The continued federal HIV/AIDS funding cuts to Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title I/II monies have forced the San Diego HIV Planning Council to make cuts for the third consecutive year, reducing services for HIV/AIDS consumers in San Diego County by $476,914 (approximately 5.2 percent). This makes the total operating budget stand at a little over $9 million for the contract year, which began March 1 and ends next year on Feb. 28.

In August, the Priority Setting Subcommittee prioritized the funding categories, determined funding levels for each area and presented it to the Planning Council. In anticipation of the cuts, the Planning Council then approved a 5-percent decrease in funding.

Three core services were eliminated from the budget, including treatment education and adherence, services for the deaf and hard of hearing, and case management/peer advocacy training.

Core services include primary care, medical specialty, drug and alcohol treatment, psychiatric services, short-term prescriptions and medications, and management and peer advocacy.

Terry Cunningham, chief of San Diego County’s Health and Human Services Agency’s HIV, STD and Hepatitis Branch, said it was extremely unfortunate that treatment education and adherence, which accounted for $93,525 of the budget, was cut entirely.

“We know that people utilize that a lot in order to understand their medications,” Cunningham said. “It’s sad that that was one of the categories the Planning Council decided to defund.”

The treatment, education and adherence service allows individual counseling and community forums to educate clients on treatment options and regimens that have been prescribed to them in primary care.

“Often, when a person is first diagnosed and given treatment, it’s difficult for the patient to understand much of what they are expected to do,” Cunningham said. “Because of the time limitations of physicians, the treatment, education and adherence counselor could spend as much time as needed – often over an hour a session, a few times during the first few weeks – to get the client to a place where she or he has a sufficient knowledge base.”

Cunningham said San Diego County is used to a shrinking CARE Act funds from year to year.

“We’ve been cut approximately $500,000 each year for the last three years, so we’ve lost 1.5 million,” he said.

The $19,040 cut to services for the deaf and hard of hearing was eliminated as a separate line item, and the county is working to incorporate that into the medical specialty category in order to ensure continued access, Cunningham said.

Another area that was eliminated from the overall budget was the case management/peer advocacy training category, which accounts for an $11,605 budget decrease. Other areas where significant cuts occurred include a $59,763 decrease within emergency housing, $60,000 from coordinated service centers and $20,000 from emergency financial assistance.

An adequate amount of funding for San Diego County is hard to speculate on, Cunningham said, due to unserved populations that do not surface with HIV/AIDS until they are in critical condition. He specified that the CARE Act is to be used for the neediest of the needy and the poorest of the poor, and is not an entitlement program.

“… Getting people tested and into care as early as possible is the goal,” he said. “In order to be successful in this, we would need at least twice the available resources.”

The CARE Act was first enacted by Congress in 1990, and was amended and reauthorized in 1996 and 2000. The funds reach over 500,000 individuals each year, making it the federal government’s largest program specifically targeting people living with HIV/AIDS.

Cunningham said overall HIV/AIDS funding increases depend on the act’s reauthorization, which was supposed to be completed by Sept. 30 when the CARE Act expired.

Senator Tom Coburn, R-Okla., introduced SB 2239, a bill that would reauthorize and amend the CARE Act, Washington, D.C.’s The Hill reported on March 7. Coburn’s bill would create new funding formulas that would take into account HIV prevalence, requiring 75 percent of CARE Act funding to be spent on primary care. The bill also would require facilities that receive federal funding to conduct mandatory HIV testing and increase annual funding for AIDS Drug Assistance Programs, which are federal and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals.

Senate Health, Education, Labor and Pensions Committee (HELP) chair Senator Mike Enzi, R-Wyo., and Senator Ted Kennedy, D-Mass., are working on another bill to reauthorize the CARE Act, according to The Hill. Enzi spokesperson Craig Orfield told The Hill that the HELP version would most likely be approved by Congress because the committee has jurisdiction over the issue.