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Changes in HIV Prevention Spending Priorities
  D.C. cuts HIV prevention for white gay men
CDC mandates more money for ‘HIV positives’

Dec. 12, 2003

The D.C. HIV/AIDS Administration has reduced the funding for a Whitman-Walker Clinic HIV prevention program targeting gay and bisexual white men from $440,000 this year to $200,000 in 2004.
HAA officials said the budget cut for the program, which is funded mostly by the federal government, is needed to comply with a new mandate from the U.S. Centers for Disease Control & Prevention calling for shifting prevention funds to programs aimed at people who are already HIV positive.
The CDC wants the money to be used to track past sexual partners of people who are HIV positive and make sure they are warned and tested, as well as to educate HIV-positive people on safe sex to protect future partners.
Whitman-Walker spokesperson Michael Cover said the clinic learned about the 55 percent reduction in funds this fall when HAA provided the clinic with a copy of its proposed 2004 contract for the program, known as “GNet.”
The program includes handing out condoms and safe sex literature at gay male meeting places such as gay bars and nightclubs and conducting “self-esteem” workshops to discourage multiple sex partners and encourage partnering. It also provides individual counseling and “skills building groups” for gay men in the D.C. area.
One of the program’s workshops, called “Cookies and Sex,” provides tips on dating and encourages relationships, according to ads for the workshop placed in the gay press.
“Full, repeated and persistent strategies of intervention are necessary to change our community members’ perceptions and to practice consistent HIV and STD prevention,” said Stephen McDonnell, director of the GNET program, in an e-mail alert to gay and AIDS activists. “This is not the time for less.”
McDonnell called on activists to contact HAA by letter or e-mail to urge the agency to restore the cuts proposed for the GNET budget.
The funding cut comes at a time when the CDC has called for a shift in the nation’s HIV prevention strategies from targeting so-called at-risk populations, such as HIV negative gay men, to people who are HIV positive. The “HIV positives” population, CDC officials have said, is pivotal to the transmission of the AIDS virus. Government funded programs should act more aggressively in persuading HIV-positive people to curtail risky behavior, CDC officials have said.
Some AIDS activists, while supportive of programs targeting those who are HIV positive, have expressed concern that such programs should not come at the expense of existing prevention programs that target HIV-negative people, especially gay men. Cutting back on prevention efforts aimed at gay men could lead to a higher infection rate for this at-risk group, activists have warned.
Feds forced the cuts, District official claims
Ivan Torres, interim administrator of HAA, said his office is bound by funding mandates set by the CDC that call on HAA to shift funds to the city’s HIV-positive population. He said HAA must also comply with funding priorities established by the local HIV Prevention Community Planning Group, an advisory body comprised of representatives of the at-risk groups.
In 2003, the planning group listed intravenous drug users as the population group at most risk for HIV infection in D.C. It listed the next highest risk group as African-American heterosexual women, followed by two groups that tied for third and fourth place: black men who have sex with men, referred to as black MSMs, and teenagers. The Community Planning Group listed gay white men, or white MSMs, in fifth place in its order of at-risk groups.
Torres said these rankings are based solely on the number of reported AIDS cases for each of the groups.
He said the prevention planning panel lowered by one notch all of the population groups in 2004 after it complied with the CDC mandate to place HIV positive people at the top of the list. That change shifted gay white men from fifth to sixth place.
With no increase in funding for the District’s HIV prevention budget in 2004, the lower ranking of the gay white male population group means that funding for programs for this group had to be cut, Torres said.
However, Torres said that HAA took steps to retain as much funding as possible for the white gay male risk group because it believes the group remains at high risk for contracting HIV.
“Although this group is No. 6 on the list, it is still set to receive almost as much [funding] as the No. 2 population group,” Torres said.
Torres said the CDC, which funds most of the city’s HIV prevention programs, reduced funds for D.C.’s AIDS prevention programs two years ago. He said the city maintained the GNET program’s funding level of $440,000 in 2002 and 2003 from surplus funds held over from the previous two years.
“We no longer have these holdover funds for 2004,” Torres said this week.
According to Torres, HAA did not receive complaints about the dating workshop or other aspects of the GNET program from Congress or anti-gay groups, even though critics have raised objections to similar programs in other cities.
“We will be working with HAA to see if we can get more funds for efforts targeting gay white men,” Cover said. “We have met all our deliverables. We have had no indication from our contract monitor or from HHS [the U.S. Department of Health & Human Services] that our performance is anything other than superb.”
Torres confirmed that the funding cut for the GNET program was based on a decrease in federal funding and the shifting of categories of groups and was not linked to the clinic’s performance.
Wayne Turner of the D.C. AIDS activist group Act Up D.C. said the 2002 contract between HAA and Whitman-Walker for the GNET program shows that $195,000 of the program’s $440,000 budget came from D.C. government funds. Turner said HAA should seek out more D.C. funds to maintain the program’s funding level. Cover of Whitman-Walker said HAA officials told the clinic that all of the program’s funding during the past year and in 2004 would come from the CDC, and that HAA lacked funds to supplement the program’s budget.
Cover said the clinic receives additional D.C. and CDC funds for other HIV prevention programs targeting black gay men, Latinos, women, and HIV-positive people.
CDC director Julie Gerberding announced CDC’s plans for shifting emphasis on HIV-positive people through an April 17 document called “Advancing HIV Prevention: New Strategies for a Changing Epidemic — United States 2003.” The document called for devoting most of the nation’s prevention efforts toward reaching out to HIV-positive people.
In response to concerns raised by AIDS activists, Gerberding said the CDC would continue to fund and endorse existing HIV prevention programs targeting HIV-negative people in risk groups, including gay men. But critics noted that the Bush administration proposed no significant increase in the CDC’s domestic AIDS prevention budget. Without a major increase, critics said, the shift in emphasis on programs for HIV-positive people would result in a cut in the budget for existing programs targeting gay men and other high-risk populations.
Paul Feldman, public affairs director for the National Association of People With AIDS, said NAPWA supports HIV prevention efforts aimed at HIV-positive people, but the group wants the CDC to provide enough funds to maintain existing funding for other programs. He said the proposed reduction in Whitman-Walker’s funds for the GNET program is the first such reduction he has heard of since Gerberding announced the CDC changes in April.
“It’s not at all surprising that it’s happening,” Feldman said. “Most major cities across the country have a program like Whitman-Walker’s.” Cutting funds for the clinic’s GNET program would be “a great loss for the community,” he said.
“This is what happens when we don’t have sufficient resources,” Feldman said.
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