Brace yourself! Tuesday, December 1, 2009 marked the 21st annual World AIDS Day. In that time do you think that the number of incidence of HIV infection is going up or going down? Last year the CDC announced that as a result of new technology and methodology the number of cases of new HIV infections was actually close to 60,000 annually, which is up almost 20,000 cases from the previously estimated 40,000 new annual cases of HIV infection. It's hard to determine if this indicates an increase in HIV infection or simply a reflection of enhanced methodology. Nonetheless, the numbers are going in an undesirable direction.
The grim truth is that as the number of HIV infections rise, funding for HIV Prevention and AIDS services has remained flat, or as we have seen in the past year, has been decimated by careless government officials. For example, I learned from Craig Thompson, Executive Director, AIDS Project Los Angeles that Arnold Schwarzenager took 35 million dollars in negotiated budget cuts in AIDS Services and HIV Prevention in CA and carelessly turned it into an 80 million dollar budget cut. In conjunction with World AIDS day I feel compelled to share what the real life ramifications are to these funding cuts. I reached out to HIV/AIDS Service providers all over the country to find out.
In regards to HIV prevention two significant issues stand out to me. First, with prevention dollars being all but removed from education services and funneled into HIV Testing and Counseling (which I experienced first hand as the program in which I was facilitating educational workshops at LA's Gay and Lesbian Center has been completely eliminated) we each have to commit to taking responsibility for our own behavior and for looking out for each other. Second, in speaking with HIV/AIDS service providers across the country I received a general consensus that it is critical for prevention and survival to get patients with HIV into treatment in very early stages. When people start receiving treatment in early stages it is more likely that their viral load can go to undetectable levels, which helps to significantly halt HIV transmission. In addition, Dr. Michael Saag, Director of the Division of Infectious Disease, and President of HIV Medicine Association, shared with me that mortality rates go from approximately 50 percent for people who have a cd4 t-cell count of 50 and below to five percent for those who have a CD 4 count above 200.
Getting people into care, however, immediately after they test positive for HIV is becoming more and more challenging while new cases go up and funding for services gets cut drastically. Dr. Saag informed me that just this past week Department of Health and Human Services put forth new guidelines indicating that everyone with a t-cell count less than 500 must be receive care (if the clinic is federally funded). Saag, agrees, but also said, "They're not providing the funding to do it. Funding is not following increased patient burden. A lot of Ryan White funding has been flat funded for the last 10 years. Clinics only have so much dollars to hire staff. The more clinic patients that show up the more costs are generated and the more clinics go into the red, and can't bail themselves out. Clinics across the country are struggling with this issue."
Cuts in ADAP (AIDS Drug Assistance Program) are being experienced universally. ADAP will maintain direct HIV treatment related drugs in its formulary, however, the drugs that treat the heinous side effects accompanying them will be eliminated. Speaking with Tyler TerMeers, Director of Men's and Youth Programs at Southwest Center in Phoenix shared that in Arizona drugs that treat side effects sometimes as severe as heart disease, diabetes, and mental health issues will no longer be covered. He said, "We have many low or middle income families relying on these assistance programs for this medication and are no longer able to access them because they are unaffordable... A lot of people are very frightened. When they see assistance programs at the federal or local level that have to be changed and restructured they get nervous about whether or not services or their quality of life are maintainable. It is hard to keep clients morale up, under these circumstances."
Quentin O'Brien, Director of Health and Mental Health Services at Los Angeles Gay and Lesbian Center said, "When people living 200 percent below the poverty line can no longer afford their drugs there is a good chance they will just stop taking them. From a Public Health perspective this is severely dangerous. People develop resistance to drugs they stop taking leading to a rise in viral load and greater chance of transmitting the virus to others." Dennis Torres, Director of Stamford Cares a program offered by Family Centers in Stamford, CT informed me that what he referred to as wrap-around services are being decimated. Wrap around services are essentially survival services like housing and food. He said, "Getting people housed and survival needs met is critical so that they can get to a point where they are even thinking about getting treatment for HIV."
I spoke with a woman named Jasmine, in Long Beach, CA. Her father, 51-years-old, was diagnosed approximately six months ago with HIV that had already progressed to AIDS. After months in the hospital, he was transferred to a nursing home and was bed bound when the insurance company executed procedures to have him discharged and sent home. She applied for home health care services from AIDS Project Los Angeles to support her father two weeks after APLA lost funding. APLA had to put her father on the wait list because they are lacking resources as a result of cutbacks. Jasmine's father was only home for a week, at which time he had to be rushed back to the emergency room with bacterial infections and pneumonia. He is still in the hospital. She is confident that with someone like a home health services expert available some of what her father is now struggling with could have been curtailed, because they would know how to better handle symptoms and what to look for.
Stories like this are being echoed across the globe, but right here in our own back yard we don't have to look very far to be a witness. With funding for prevention severely diminished and services being drastically cut it is critical that we generate the internal and external resources to maintain our health and well being. More specifically, this means not buying into things like abstinence only education regardless of how old you are. If you are sexually active responsibility means ensuring items like condoms are accessible and that you actually use them. It also means getting tested regularly and knowing what your HIV status is. And, it means having compassion for those living with HIV/AIDS and their caregivers. We also have to do whatever we can to support one another and help ensure that funding for critical services remains intact. If you have not yet done so call local senators and congress people to help ensure that funds that have already been decimated don't get cut any further and that they are eventually restored.