low-income people living with HIV and AIDS. The Senate responded to House AIDS funding cuts by increasing CARE Act program budgets by the amounts they were cut in the House, seemingly designed to assure flat funding for the programs when the two competing versions of the budget are reconciled in September. In addition, the Senate provided only a $25 million increase for ADAP. At a time when more people living with HIV/AIDS are in need of services than ever before, flat funding is tantamount to cuts in funding and will severely limit access to care.
The House Appropriations Committee passed the Veterans Administration (VA) and Housing Urban Development (HUD) Appropriations bill, which included a $7 million increase for Housing Opportunities for People With AIDS (HOPWA) as proposed by the Bush Administration (bringing total HOPWA funding to $297 million). AIDS advocates applauded the leadership of Congressman Jerry Nadler (D-NY), who offered a successful floor amendment to increase HOPWA by an additional $5 million, to a total of $302 million in FY 04.
The recently approved global AIDS initiative calls for $3 billion per year over the next five years to fight HIV in the developing world. However, efforts by the Senate and House to appropriate $3 billion in FY 2004 were defeated when the Bush administration informed Congress that additional resources could not be spent effectively in this fiscal year. Instead, global AIDS programs are slated to receive approximately $2 billion (including funds for tuberculosis and malaria programs as well as research on global health issues at the National Institutes of Health).
While the House has finalized its global AIDS figures, the full Senate will further address Global AIDS funding when it returns in September and several Senators are considering amendments to increase these spending levels. The Senate will also have an opportunity to challenge the Administration on its funding requests when questioning Andrew Tobias, the newly appointed Global AIDS Coordinator, who faces confirmation hearings in early September.
In an effort to reverse the tide of 40,000 new HIV infections per year in the U.S., the Centers for Disease Control and Prevention (CDC) announced a new prevention initiative aimed at people living with HIV and their sexual partners in April of this year. The "Advancing HIV Prevention Initiative" would dramatically shift community-based HIV prevention funding towards HIV testing, prevention case management and partner counseling and referral programs and away from community HIV prevention programs targeted at populations at risk for HIV infection. States will now be required to make prevention programs targeting people living with HIV/AIDS their top priority, calling into question the role of community planning and priority setting. Many longstanding programs targeting populations at risk for HIV would be required to develop new programs consistent with the CDC's initiative to successfully compete for funds.
The proposed changes were roundly attacked by HIV prevention scientists, AIDS advocates, people living with HIV/AIDS and directly-funded CBO representatives because the concept was not subjected to consultation by affected communities or to scientific review. In addition, other divisions of the Department of Health and Human Services responsible for treating people with HIV were not involved in the preparation or coordination of the proposal prior to its release. In recent days, acknowledging that mistakes have been made, the CDC has agreed to revise the initiative to include outreach and education to at-risk populations. The CDC reinforced its new position through Dr. Ron Valdisseri, Deputy Director of the HIV/STD/TB Branch, during a briefing he gave on August 7th to the Presidential Advisory Council on HIV/AIDS. Revisions to the initiative will be released through Requests for Proposals and Program Guidance to states and communities through the remainder of the calendar year.
On Saturday, August 2nd, Governor Davis signed the long-delayed budget for the California 2003-04 Fiscal Year following months of disagreement among Democrats and Republicans about how to address the state's $38 billion deficit. The final budget includes a $27 million increase in funding for the AIDS Drug Assistance Program (ADAP). Proposals to require ADAP clients to make sizeable co-payments for HIV medications were defeated by the Legislature before the budget made its way to Governor Davis for his signature.
Beginning in January of this year, advocates mounted an aggressive campaign to persuade the Governor and Legislators that despite the state's fiscal emergency, it is critical to assure Californians with access to life-prolonging HIV medications. Given the difficulty of this budget year, advocates identified a package of existing revenue sources that could be used to increase the overall ADAP budget by $27 million to a total of $211 million.
