San Diego’s HIV community received distressing news this week when the Department of Health and Human Services announced the 2004 Ryan White CARE Act Title I awards. Forty major U.S. metropolitan areas, including some of the most AIDS- impacted urban areas in the country, have received significant decreases in federal funding. San Diego, in particular, received a $477,506 cut in funding from the previous year. The cuts came as a shock to San Diego’s HIV and AIDS community, which expected to receive the same level of funding as in the previous year.

In addition to a 4.4-percent cut to Title I funds, an additional 5 percent ($14,412) was cut from Title II funds. In the meantime, the county, not knowing about or expecting the cuts, has had to renew contracts with service providers using last year’s numbers, which will now need to be cut to make the proposed budget. The county must notify all contract providers prior to canceling contracts, creating an additional shortage of funds. All totaled, the HPC is expecting to cut close to $620,000 from the current year’s budget.

“We will basically be following the process that is guided by the priorities that have already been set in San Diego,” said Alberto Cortez, interim chair of the HIV Planning Council, “to support the items that have been identified as higher priority and reducing those that haven’t been as highly prioritized, but with a lot of care and caution. It’s never easy, as was demonstrated last summer, to cut programs.”

As part of its standard budget review process, the HPC will be taking recommendations from the HIV Consumer Council, the Priority Setting Committee of the HPC and from the grantee, the Office of AIDS Coordination (OAC).

“We’re going to be making our recommendations, but we are going to be doing that after the Priority Setting Committee makes their recommendations,” Terry Cunningham, of the Office of AIDS Coordination said of the OAC’s proposed cuts. “The grantee always makes recommendations, but we have been accused in the past of influencing the Priority Setting Committee so I want to make sure that there is no perception that that is happening.”

The Priority Setting Committee, which is made up of members of the HPC, is charged with the responsibility of evaluating the services provided to people with AIDS and makes recommendations based on those evaluations to the HPC.

“Making funding recommendations in the face of large reductions like this is an extremely painful and difficult process,” said Delores Jacobs, the chair of the Priority Setting Committee, in an interview with the Gay & Lesbian Times. “When there are funding reductions of this magnitude, the Priority Setting Committee is tasked with making recommendations to the full Planning Council based upon all of the data provided by the consumer needs assessment and the priorities ranked by consumers, the service utilization data, the epidemiological data and the need to preserve medical services and categories. Once we have arrived at recommendations based upon those priorities, they are forwarded to the full Planning Council where that body will discuss them (and the recommendations of the Consumer Council and the grantee) and make final decisions.”

The HCC will meet on Tues., Mar. 16, to discuss what the consumers see as priorities when it comes time to make the cuts. Last year during the budgeting process it was the Consumer Council that lobbied the most heavily to retain the complementary therapies program and the benefits counseling, which was completely written out of the budget.

“Right now I would say we are very concerned about cuts and loss of services,” said St. Clair Adams, chair of the HIV Consumer Council. “One of the things that I know we really should look at, and follow, are bottom-line facts. If a program such as complementary therapies is cut, that’s not just $80,000 of lost benefits in that category for consumers, it’s going to be all of the volunteer hours from the chiropractors, massage therapists and acupuncturists, which could total $250,000 to $300,000. There’s more coming out of the community, not necessarily Ryan White dollars.”

Adams said some of the areas the HCC plans to look into include making sure that case management is properly run; identifying areas where services are being duplicated; and the need for a coordinated service center to oversee all of the programs.

“One of the significant things we have to look at is, if we go through and cut programs, take percentages out of programs, are we going to be making those programs ineffectual,” Cunningham said of the budgeting process. “I think what we have to do is take a real hard line on this and actually cut programs.”

He added, in response to the HCC’s concerns about cutting programs, “I sympathize absolutely, but we have to be realistic. This is a time of very difficult decisions that have to be made. … Unfortunately, too many people get really emotional about this. We need to look at the charge of the Ryan White Care Act, and that was to maintain primary medical care and medications. Anything else is basically an auxiliary service and I think that there are those that we need to maintain and those that we need to look at making significant cuts to.”

The budgeting process last summer took four weeks to complete, nearly twice as long as expected. At the time, the budget needed to be set so that the county could begin its grant-writing process and receive this year’s funds. Now that the cuts have come down from the federal level two weeks into the start of the 2004 fiscal year, the HPC is working against the clock to potentially cut more than $620,000 from its budget.

“I don’t want to make any predictions on how long or short it will be,” Cortes said about the process. “The critical piece [is that], unlike the process last August, time is not in our favor. These are funding cuts that were effective March 1st, so we are pressed to expedite a revised budget.”

During the budget-setting process last summer, Cunningham cautioned: “The message from the director of the AIDS Bureau at HERSA [The Health and Human Services Administration] is, ‘We are facing a zero stop gain’, that there will be no increase in Ryan White Care Act funds, and zero indication that we will have any in the next two years and most probably not for the next six years. The money that we have now is the money that we are going to have to work with, and that is what we are going to need to use for our priority setting process.”

He also said, “The message from HERSA is extremely clear. There will be no more money, and primary medical care and medications are where we need to focus our priorities.”

Among the services that were vulnerable to funding cuts last summer were the benefits counseling program as well as the complementary therapies program, which funds the Holistic AIDS Response Program (HARP) through The Center.

At that time, Cunningham cautioned the HIV Planning Council (HPC) that programs like complementary therapies were the types of county programs that HERSA was implying needed to be cut in order to avoid facing a reduction in funding from the Ryan White Care Act.

“I wasn’t hinting, I was trying to give people the direction we had gotten,” Cunningham said this week. “The problem is, HERSA won’t put anything in writing like that. They tell you that face to face and I bring it back here and people think that I am blowing smoke, but it’s what we heard.”

After making major cuts that included $150,00 from the food services category, which funds Mama’s Kitchen’s meal delivery service, and after completely de-funding the benefits counseling program, the HPC did manage to save the complementary therapies program, but put it on a shoestring budget.

“Terry is a very wise man, but I’m not so sure that [we should have a] fear of potentials without a basis to really justify cutting programs,” said Adams. “If we’re covering our primary medical and we can justify them, and these aren’t out of their scope, these are things we can do, otherwise we wouldn’t have been doing them for all of these years. Granted, do they want to cut the Ryan White dollars back, I’m sure they do, but the point that I think is lost when you make something as categorical as ‘These services are going to lose us grant money’, I’m not sure that’s really fair to the process.”

Last summer, the HIV Planning Council (HPC) made cuts to the 2004 proposed budget to compensate for funding cuts at the state level. Because of the state budget crisis, statewide viral load and resistance-testing programs were cut. As a result, the $540,000 that had funded the program needed to be made up through federal funds. Meanwhile, according to the Office of AIDS Coordination, the word coming out of Washington D.C. warned against expecting an increase in funding, meaning the $540,000 would have to be cut from the budget.

Now that the year 2004 federal funding designations from the Ryan White Care Act have been announced, however, efforts to save programs like the complementary therapies program may have been in vain, as other programs are now facing serious budget cuts.

The HPC will meet on March 24 to begin talks on the new budget. The meetings are open to the public. Consumers who are interested in becoming involved in the process are also invited to the HCC meeting on Tues., Mar. 16, at 6:00 p.m. The meeting will take place at the Veterans War Memorial Building, located in Balboa Park near the corner of Park and Upas.