The latest round of federal cuts to Ryan White CARE Act Title I/II monies placed considerable strain on the San Diego HIV Planning Council to once again reduce services for HIV/AIDS consumers in the county, this time by $673,376 (approximately 6.6 percent) making the total operating budget $9.5 million for the contract year, which began March 1. Because federal grants in the last several years have been awarded on or after the deadline, the Planning Council has had to adjust for the overage in dollars they spent in the first few months of their contract year in addition to addressing the shortfall in grant monies.

Priority Setting Committee and Planning Council meetings held in the last two weeks had area service providers and consumers debating which programs could feasibly be reduced without crippling them, or cut entirely in an effort to preserve core services.

Core services include primary care, medical specialty, drug and alcohol treatment, psychiatric services and short-term prescriptions and medications, as well as case management and peer advocacy. Countywide/regional case management, which was reduced by $17,887, was the only core service affected by this year’s budget cuts, though peer advocacy training, a case management support service, was cut by almost 78 percent.

“There’s certainly difficult choices now. All the services are very important, but the dollars need to be cut from some place, and it’s just very difficult choices that have to be made by the council,” said Dan O’Shea, senior health planner of the Planning Council Support Staff.

The Priority Setting Committee and Planning Council uses data gathered from consumer needs assessments, conducted every other year, to help gauge where funds should be applied, if new programs are needed and if existing ones can be made more efficient. Last year’s needs assessment was used as a guide when deciding what to cut last month, along with epidemiology and service utilization data.

Support services are designed to help consumers satisfy daily necessities such as food, housing, transportation, childcare and hygiene products, and also to assist them with legal, financial, treatment, outreach and referral services. Budget cuts in the last two years have considerably reduced support services, and some of the hardest this year were treatment education and adherence, reduced by 58 percent, and emergency financial assistance, reduced by 26 percent. Some treatment education and adherence funding can be gotten through other funding.

Services for the deaf/hard of hearing and hemophilia populations were cut entirely, with the caveat that those consumers have access to support services through other resources and government requirements.

Nineteen percent was cut from the total budget for drop-in coordinated services centers, designed to be an access point to a variety of services for consumers in rural areas. Funding for coordinated services in North County was on the chopping block, but was preserved in an 11th-hour vote. The Planning Council cut an additional 3 percent from other support services to bypass cutting North County’s funding.

Field outreach was reduced by 25 percent overall, while emergency-housing services took an 18-percent cut and shallow rent subsidies took a 14-percent cut.

Fourteen percent was cut from stand-alone peer advocacy, which is drop-in guidance on how to access resources with or without a case-management referral, and 12 percent was cut from legal services, which helps clients with health insurance and disability funding, as well as credit, employment and housing issues.

“For every time we save you a client by getting them SSI, we save thousands [of dollars] in services that are diverted to other programs,” said Tim Pestotnik, a former chair of the Planning Council who spoke on behalf of legal services at a March 24 Planning Council meeting. Average fees per hour of legal service are $300 to $350, he said.

HIV/AIDS support services for women, children and families, the total percentage of which HRSA requires to reflect the percentage of such cases in the region (11 percent in San Diego County), was spared deep cuts, though personal hygiene supplies were eliminated.

Planning Council support, which provides subject matter expertise, assists in the grant application process and coordinates consumer involvement, was cut 18 percent. However, a friendly amendment held harmless translation, interpretation, consumer reimbursements and outreach to preserve consumer representation on the council.

The San Diego HIV Planning Council currently has 38 members: three County Health and Human Services Agency representatives, 15 service providers that receive Title I/II funds, four service providers that do not receive any Title I/II funds, four community leaders and 12 “unaffiliated consumers.” The Ryan White CARE Act requires that 33 percent of Planning Council members must be people living with HIV/AIDS or those who use Title I/II services – such as parents, caretakers and guardians – and are not employed by or serve on the boards of agencies that receive Title I/II funds.

Deborah Roseman, lead health planner of Planning Council Support Staff, said several new members will be appointed next month.

During budget allocation meetings, all service providers who receive Ryan White Title I/II funding in a certain service category must abstain from voting on that category. All meetings are open to the public.