After two weeks of meetings, which included a marathon seven-hour battle on Aug. 13 over a $540,000 reduction in state HIV/AIDS funding, the HIV Planning Council (HPC) still did not have a budget for 2004 as of press time. Statewide, $9 million has been cut from HIV/AIDS funding.

Just weeks before they were scheduled to finalize their budget, the county was informed that the state of California’s budget compromise contained cuts to HDAP, the program that funds resistance level and viral load testing for people with HIV/AIDS. These tests provide physicians with vital information, including when to start life-saving medications and which specific medications to administer. In order to make up for the loss of state funds and no funding increase from the federal government this coming year, several programs of The Center, including complementary therapies and benefits counseling, are in danger of being defunded completely (complimentary therapies provides free massage and acupuncture to those living with HIV/AIDS; the only such program running currently is through The Center).

“$540,000 that we were counting on going into next year will not be there,” said Tim Pestotnik, the chair of the HPC at the first of the two scheduled budget meetings, held Aug. 6. “This is a fact which none of us knew about ten days ago. The [County] has given us recommendations for the year-14 budget — so has the priority setting committee and the consumer council — but at the time they were unaware of the $540,000 that we have to come up with in funding.”

The cut in state funding for viral load and resistance testing is further complicated by word from the federal government that Ryan White Care Act funding is not expected to be increased in the next two years, and most likely will remain fixed for the next six years.

“The message from HRSA (Health Resources and Services Administration) is extremely clear,” said Terry Cunningham, chief of the Office of AIDS Coordination, who attended recent meetings in Washington, D.C., to discuss future funding. “There will be no more money. Primary medical care and medications are where we need to focus our priorities. We also need to look at our duplication of services so that there is no duplication of services between titles.”

A priority setting committee (PSC) was set up earlier this year and charged with reviewing all of the categories that are currently funded, then prioritizing them to deal with potential budget cuts like those currently being considered. In their initial proposal to the Planning Council, the PSC made recommendations that included cutting complementary therapies, which funds the Holistic AIDS Response Program (HARP) and benefits counseling, both of which are run through The Center. However, those two cuts alone covered less than half of the amount needed to make up for the loss in state funding.

Other cuts recommended by the Priority Setting Committee included a $100,000 cut to food delivery services and complete defunding of the relief/respite and emergency help, outreach tech assistance and outreach capacity building categories. The county initially agreed to go with all of the PSC’s recommendations in their proposed budget.

At the first budget meeting on Aug. 6 a large turnout of consumers showed up to voice their support for both complementary therapies and benefits counseling.

Artie Edwards, a member of the HIV Consumer Council (HCC) who sits on the HPC, stressed the importance of keeping these programs alive, saying, “We all know that once a program is defunded it’s not coming back.”

Those words became the rallying cry to save the programs in danger. The night before the budget meeting, the HCC revised their recommendations to compensate for the state funding loss and proposed a five percent cut to all non-medical categories in order to preserve the programs that were in danger of being defunded. At the time of the HPC’s first budget meeting, final numbers showing the impact of the HCC recommendations were not available to review.

After three hours, the HIV Planning Council adjourned the meeting so that members could review all of the proposed budgets for the 2004 fiscal year and make changes to reflect the concerns voiced by the consumers who attended the meeting.

At the follow up meeting, held on Aug. 13, the county and HCC both presented revised budgets. The county’s revised budget made additional cuts to pull together the $80,000 needed to keep complementary therapies funded. The most significant cuts came in the form of $29,000 from case management, $23,000 from outreach and $28,000 from drug and alcohol outreach. Some of these numbers were based on unused amounts from previous years that the county felt could be best used in other categories

“We conceded to the voice of the consumers from the last meeting,” Cunningham said, presenting the county’s revised budget. “We decided that we would put $80,000 into complementary therapies and do a study during this year as to the efficiency of the program and see if we can restructure the program to see if people in outlying areas are receiving their services.”

While the county did make concessions to keep complementary therapies, benefits counseling remained on the chopping block. However, as a concession to concerns that there is still a need for benefits counseling services, the county moved an additional $10,000 into the peer advocacy-training category to help compensate for the loss.

In their revised budget proposal the HCC maintained funding levels for primary medical care, while breaking out a line item in the budget to cover viral and resistance testing so that the money could be re-directed if state funding did come back. They also kept funding levels the same for 2004 in the medical specialty and prescription medications categories. The rest of the categories took a five percent cut to raise the funds to keep the programs in danger of being zeroed out funded.

After the first three categories passed smoothly, things heated up when the HPC chose to keep funding levels for countywide case management at 2003 levels instead of the five-percent cut that was recommended by the HCC. Realizing that their proposal for a five-percent cut across the board relied on adoption of all of their recommendations, the HCC put a motion on the table that a vote be held to accept all of their recommendations.

“The motion has an impact on the funding of every category on the page and therefore it is beyond question that everyone who votes on it must not have a conflict,” said Pestotnik. “If you are an agency affiliated with any of those line items you may not vote. That is not a recommendation, that is a statement of law.”

The motion was seconded and did go to a vote. The motion failed, 5-5, and the HPC resumed reviewing each of the categories individually to compensate for the $540,000 loss in state funds.

The most drastic cut in the budget came in the area of food services: home-delivered meals. Because of the reduction in service providers in this category from two to one — the county decided to fund Mama’s Kitchen and not Special Delivery this year — a $100,000 cut was already proposed to compensate for decreased utilization.

Members of the HCC pushed for more drastic cuts, saying that the original sum of money was meant to also fund Special Delivery. After a motion to cut meal delivery funding by $180,000 failed, a second motion to cut funding by $150,000 passed.

As the meeting entered hour six, the HPC finally reached the complementary therapies category and, despite efforts of members to gain more funding, the HPC voted to keep them at $80,000 for the program. This was in sprit of concerns raised by some representatives who said that the program was not accessible to clients living outside of the central San Diego area and minorities who might not be comfortable going to The Center, where the program is hosted. The amount was based on a figure that Delores Jacobs, executive director of The Center, gave the council as a “bare bones” amount that the program needed in order to continue in existence.

In their final vote of the night, Aug. 13, the HPC voted to defund The Center’s benefits counseling program completely, still leaving more than $157,000 that needed to be cut from the remaining 11 categories. If the council is not able to make up for the $157,000 deficit, it will have to revisit some of the categories that were addressed in last week’s meeting to make additional cuts. In other words, every budget decision that has been made may have to be revised. The HIV Planning Council was scheduled to discuss the budget again on Wednesday, April 20. Look for a report on the outcome of that meeting in next week’s edition of the Gay and Lesbian Times.