Bay Windows - March 11, 2004
Ethan Jacobs, ejacobs@baywindows.com.

On March 1 the U.S. Department of Health and Human Services (HHS) announced that Boston would receive about $14.8 million in federal grant money to provide primary care and other services for low-income people living with HIV/AIDS. This year's HHS grant represents a $550,000 cut in the federal funding that the city receives under Title I of the Ryan White CARE Act, which provides money to the 51 urban areas around the country most impacted by the AIDS epidemic.

The cut in federal funding follows on the heels of several years' worth of cuts to HIV/AIDS services in the state budget. The Bay State's AIDS budget line item has hemorrhaged money for the past three years, dropping from $51.1 million in Fiscal Year 2001 (FY 01) to $32 million in FY 04.

In contrast, federal funding under Title I had remained fairly stable prior to this year. For the past three years Boston's allotment had hovered between $15.4 and $15.2 million, City officials say the magnitude of this year's cut was unexpected.

"We were surprised at the cut," said John Auerbach, executive director of the Boston Public Health Commission, which administers the Title I funding.

He said Boston public health officials had been prepared for a small reduction in this year's grant due to the changes in the AIDS epidemic across the country. Part of the grant is determined by a formula based on the estimated number of people living with AIDS in a given urban area, and Auerbach said that Boston represents a smaller percentage of HIV/AIDS cases nationwide than it had a few years ago.

But HHS figures show that Boston sustained cuts in its HHS budget across every funding category.

The formula grant "was a relatively minor part of the overall reduction," said Auerbach.

To make matters worse, this year's Title I funding arrived later than usual.

"We didn't even receive notification of what our award would be until after March 1," said Auerbach, explaining that the fiscal year for Title I was set to begin on that date. Without a sense of the magnitude of the budget cuts until after the beginning of the current fiscal year, Auerbach said that the Boston Public Health Commission and the agencies that receive Title I funding overestimated their resources. He said organizations will consequently be even more strapped for funds by the end of the year.

Kevin Ropp, press officer for the Health Resources and Services Administration (HRSA), the division of HHS that oversees the Ryan White CARE Act, said that the cuts to Boston's funding are a result of an overall reduction in the HHS budget for Title I funding.

"You can see it's been a $4 million decrease overall," said Ropp. Of the 51 urban areas allotted funding under Title I, 40 received a reduction in funding this year.

Boston's grant "looks, in comparison to other cities and states, fairly substantial," said Ropp. He said HHS takes into account severity of need in issuing their grants.

According to Ropp, HHS has not investigated the impact that this year's cuts would have at the local level in Boston and the other affected urban areas.

"It's a local determination about how the funds are distributed," said Ropp. "We don't get involved in that process at all."

Auerbach said that the city currently has 150 different contracts with community-based agencies under Title I, mostly with Bay State agencies but also with a few organizations in New Hampshire. He predicted that nearly all of those agencies would take some sort of cut this year.

Additionally he said the Boston Public Health Commission would be forced to entirely defund 14 agencies, including several focusing on advocacy, case management for people living with HIV/AIDS, and adoption and foster care for children of parents with HIV/AIDS. He said he expects major reductions in the services around the state, including fewer visits from case managers, fewer state-funded hot meals, and reduced access to mental health and dental services.

Rebecca Haag, executive director of AIDS Action, said that the federal cuts will mean less funding for her organization to provide case management services, nutritional counseling and support for people living with HIV/AIDS, and transportation services for patients to and from doctors appointments. Yet she said her main concern is the impact of the cuts to services around the state. Over the past few years service providers have worked to minimize the impact of state budget cuts on services by reducing overhead expenses and partnering with other programs.

"I think now we're facing the actual cut to services for people with HIV and AIDS," said Haag.

She said among AIDS advocacy organizations there are worries that the cuts to Title I funding are a sign that the White House and its supporters are no longer committed to maintaining the Ryan White CARE Act.

"My fear is that I think these cuts for the allocation are more severe than expected, and it doesn't bode well for the reauthorization of Ryan White, which is next year," said Haag.

She said AIDS Action is working with other organizations from around the country to lobby for reauthorizing the Ryan White CARE Act.

"It's not like somehow this is just Boston," Haag said. "These are cuts across the country."

Locally, Auerbach said he hopes legislators will see the cuts as reason to increase AIDS funding at the state level for FY 05.

"I hope that we're able to successfully appeal to the legislature to restore some of the AIDS cuts over the last few years," said Auerbach.

Gov. Mitt Romney released his proposal for the FY 05 budget last month. It includes a $1.7 million cut to the AIDS line item, along with cuts to substance abuse programs and to the HIV MassHealth program, which provided state Medicaid benefits to HIV-positive people. The House and Senate will release their own budget proposals in the coming months.

Roseanne Pawelec, spokesperson for the Department of Public Health, said that the impact of Romney's proposed cuts would be reduced by federal funding to community based agencies through other funding streams from HRSA and the Centers for Disease Control (CDC).

All of the advocates and city officials interviewed for this story said that the federal funding cited by Pawelec would not counter the loss of state funding over the past three years.

Pawelec said that Romney's proposal to reduce funding to the AIDS line item was relatively small compared to the efforts of House leadership in FY 04 and of prior administrations.

"The reduction, given the fact that there are multiple [federal] funding streams ... is not in the same type of realm as cuts under former administrations," said Pawelec.

Auerbach said that those prior cuts may have already had a negative effect on efforts to combat the AIDS epidemic. He said with reduced prevention efforts the city is seeing evidence of more risky sexual behaviors and increased cases of syphilis, especially among gay men. He also said that the increase in participants in needle exchange programs may be a result of budget cuts to substance abuse efforts. Health officials fear that the decreased federal funding, combined with further cuts to the state budget, could make the situation worse.

"We're worried that the result of the budget cuts is already leading to increased transmission," said Auerbach.

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