Where’s the Rage and Anger?

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Last night (August 11, 2009), several AIDS service organizations pulled together a downtown candlelight vigil and march to protest Governor Schwarzenegger’s recent budget cuts for HIV/AIDS services. The vigil was a compelling event. Although appropriately solemn and mournful (given how many important HIV/AIDS services are being devastated), it inspired many to keep on fighting to preserve the safety net of services that we have effectively built over two decades.

On July 28th, Governor Schwarzenegger shocked the state when he vetoed $59.1 million in additional State funds to HIV/AIDS programs. In all, including budget cuts that had already been approved by the State Legislature, State General Funds to the California Office of AIDS (OA) in 2009/2010 were reduced by approximately $82 million. While, at the time of this Adelante issue’s publication, it remains unclear how these cuts will impact direct programs, it is certain that significant service reductions and closures will result and an effective service delivery response gutted.

Although the AIDS Drug Assistance Program (ADAP) and HIV reporting/surveillance were thankfully preserved, all State General funding was eliminated for the following programs:

Therapeutic Monitoring Program: the Therapeutic Monitoring Program (TMP) provides laboratory test vouchers (e.g., genotype, phenotype and viral load) for providers to monitor which medications and treatment plans will be the most effective for individual patients.

Home and Community Based Care: the Case Management Program (CMP) and the HIV/AIDS Medi-Cal Waiver program provide in-home case management and support services to severely ill patients with HIV/AIDS. These services are provided as cost-effective alternatives to skilled nursing homes–many of which are not equipped to handle HIV patients anyway.

HIV Counseling and Testing: resources for HIV/AIDS screening, testing and counseling services.

Education and Prevention: programs including risk reduction, social marketing and other HIV prevention activities in local health jurisdictions.

Early Intervention Programs (EIPs): comprehensive HIV-specific ambulatory medical programs to enroll patients and provide them with care, treatment, support and referral services.

Housing Services: housing programs help coordinate local housing and referral systems.

While HIV/AIDS stakeholders around the state are waiting for OA to announce its plans how it will implement the budget cuts, officials estimate that, at a minimum, LA County will lose close to $15 million in funding for HIV prevention, care and treatment services. All of LA County’s contracted HIV prevention providers and medical clinics, and many HIV social service organizations, will experience serious budget, and possibly, service reductions.

Thanks to the efforts of many, a lot of people showed up for the vigil. It was important that they did—the protest was intended to show our representatives that we won’t accept the slow disintegration of HIV/AIDS services at the hands of non-responsive State leadership. The thousand plus people who shut down several downtown streets was an impressive demonstration that our community is unwilling to let this happen. However, many of us left the event wondering why there weren’t even more people there.

In the early days of the disease ACT UP advocacy turned out thousands who were filled with rage about how poorly our government was addressing the needs of HIV-impacted communities. Where is that anger now, as our State government inches us closer to HIV response that more closely resembles the late 80’s than the first decade of the 21st century?

HIV/AIDS organizations and stakeholders throughout the State have called for the Governor to restore the funding he cut from the Office of AIDS, but it is an uphill battle now that the budget has been passed. The State Legislature could override the Governor’s budget vetoes with a two-thirds vote, but it is unlikely given that the Republicans will not support such a vote. Other legislators are discussing the possibility of the Assembly returning and passing additional measures that close last month’s budget gap. And, Democratic leaders in the legislature are pursuing a well-publicized legal challenge to the Governor’s authority to veto items in a budget amendment bill.

Few solutions have been offered by our federal representatives. The Administration and California’s Congressional representatives have declined to propose strategies for federal assistance or aid. And, while numerous commercial interests have benefitted from hundreds of billions of dollars in direct federal grants and loans—all based on the theory that “they’re too big to fail”, California is receiving comparatively little federal assistance and/or attention.

In spite of the bad news this year, even more sobering challenges loom in next year’s State budget. Given that next year’s budget is already projected for a $7 – $8 billion deficit in FY 2010-2011, even with the current cuts, HIV/AIDS services may face even worse conditions then. With State general funding removed from all but ADAP and surveillance, the Governor and Legislature may turn to those programs for further cuts. Discussions earlier this year included reducing eligibility and available medications on ADAP’s formulary—changes that may be raised next year in the State’s bleak financial scenario. We must begin preparing now to stop further cuts in forthcoming months.

Remember, your voice is the most powerful and compelling tool that we have to inform sound decision-making. Don’t be afraid to use it. Let it resonate with fury over how HIV/AIDS services have been decimated this year, and fill it with hope that, collectively, we, as a community, can change this course. Share your personal experiences and stories, and let our leaders know how their decisions will significantly impact your lives:

Demonstrate your outrage by reminding the Governor how appalled you are by his State funding cuts for HIV/AIDS programs (contact the Governor at: State Capitol Building, Sacramento, CA 95814; Tel. 916.445.2841; Fax. 916.558.3160).

Contact (e-mail, call, fax and/or write) your State (Assembly and Senate) representatives to remind them of the value of these services to people with HIV/AIDS (look up your State representatives at: http://www.legislature.ca.gov/port-zipsearch.html) and urge them to take whatever measures necessary to restore HIV/AIDS funding.

Call, write and visit your Congressional representatives (in particular, the Speaker of the House, Nancy Pelosi; Congressman Henry Waxman; Senators Boxer and Feinstein; and your personal House representative) and participate in their health reform town halls to urge their support for federal intervention (e.g., loans, direct assistance, bail-outs) in California’s health and human service crisis while they are in their districts this month (look up Congressional contact information at www.takeaction.lwv.org).

By: Craig Vincent-Jones
Craig Vincent-Jones is the Executive Director of the Los Angeles County Commission on HIV.HIV

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