OC HIV/AIDS services targeting minorities in jeopardy

On April 15, 2007 I posted on the final resolution of the Orange County Health Care Agency’s mismanagement of federal HIV/AIDS funding targeting minority populations, Getting Away With Fraud.

I found this report from Raw Story about the suspension of funding for HIV/AIDS services targeting miniority populations. The delay in funding these programs has a direct impact on the level of care received by Latino and African-American Orange County residents living with HIV/AIDS. These individuals have on average a greater rate of mortality, and most difficulty in accessing care ant treatment services. This is just one more example of the Bush Administration and the Republicans in Congress screwing the people in greatest need out of necessary services.  But of course, they’ll say race has nothing to do with it.

From RAW STORY on April 27, 2007
Filed by Julie Weisberg

Funding for a federal grant program to help city and states fight rising HIV infection rates within minority communities has been suspended only days before the Center for Disease Control released a report calling for a “heightened response” to the “major health crisis” of HIV/AIDS in African American communities.

“This could be catastrophic for many organizations,” Damon Dozier, director of government relations and public policy for the National Minority AIDS Council, said of the funding gap in an interview with RAW STORY Tuesday. “This funding is critically important.”

The Minority AIDS Initiative

The Minority AIDS Initiative (MAI) was created in 1998 in response to rising HIV infection rates within racial and ethnic minority communities and was intended to provide HIV/AIDS-related services to under-served and heavily-affected minorities. The hope was that channeling funding through local community-based organizations would make it possible to reach high-risk populations, who tend to fall through the cracks of more traditional HIV prevention, education and treatment services.

The overall initiative — overseen by the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies — hands out money to several different federal agencies, including the Centers for Disease Control and the Substance Abuse and Mental Health Services Administration. However, the grants for cities and states are awarded through the Health Resources and Services Administration (HRSA), which falls under the larger umbrella of the Department of Health and Human Services.

Last year, HRSA handed out more than $42.9 million in MAI grants to cities and more than $6.8 million to states. Each municipality and state appropriates and passes on portions of their grant money to local community organizations.

African Americans account for 51% of new HIV cases

The Minority AIDS Initiative’s importance was heightened early last month, when the CDC released its latest numbers regarding disparities in HIV infection rates between the nation’s African American community and other ethnic groups. According to the report, blacks accounted for 51 percent of new HIV diagnoses between 2001 and 2005, even though they only make up some 13 percent of the population. Black men who have sex with other men (MSM) made up the majority of those new infections.

In response to its findings, the CDC simultaneously released a “heightened response” plan to ramp up its efforts to lower infection rates in African American communities nationwide. The plan [PDF link here] focuses on four main areas: expanding the reach of prevention services, increasing opportunities for diagnosing and treating HIV, developing new, effective prevention interventions, and mobilizing broader community action.

While the CDC plan received mixed reviews within the HIV/AIDS community, advocates are in agreement when it comes to the importance of HRSA’s MAI grants in targeting at-risk minorities that larger organizations, like the CDC, may have difficulty reaching.

Alterations to the funding process

In the past, HRSA awarded its grants in an ongoing, formula-based process. Last December, however, President Bush signed into law the Ryan White Treatment Modernization Act of 2006, making significant changes to the Ryan White Comprehensive AIDS Resources Emergency Act. One major change involves how funds are awarded across the country — including funding under the Minority AIDS Initiative, which was codified and incorporated into the renewed act.

Previously, MAI grants were divided among all eligible metropolitan areas according to a formula based on their proportion of racial and ethnic minority AIDS cases. Similarly, state grant awards were based on each state’s proportion of all racial and ethnic minority AIDS cases nationwide.

But according to the new law, HRSA’s Minority AIDS Initiative grants for Plan A (cities) and Plan B (states) will now be awarded through a competitive “request for proposal” process. This funding change will only affect HRSA’s grant program, not any of the other federal agencies that receive MAI money.

To focus on meeting the new requirements, HRSA officials suspended its MIA grant program for the two plans beginning March 1.

“We needed time to actually get a competitive process set up,” David Bowman, a HRSA spokesperson, told RAW STORY in a phone interview Wednesday, explaining that the agency was forced to suspend the funding while they developed the new competitive process. “It is a matter of the law.”

Disrupting services and lives

Bowman said HRSA expects to award funds through the Minority AIDS Initiative for cities (Part A) and states (Part B) programs in August. The criteria the agency will use to award the new competitive grants should be released sometime later next week, he said.

But some advocates say that the HRSA funding gap could have a destabilizing effect on thousands of low-income, uninsured and under-insured people living with HIV/AIDS who receive care, treatment, and support services through minority community-based organizations.

“Clearly, this is causing a lot of disruption around the country,” Michael Kink of Housing Works — a minority community-based organization that provides housing, health care, advocacy, job training, and supportive services to homeless New Yorkers living with HIV/AIDS — told RAW STORY.

“These organizations are the front door to many services” for the high risk populations they serve, Kink said. “It’s not enough to have large organizations. Having folks you recognize and trust is very important in [HIV/AIDS] care.”

Kink said that in his recent discussions with some of the smaller community-based organizations around the country, many of them are already “running on fumes,” and this six-month gap in MIA funding could cause them to “go out of business.”

“We are concerned that HRSA is not moving as quickly as the community deserves,” Damon Dozier said, adding that many of the community-based organizations that depend on this funding have “very limited budgets.”

Dozier pointed out that MAI grant money makes up some 10 percent of the budget for many HIV-related minority community-based organizations in Washington, D.C.

“These are the people right in the community… who are out on the streets,” working directly with local high-risk population, he said of community-based organizations. “This is critical work.”

Bowman, however, said creating a competitive process “takes time.”

“We are working as quickly as we can,” he added.

“We could see something catastrophic in May”

Advocates say the suspension and funding process change come at a difficult time, when money and resources for community organizations are already highly competitive.

“The more community-based you are, the more likely you are” to have your MAI-related funding cut by cash-strapped municipalities and states, Jane Shull, executive director of the AIDS service organization Philadelphia FIGHT, told RAW STORY.

FIGHT receives MAI grant money through the city of Philadelphia. Worried about HRSA’s suspension of MAI funds, the city has decided to flat-fund the HIV-related community organizations it supports through the HRSA grant program for the next eight months, Shull said.

Supplemental MAI grants through HRSA, which have also been delayed due to the law change, are slated to be awarded by April 30. Shull is concerned, however, that many cities expecting to use that supplemental funding to get them through to August, may be disappointed.

“I think we could see something catastrophic in May,” Shull said. “You just can’t go on hiatus [for eight months]… people will just shut down and find something else to do.”