The bulk of increased funds for the program-some $18 million-will come from rebates paid by drug companies to ADAP. These manufacturers currently return approximately 13% to the program for their purchases; money that is spent to buy more drugs with the effect of generating even more in rebate income. Because of the state's desperate cash situation, the Davis administration considered putting much of the ADAP rebate income, which has historically remained in ADAP, into the state General Fund to pay for other programs. Advocates argued that pharmaceutical manufacturers would have little incentive to continue to provide rebates to ADAP if those funds were used to pay for other state programs - a point several companies also made in calls to the Governor's office. Ultimately, the Governor agreed with the Legislature to keep all existing rebate revenue in the program.
To complete the $27 million funding increase needed for ADAP, approximately $2 million of an $80 million increase approved by Congress for the program came to California. Finally, advocates agreed to shift $7 million of the $8 million in funding for the HIV Diagnostic Assay Program, which pays for viral load and resistance testing, to ADAP for drug purchases. Many counties are now working to identify local resources to pay for such diagnostic testing services. The $1 million remaining in the diagnostic program will continue to be available to the state's Early Intervention Program.
A critical victory in the ADAP funding effort this year was the defeat of proposals to impose co-payments on ADAP clients. Many key legislators were adamant that co-payments threatened to force many ADAP clients to choose between medications and other basic life expenses. Advocates are extremely grateful that these legislators understood the realities of life for low-income Californians living with HIV and AIDS.
The Foundation has expressed its great thanks to the Governor and a number of Legislators for their strong support for ADAP in this past budget cycle. In particular, Assembly Members John Laird (D-Santa Cruz) and Mark Leno (D-San Francisco) and their staffs worked diligently with advocates to assure funding for the program. Joining them were Senators John Burton (D-San Francisco) and Wes Chesbro (D-Arcata) and Assembly Members Jenny Oropeza (D-Long Beach) and Judy Chu (D-Monterey Park). Also to be commended is Michael Montgomery, Chief of the California Office of AIDS who worked tirelessly to negotiate increased drug rebates and other savings from pharmaceutical companies to help relieve rising ADAP costs.
The final state budget flat-funded all other HIV/AIDS programs with the exception of a $1.2 million cut to prevention programs conducted by public schools and a $2.3 million reduction in HIV-related research conducted by the University of California. The budget also cut reimbursement to Medi-Cal providers by five percent.
San Francisco Watch
We previously wrote of cuts proposed to HIV/AIDS programs as a result of San Francisco's budget deficit. Led by Supervisors Tom Ammiano and Chris Daly, the Board of Supervisors made a thorough review of spending in all city departments and identified approximately $2 million to prevent cuts to HIV prevention, mental health and substance abuse related programs. The Supervisors also identified $110,000 to meet the rising cost of the housing subsidy program operated by the Foundation and prevent the loss of some 10 units of affordable housing for people living with HIV/AIDS. The Foundation thanks Supervisors Ammiano and Daly for their leadership.
HIV Advocacy Network
The increase in support for ADAP included in the final state budget would not have been possible without the active participation of the members of HAN in letter-writing and phone calling at crucial points in the budget process. As pressures continue to mount on HIV/AIDS funding and conservative agendas threaten proven approaches to HIV prevention, it is essential that more people join in grassroots advocacy for sound public policy. Please take a moment to contact firstname.lastname@example.org for tools you can use to help recruit new members of HAN among your friends, colleagues and clients.
The Foundation has completed profiles of the 20 Congressional districts in Northern California. Stretching from the Oregon border to central California, these profiles provide detailed information on the HIV epidemic as well as a calculation of selected federal AIDS funding for each congressional district in FY 2002. These profiles, which can be helpful advocacy tools when meeting with your member of Congress, can be viewed at www.sfaf.org/policy/districts or you can contact us at 415-487-3080 to receive a copy of your district's profile.
U.S., a Leader in Efforts Against Global AIDS Epidemic, Is Failing to Address the Disease at Home, Says New Report
This article was provided by San Francisco AIDS Foundation. It is a part of the publication HIV Policy Watch. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.