A little-known initiative added to the recently-renewed Ryan White HIV/AIDS Treatment Act will divert $60 million from the Center for Disease Control's HIV/AIDS prevention budget over the next three years into a fund for which no states actually qualify.
CDC officials say that if no new money is appropriated to offset the annual funding loss, the agency will be forced to make cuts in its support for state HIV programs to make up the difference.
Renewed by Congress last fall and signed into law by President Bush in December, the act supports a wide range of care and treatment services for those living with HIV/AIDS. But a provision inserted into the act's budget by conservative Republican Sen. Tom Coburn (R-OK) could dramatically reduce funding for prevention programs.
Coburn's HIV Early Diagnosis Grant initiative mandates that $30 million in CDC's HIV/AIDS prevention dollars be set aside annually to fund grants for states that meet a specific set of qualifications regarding HIV testing.
The problem, according to HIV/AIDS community advocates, is that no states currently qualify for the grant program. However, the CDC's prevention budget will still lose that $30 million annually, whether any state qualifies and applies or not.
"It's shocking, really," Sean Barry, Director of Policy for the New York-based Community HIV/AIDS Mobilization Project (CHAMP), told RAW STORY last week. "That's $30 million a year whether any state qualifies or not... that money could, effectively, be wasting away in the Treasury Department."
CDC spokesperson Jennifer Ruth confirmed that the agency "is not aware of any states that currently qualify" for the program.
"Some states have indicated that they are pursuing statutory or regulatory changes which may make them eligible for the funding in the future," Ruth wrote in an e-mail to RAW STORY last Friday.
But Coburn spokesperson John Hart said while "it is not certain how many states would currently be eligible for the funding," the initiative was actually "set up as a financial incentive to encourage states to adopt CDC testing recommendations and to prioritize early diagnosis of high risk groups and efforts to eliminate baby AIDS."
Hart confirmed that any unused grant money would not be returned to the prevention budget.
Congress blocks the transfer of funds for the current year
The HIV Early Diagnosis Grant program would make available multi-million dollar grants to states under two categories. Twenty million dollars would be available annually for states that have voluntary ("opt-out") HIV testing of pregnant women and universal testing of newborns, with a yearly $10 million grant limit per state. Another $10 million would be available for states that perform voluntary HIV testing of clients at sexually transmitted infections clinics and at substance abuse treatment centers.
The money can be used by states to pay for HIV/AIDS testing, prevention counseling, treatment of newborns exposed to HIV/AIDS, treatment of infected mothers and newborns exposed to HIV, and costs associated with connecting those diagnosed with HIV to care and treatment.
Earlier this month, when the Senate approved the 2007 budget resolution, Democratic leaders included language which bars the use of CDC prevention funds for the early diagnosis program this year. President Bush signed the bill into law on February 15.
Sean Barry of CHAMP pointed out that the Bush administration has already cut CDC HIV prevention grants to state and local health departments by a total of $21 million since 2003.
Barry added that if the Democrats had not blocked the funding for 2007, the money transferred to the program would have amounted to a $30 million budget cut to the CDC's prevention budget, with all the money "just sitting on the shelf." He stated, however, that it will be more difficult for HIV/AIDS community advocates to urge Congress to block the fund transfer in future budget years.
To offset the anticipated loss of funds next year, the CDC has included a request for $30 million in new money in the agency's 2008 budget to support the program, the CDC's Jennifer Ruth said.
"If an increase is not appropriated in 2008, funds would have to be redirected from existing programs for state health departments in order to support it," Ruth wrote in an email to RAW STORY.
Senator Coburn refuses to compromise
Laura Hanen, Director of Government Relations for the National Association of State and Territorial AIDS Directors, said advocates had urged a compromise with Coburn and other government officials to allow any unused portion of the $30 million to return to the CDC's prevention budget each year.
Instead, Senator Tom Coburn - a frequent critic of how the CDC has spent portions of its HIV prevention budget in the past and a former co-chair of George Bush's President's Advisory Council on HIV/AIDS (PACHA) - inserted language in the legislation requiring the money be stripped from the CDC's HIV prevention programming dollars.
"It's just not acceptable to take that money away," Diana Bruce, director of policy and government affair for AIDS Alliance for Children, Youth & Families, said. "It would be a very different situation with new money."
Coburn's spokesman John Hart disagreed. Hart said the senator had sought to include the measure in the Ryan White Act to ensure funding for early diagnosis efforts, citing a "long history" of financial neglect. The initiative, he said, is also aimed at meeting the CDC's own 2003 recommendations and ensuring fiscal responsibility.
"As a fiscal conservative, Dr. Coburn believes that it is irresponsible to add to the federal budget deficit and that all new spending should be offset," Hart said. "This is simply prioritizing government spending in a fiscally responsible manner."
The potential loss of funds to the CDC's HIV prevention program could not come at a worse time, advocates say. Infection rates remain high among the poor and minority groups. AIDS is now the leading cause of death among African-American women 24-34 years old.
Bush's 2008 budget, unveiled earlier this month, requests $93 million in additional funds that are nominally for the CDC's prevention program: $63 million for a targeted HIV testing program and the $30 million requested by the agency to offset the loss of funds to Coburn's grant program.
No new money, however, has been requested to fund actual prevention efforts - such as counseling or sex and HIV education - which target those who have yet to become infected in hopes of deterring or changing high-risk behaviors. Instead, the additional funding, if appropriated, will go towards identifying those who already have the disease.
An argument over how to spend funding most effectively
Laura Hanen of the National Association of State and Territorial AIDS Directors, which supports universal testing of pregnant mothers, argued that members of the HIV/AIDS community have "basically been defending prevention programs" since the Bush administration took office six years ago.
However, Laura Bruce of the AIDS Alliance for Children, Youth & Families countered that, while Coburn "is a senator who cares a lot about HIV/AIDS" issues, funding his initiative through the CDC's HIV prevention budget is misguided.
"There already is a massive effort to prevent mother to child transmission ... the CDC has its own prenatal transmission programs," Bruce said, adding that about 100 babies a year are HIV positive. "That's why the numbers are so low."
Bruce added while voluntary testing is important - AIDS Alliance does not support mandatory HIV testing - the most effective way to eradicate mother-to-child HIV transmission is through "intensive case management" for HIV positive mothers. She said that this would take about $10 to $30 million.
"That's a lot cheaper than $90 million," she said.
John Hart of Sen. Coburn's office responded that the senator "believes that this initiative - based upon CDC's own recommendations - has the greatest potential for HIV prevention and will result in long term cost saving."
Bruce said she didn't think that three years would be enough time for states to change their HIV testing policies to qualify for the grant program before the legislation sunsets in 2009.
"I think realistically, that money will be sitting there for the duration," she said.
While funding for the grant program was blocked by Congress for the current fiscal year, if the initiative receives appropriations the following two years, that would give states until late summer of 2009 to change their HIV testing laws and apply.