Addressing actual and anticipated state cuts to HIV core services, the San Diego HIV Health Services Planning Council – which decides how federal HIV dollars will be spent for San Diego County HIV services – passed its 2010/2011 budget with increases to core services and decreases to (and elimination of some) supportive services at the County Health Services Complex last Wednesday, Aug. 5.

“We can do better than this. The impact of the governor’s HIV cuts is not a theoretical impact. It’s not a budget impact. It’s a human impact. And when we’re making decisions about people’s lives or if they should be able to eat or have housing or have medications, there is something wrong with that system that’s ill thought out and unconscionable,” said San Diego LGBT Community Center Executive Director Delores Jacobs, who sits on the council.

The council voted to increase its budget for viral load testing, which checks the amount of HIV in the body, and resistance testing, which measures the degree to which an individual’s HIV has become resistant to antiretroviral drugs. Both tests are considered core HIV services or those that are medical based. The council increased its budget for the testing in anticipation of the state cutting funding for the service.

The council also increased funding for dental services, considered another core service, by $281,000 in response to the near elimination of Denti-Cal, the state program that covered most dental services for Medi-Cal recipients, including people living with HIV/AIDS. The federal government requires that the council allocate 75 percent of its budget on core services.

After accounting for a $25,000 gap in its budget, the council voted to cut a total of $579,000 from HIV supportive services, which support access to medical services, in order to fund its increase to core HIV services.

“The committee was in a position of needing to increase funding [in core services] and then find the money from the remaining categories [supportive services]” said Jacobs, referring to the Priority Setting Committee, which proposes the annual budget that the council votes on in the form of service categories.

Among the HIV supportive service categories the council voted to cut were the following:

• $78,967 from Emergency Housing ($264,967) to $186,000 (two-week hotel vouchers provided HIV/AIDS clients in need of temporary housing)

• $159,929 from Shallow Rent Subsidy ($446,786) to $286,857 (housing subsidies for HIV/AIDS clients)

• $87,546 from Transportation ($401,140) to $313,594

• $87,545 from Food Services: Home Delivered Meals ($380,392) to $292,847

• $25,265 from Legal Services ($125,265) to $100,000

• $23,991 from Emergency Financial Assistance ($73,991) to $50,000

The council eliminated funding for two HIV supportive services:

• $30,923 from Information and Referral to $0

• $59,834 from Volunteer Peer Advocacy to $0

Many of the council members voiced opinions about each funding cut before voting on it.

“While I see a tremendous need to increase primary care [a core service], I’m concerned that we’re not going to utilize that much primary care when people won’t be able to get to their appointments,” council member Mary Coffer said, responding to the proposed funding cut for transportation, which provides funding for van and cab service for people living with HIV/AIDS to get to and from the hospital.

“I am a person with HIV/AIDS who has a severe disability because of my AIDS, and there are times when I go to the hospital, after having a procedure, I’m useless, and to use my guide dog or to use my cane is useless, and I need assistant transportation to go home,” said Roman Hernandez, who also sits on the council.

The elimination of funding for Volunteer Peer Advocacy (VPA), which provides funding for the training of volunteer peer advocates and program coordination, elicited the most discussion, primarily by a half dozen volunteers from HIV service provider Being Alive San Diego, which receives federal funds for its VPA program. The volunteers told the council how they had been helped by the program and asked it not to cut its funding.

“We are the first in the line. We are the first agency that people come to. And to eliminate that [funding for volunteer peer advocacy] would just leave a huge void in the community,” said a volunteer named Eric.

“When you are dropping their funding, you’re going to close their doors, and there’s going to be thousands of people who have gone before me, who will get nothing from now on. It’s a shame. It’s really cruel. You’re hurting a lot of people,” said another volunteer named Jim.

Scott Suckow, council chair, was quick to point out that the council does not deal with HIV providers but service categories.

“This is not a vote about the provider …. This is about a service category, and so we have to keep our thoughts on that and realize that,” Suckow said.

Once the council passes the budget, it is the “grantee,” in this case, Terry Cunningham, chief of the HIV, STD and Hepatitis Branch of Public Health Services, who decides which HIV service providers, such as Being Alive San Diego, receive the funds.

As a result of the cut to VPA, Being Alive San Diego will lose about 20 percent of its annual budget, said Being Alive San Diego Executive Director Shannon Wagner.

Given that the nonprofit has also seen a 30 percent reduction in private donations – most of its budget comes from private funding – Wagner said the cut to its program “will be a big hurdle to overcome.”

The state’s cut to HIV services, reflected in the council’s cuts to county HIV services, may not be the only cuts this year, Jacobs said after the meeting. “Everyone is standing by and waiting to see.”