[HARMRED] Mass. services for HIV face cuts Agencies fear rise in infections as US shifts funding

[Mark Kinzly]

Mass.services for HIV face cuts
Agencies fear rise in infections as US shifts 
funding
By Kay Lazar
Globe Staff / August 15, 2011 
Deep cuts in federal funding will force Massachusetts to 
immediately slash or eliminate many key HIV and AIDS prevention services, 
programs that were central to driving down the infection rates in the state by 
more than 50 percent over the past decade, according to a top Patrick 
administration official.
The state Department of Public Health began notifying a 
network of community health agencies on Friday about the $4.3 million reduction, 
which is roughly one-quarter of the state’s annual AIDS prevention 
budget.
Services that will be cut back include distribution of 
free condoms to schools, colleges, and health facilities, and programs that give 
intravenous drug users clean needles, said Kevin Cranston, director of the state 
Bureau of Infectious Disease.
A program that sends education counselors to night clubs 
and other areas frequented by gay men, a population that has historically had 
the highest infection rates, will be eliminated. Billboards, radio, and other 
media ads promoting HIV testing and prevention programs will be scrapped. So, 
too, will be training for community case managers who work directly with AIDS 
patients.
Fueling the cuts is a dramatic shift in the way the 
federal Centers for Disease Control and Prevention will be funding state AIDS 
prevention programs.
The CDC is taking money from states like Massachusetts with lower 
rates of HIV infection to focus its resources in states, including many in the 
South, with high or increasing rates. New regulations will also significantly 
restrict the way Massachusetts can spend its federal HIV 
prevention dollars, a change that will compound the cuts. It will require the 
state to shift money from community-based programs that aim to prevent further 
infections to clinic-based HIV testing and programs targeted to people who are 
already infected.
We are “ensuring that money actually follows the 
epidemic,’’ Dr. Kevin Fenton, director of CDC’s National Center for HIV/AIDS, 
Viral Hepatitis, STD, and TB Prevention, said during a recent press 
conference.
“As we move forward in these challenging economic times . 
. . we have to maximize the availability of every dollar,’’ he 
said.
But Cranston, who has led 
Massachusetts’s AIDS prevention initiatives 
for most of the past decade, said he is worried the new federal strategy will 
backfire by weakening efforts to prevent new infections in high-risk 
populations.
“Well-trained staff in the field, good information, as 
well as direct services for HIV-negative and positive people, together, have 
given us the success this past decade,’’ Cranston said. “I would hate to see a 
resurgence of HIV in Massachusetts after being so successful this 
decade.’’
A decade ago, Massachusetts was seeing about 1,000 new HIV cases a year, 
and that has dropped below 500, Cranston said. Nationally, however, new cases 
have held steady over that time, and increased among some populations, including 
gay black men.
The federal cut represents half the federal AIDS 
prevention money now coming to the state. It is being phased in over five years, 
but the biggest single reduction - $2.3 million - is required to be completed by 
January, and the state is beginning immediately by slicing $1 million from 
contracts with community agencies, Cranston said.
Among those cut are some of the state’s most visible and 
active AIDS prevention organizations, including Fenway Health and the AIDS 
Action Committee of Massachusetts.
Rebecca Haag, AIDS Action’s president and chief 
executive, said the cuts will probably mean the organization will have to shut 
down its hot line, which it has operated for 25 
years.
“We are the sole HIV hot line for the state,’’ she said. 
“And we actually picked up coverage for Rhode Island when the government chose to not 
fund its hot line. We can no longer fund two statewide hot lines without any 
support.’’
Haag, who was briefed by state officials on Friday, said 
the agency is still trying to sort out precisely which services it will need to 
cut or scale back.
Fenway Health will be losing about 20 percent of its AIDS 
prevention funding - which comes as the agency is pioneering research in 
preventing infection.
Fenway was one of two sites in the United States 
that recently showed that giving people who are at risk of infection one daily 
tablet of widely used HIV medications substantially reduced infection rates. The 
study was published last year in the New England Journal of 
Medicine.
“There is no question in my mind that these cuts will 
have an effect on our ability to cut infection rates,’’ said Dr. Stephen 
Boswell, president and chief executive at Fenway Health and assistant professor 
of medicine at Harvard Medical School.
At Tapestry Health, which serves much of Western 
Massachusetts from Springfield to North Adams, president and 
founder Leslie Laurie said her agency will probably have to ration many of its 
core services, including its needle exchange program for IV drug 
users.
The agency also runs a mobile van, which travels to 
county fairs and community centers in the rural region offering rapid HIV 
testing that can give results within 20 minutes.
The agency provides services to some of the state’s most 
hard-hit communities with HIV infections, including Springfield and Holyoke. Laurie said the cuts will probably 
mean significant delays for more than 100 patients whom the agency helps with 
getting stable housing, medical care, and health 
insurance.
“Massachusetts is one of the few states where HIV 
infection actually went down, so the penalty was to have the support for 
continuing this both life-saving and cost-saving [services] to get cut,’’ Laurie 
said.
 
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Mark Kinzly

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York, ME 03909
markkinzly at yahoo.com
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