FORT LAUDERDALE – At this time last year, William E. Green, Broward County Health Care Services administrator, knew just how much federal financing to expect for the Ryan White Part A program, a federal grant that supports Broward’s low-income HIV-positive residents: $15,390,000.
This year, however, the program has received about 37 percent of its 2012 federal award, Green said, with the understanding that “we will receive the balance” once federal budgetary issues are ironed out.
In the meantime, he says he’s struggling to scale up testing, maintain adequate care and treatment (last year, to 7,100 people), as well as supporting new additions to the program. “The difficulty is trying to sustain a system that you know is already at critical mass.”
Three months into the sequester – mandated spending cuts that kicked in after Congress failed to agree on how to reduce the federal deficit – state and county public health officials and activists remain uncertain how it will impact their HIV/AIDS services. Others have found additional funding to make up the deficit.
It’s happening as many focus on HIV Vaccine Awareness Day, May 18, an annual observance for educating communities regarding HIV preventive research and recognizing those working for it.
According to reporting from the Centers for Disease Control and Prevention (CDC), Florida in 2011 ranked second in the nation — after California — in reporting the highest number of HIV diagnoses, with 5,403 and 5,973, respectively.
South Florida is ground zero, where Palm Beach, Broward, Miami-Dade and Monroe counties log some of the state’s highest rates of HIV prevalence.
Blacks account for roughly 50 percent of the HIV-positive population in Miami-Dade and Broward counties, where more than 23,000 and 16,000 people, respectively, are positive, according to DOH. In 2011, Miami-Dade, Broward and Orange counties combined reported the highest number of HIV cases, 50 percent of the statewide total.
$1.4 MILLION HIT
The sequester is expected to cut $1.4 million from the Florida Department of Health (DOH), resulting in about 35,900 fewer HIV tests, according to a report released by The White House in February.
In addition the report states that 7,400 fewer patients will have access to life-saving medications through Florida’s AIDS Drug Assistance Program (ADAP). Late last year ADAP lifted a wait list that had been in effect for two years, delaying some patients from quickly receiving critical medicines.
The report further warns of the potential for increased health care costs, HIV transmission and HIV-related deaths.
In an email, however, Molly Koon Kellogg, DOH press secretary, said Florida received significant increases in CDC Prevention money in 2012, and again in 2013, with Broward and Miami-Dade receiving a large portion.
“As a result, we do not expect the sequester to have a significant impact on testing,” Kellogg said, “To avoid an impact on the public, DOH is continuing to implement efficiencies, work closely with community partners and reallocate funds if needed.” Timothy O’Connor, a Palm Beach County Health
Department spokesman, said at this point, federal cuts to HIV/AIDS funding would be absorbed at the state’s administrative level, and wouldn’t reduce Palm Beach County’s ability to provide patient care and prevention services.
Although minorities are a lesser proportion of the community in Monroe County, they carry a higher burden of the disease, said Cyna Wright, HIV/AIDS program coordinator for the Monroe County Public Health Department.
“A lot of times we have a late diagnosis in our African-American community,” Wright said. “So when they do come in, the disease has progressed more than, say, another demographic.”
Health officials agree that early access to care and drug treatment is important to prolonging life expectancy. Reductions don’t just affect those in treatment, but also
prevention services, Green said. “We have already seen reductions in the workforce of some of our providers.”
“If (Broward DOH) can’t purchase the same number of HIV test kits at more than 70 registered testing sites, that means less people are going to get tested, less people are going to be identified to get into care,” he added. “That’s taking a lot of steps backwards.”
DON’T EVEN KNOW
The high prevalence is frustrating for community organizers and activists, who say combating stigma within the black community is a persistent battle. On average, one in five people are positive, but do not know it because they have not been tested.
“We’re still dealing with the cause and not the root problem,” said Metris Batts, Minority AIDS Coordinator for the Palm Beach County Health Department, who rattled off a litany of challenges, including broken families, substance abuse, poverty, illiteracy, low self-esteem and lack of awareness.
Donovan Thomas of Fort Lauderdale, a community activist and founder of RCP Movement, an HIV/AIDS awareness group, faults a lack of cohesion between various organizations, and a focus on educating the community primarily during specific awareness events.
“For HIV to be as big of an issue, it should be everywhere,” said Thomas, 31. “There should not be any place, event, activity where HIV is not somehow infused into it.”
For HIV counseling, testing and referral sites, visit doh.state.fl.us/disease_ctrl/aids