The funds for HIV, viral hepatitis, STDs and TB will create jobs, strengthen health infrastructure, and address an urgent health threat.

As debate swirls around the stimulus package put forward by Congress, it is imperative that the final package include $400 million proposed in the Senate package for infectious disease screening and prevention, such as HIV and STD. The money should be sent to the Centers for Disease Control and Prevention's (CDC's) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention to prevent some of the most common, costly and controllable infectious diseases in the U.S. Adjusted for inflation, CDC's HIV prevention budget has decreased by 19.3 percent since fiscal year 2002. CDC's STD budget has declined 15 percent since 2002 as well.

In discussing the stimulus bill, President Obama has continually stated that the country must shore up and improve its infrastructure. The infrastructure of our public health system, particularly the public health workforce must not be ignored in these discussions. One quarter of the current public health workforce will be eligible to retire by 2012; we must invest now in training and retaining the next generation of public health professionals. States are in desperate need of resources to tide their public health programs over until their budget situations improve.

Funds Are Desperately Needed to Address Urgent Health Threats

The money in the House and Senate bills would be used to prevent some of the most common, costly, and controllable infectious diseases -- HIV, viral hepatitis, STDs and TB.

• Every year, 19 million Americans become infected with STDs, including HIV. Most do not know they are infected.
• 21 percent of HIV-infected persons are unaware of their infection.
• One in four teen girls has at least one STD. These infections increase the risk of infertility, ectopic pregnancy and poor pregnancy outcomes, cancer and HIV infection.
• These infections continue to disproportionately impact racial and ethnic minorities in our nation.
• The rate of new HIV infections among African American women is 15 times higher than that of white women.
• 71 percent of AIDS cases diagnosed in 2006 were in communities of color.
• In 2006, the rate of syphilis among African American women was more than 16 times higher than among white women.
• Approximately half of persons with chronic hepatitis B are Asian Americans and hepatitis C infection is 2 to 3 times as prevalent among African Americans as it is among whites.

Economic Benefits of Investing in HIV, Viral Hepatitis, STD and TB Prevention Are Many

Chronic underinvestment in prevention has resulted in sustained transmission, severe health disparities, spiraling healthcare costs and public health work burnout and attrition. The funds included in the stimulus would directly be responsible for creating jobs, modernizing healthcare infrastructure and reducing unnecessary healthcare costs.

Job Creation

• The majority of stimulus funding would be used to support state and local health departments and communities. Health departments across the nation are experiencing budget shortfalls and are being forced to reduce staff and provide fewer public health services.
• The Center for Budget Policy and Priorities has said that 46 states are currently facing budget shortfalls and that 26 states have made or are proposing cuts to their public health programs.
• In the past three years, over 1,000 TB program staff across the country have been furloughed, laid off, or lost.
• California has reduced the work week of state health staff by 10 percent due to the declining state budget.
• One state has proposed eliminating its Health Department entirely, due to severe budget shortfalls.
• Due to state budget cuts in 2008, funding for all seven STD clinics in Massachusetts has been eliminated.
• Most funds would be used to retain and hire thousands of workers in a broad range of fields, including: nurses and nurse aides; community outreach workers; medical assistants; other allied health and public health professionals, including: phlebotomists and prevention counselors; laboratory technicians; IT specialists, including software developers, technicians and engineers and clerical staff.
• There is currently no federal funding to provide core public health services for viral hepatitis; states receive on average $90,000 for adult hepatitis prevention. This provides for little more than a position in the health department. Funds will be used by states to shore up these programs to ensure that at least one staff person is dedicated to combating viral hepatitis in their jurisdiction.
• Funds would also support local economies and promote secondary job creation through:
  • Increasing the purchase of screening and diagnostic tests and laboratory equipment and supplies.
  • Increasing the purchase of drugs and therapies for those diagnosed with HIV, TB, viral hepatitis and STDs.
  • Reducing the loss of productivity and absenteeism due to complications of diseases.
  • Increasing funding to nongovernmental organizations to deliver, monitor and evaluate services.

Modernization of the Public Health Infrastructure

Investments in training, information systems, laboratories, and new technologies would increase efficiency, ensure program effectiveness and protect the health of future generations.

• Funds for implementation and upgrading disease surveillance systems to increase completeness and efficiency are urgently needed.
• Some states still use paper to report cases to CDC, which is costly and slow and limits the ability of states and CDC to respond to disease outbreaks.
• There is no federally funded chronic hepatitis B and C surveillance system in our country. Stimulus funds will allow states to begin to develop hepatitis surveillance systems to monitor disease incidence, prevalence, and trends.
• Health IT experts will be utilized for electronic records implementation and electronic laboratory disease surveillance implementation.
• Funds to support the transition to faster, better diagnostic technologies are needed.
• Diagnostic tests currently used by most states for TB and STDs are decades old. States need assistance to purchase equipment and train staff to adopt new technologies.
• A rapid test for the identification of hepatitis C is expected to be approved this year. Support to implement a comprehensive screening and testing program will be necessary to take advantage of this technology.
• CDC currently has a waiting list for training of more than 2000 organizations to deliver scientifically proven prevention interventions.
• Education opportunities to develop a 21st century public health workforce are needed.
• Additional surveillance resources are needed in order to eliminate backlogs of cases waiting to be investigated and entered into state and local surveillance systems.

Reduce Healthcare Costs

These investments will reduce healthcare costs and improve the health of Americans.

• For every dollar spent on STD prevention, $43 is spent each year on STD related treatment costs
• Undiagnosed infections drive up medical care costs due to disease complications and ongoing transmission. It is imperative that we make individuals aware of their infections to increase quality of life and decrease costs.
• The cost of HIV treatment and lost productivity is largely borne by the public sector and can reach $1 million per infection.
• Screening for STDs such as Chlamydia is cost effective and can prevent more serious complications.
• Individuals who are aware of their HIV infection are far less likely to transmit the virus; in fact they have an estimated transmission rate of 1.7 percent to 2.4 percent in contrast to estimated transmission rates of 8.8 percent to 10.8 percent for those who are unaware that they are infected with the virus.
• At least 3 million Americans are chronically infected with hepatitis C virus. The projected direct and indirect costs of this epidemic, if left unchecked, will be over $85 billion for the years 2010 through 2019.
• Treatment costs for multidrug-resistant (MDR) TB range from $100,000 to $300,000, which can cause a significant strain on state public health budgets.

Congress Needs to Act Now

One time investments in the prevention of HIV, STDs, viral hepatitis and TB is an effective way to create thousands of jobs, modernize and strengthen the public health infrastructure, accelerate prevention efforts and hasten the elimination of these preventable infectious diseases. The nation must invest in turning the tide on these infections for a healthier society and improved healthcare infrastructure.