Yesterday, the Illinois Lottery Commission and the state’s Department of Public Health announced the rebirth of ’Red Ribbon Cash,’ an instant game lottery, which will raise an estimated $1 million for local HIV prevention services. This story illustrates one of the many strategies to offset the states’ shrinking budgets for fiscal year 2013.
HIV prevention spending has been cut in many states over the past few years. Much of the cuts are related to shifting limited resources for long-term HIV care for the estimated 1.1 million people living with HIV in the United States. Compounding the scarcity of resources in the reality people without insurance or public benefits cannot afford the estimated annual costs of $60,000 per year.
HIV prevention money is being swept away along with state Medicaid spending cuts. The Community Access National Network reports in the August 1 update of Medicaid Watch that 40 states cut Medicaid in fiscal year 2013. Only three states (MD, MA, VT) and Washington, DC are expanding Medicaid. The remaining seven states (CA, CT, IA, IN, MN, NJ, OR, TX) will have a mix of cuts and expanded coverage.
According to the CDC, there are 48,000 new infections annually, which is about a 4% increase in total cases. About 44% of those with HIV reside in 12 urban centers including the country’s largest cities such as New York, Los Angeles, and Chicago, but also Philadelphia, Baltimore, and San Juan, Puerto Rico and others . What this means for stretched state budgets is that prevention programs are being cut where no federal funding can be are stretched in regions where HIV needs are the highest.
The situation worsened when the Centers for Disease Control’s cut in state HIV prevention dollars that began in January 2012. There was a large outcry among health departments, advocacy organization, and patient groups around the country. The CDC revised its budget in response to criticism, but ultimately has adopted a redistribution strategy to focus on top 10 epicenter cities. This means that New York City may see prevention dollars, whereas a smaller city such as Syracuse will be denied support.
In a tragic paradox, epicenter cities slated for the CDC’s new ’High Impact HIV Prevention’ are barely holding their ground in coping with newly identified infections. Preventing new infections is a goal that isn’t being supported with real dollars. New York City cut prevention contracts last fiscal year, but has reinstated $1.3 million for the 2013 fiscal year that began last month on July 1st. This funding does not come from the CDC, but from the New York City Council’s discretionary budget. While the restoration of HIV prevention funding is good news, it only means that organizations can restore prevention services, but not necessarily extend them.
These draconian cuts of state budgets have occurred in the wake of international awareness of the ongoing pandemic of HIV/AIDS. The theme of the 2012 International AIDS Conference was an ’AIDS-free generation.’ The challenge to meet the promise of eliminating HIV is that prevention and treatment are linked. The prevention side is charged with outreach, testing, and referral to care. Those steps lead to effective treatment. And conversely, treatment is prevention as mounting research shows that individuals successfully connected to HIV care achieve viral suppression and are significantly less likely to transmit the virus.