While new studies report that HIV rates are once again on the rise, federal funds under the Ryan White Care Act are shrinking year by year and local health providers are being called on to make tough cuts when it comes to HIV-related care and services. The HIV Planning Council (HPC) is comprised of HIV-positive men and women along with representatives of local service providers and county contractors. Last year, because of cuts at the state level, the HPC was forced to compensate by cutting $500,000 from its services and when they received their federal grant this March, they were again forced to make cuts because of funding shortfalls.

“Last year we got about a million dollars worth of cuts in two separate times, once in August and once again after we got the grant application,” said Terry Cunningham, executive director of the county’s Office of AIDS Coordination. “It was the first time we had ever really suffered cuts like that. This time people were more prepared for it, but it’s still not easy to make cuts.”

To set the priorities for this year’s budget planning process, the HPC’s Priorities Setting Committee took into account 1,151 needs assessment surveys which were submitted to the HPC by people living with AIDS.

The Center’s Executive Director Delores Jacobs, who chairs the Priority Setting Committee, describes the process saying, “The Priority Setting Committee is comprised of planning council members, consumers, and service providers who meet for five months prior to the budget meetings to review all of the data: epidemiology reports, service utilization statistics, the countywide consumer needs assessment, consumer focus group and interview transcripts, and other available information.”

Two of the major categories that consumer activists fought to maintain last year were complimentary therapies, which provide acupuncture and massage services to help people with AIDS cope with the side effects of treatment, and the outreach/tech assistance category, which provides computer support to help agencies collate and gather data. This year, both categories were completely defunded in order to meet the budget restraints.

“It’s always a difficult process to cut programs,” Cunningham, who attended and annual conference outlining expectations about the use of federal funds granted under the Ryan White Care Act said. “We’ve been in a very fortunate situation in San Diego to get a lot of services funded that are not what would be called core medical services. So in making a cut to something like complimentary therapies, unfortunately it is not one of those that is recognized by HRSA [Health Resources and Services Administration] unless a doctor prescribes that modality. So it’s one of those types of services that is the first one on the chopping block.”

Both complimentary therapies and outreach/tech support came under fire because the services were not being utilized by the entire HIV positive population, a problem that has been on the rise in recent years. Some still consider HIV and AIDS to predominantly affect gay men, but as more heterosexual and GLBT people of color are becoming infected, the needs of the HIV community are changing. As new treatments become available, people are living longer, only to face new healthcare challenges.

Despite the fact that funds for county contracts for complimentary therapies have been cut, local organizations are working to keep programs active on a limited volunteer basis.

“In this current year, the services were transitioned to the coordinated service centers (South Bay, North County, Southeast, women and children) and to Being Alive central,” Jacobs said.

This year, funds to cover costs for medical specialties, peer advocacy training, food services (home delivered meals), coordinated service centers (drop-in service providers) and treatment education were the hardest hit with funding cuts. The only categories that saw an increase in funding this year were primary medical care and dental, which received $137,661 and $80,000, respectively, to cover increasing costs.

Members of the HIV Consumer Council (HCC), which has been placed on hiatus in order to reorganize it to better meet the needs of the changing HIV community, also petitioned for no cuts to the stand-alone peer advocacy programs.

“Peer advocacy is people who are either newly infected or newly in the process talking to someone who has experience going through the process,” Cunningham said, explaining the importance of the program. “That is always a much more humane way to do things, but it’s not necessarily cost effective and with the new regulations, everything has to have measurable outcomes; and it’s very difficult in a peer advocacy situation or peer advocacy service to have those outcomes documented formally in the way that they need to be done. That makes it a very difficult sell when you are looking at some services that are documentable, that do have outcomes that are measurable.”

In the end, the peer advocacy program’s $60,825 budget was preserved. This year’s total budget proposal is calling for $10,046,722 in federal Ryan White Care Act funds, a decrease from last year’s budget of $10, 181,619.