What’s next for HIV/AIDS services?

With drastic budget cuts looming, federally-funded HIV/AIDS treatment, prevention and education programs could be lost completely

Phyllis Guest
Taking Notes

On Dec. 15, four HIV/AIDS policy, planning and treatment groups offered a webinar entitled “Is No Deal a Good Deal? Deficit Reduction, HIV Services and What Comes Next.”

Experts from the AIDS Foundation of Chicago, AIDS United, Harvard Law School Center for Health Law & Policy Innovation and the Treatment Access Expansion Project took turns speaking about different aspects of the challenges HIV/AIDS service providers face in light of political realities in DC. They divided their presentation into four parts and used 50 illustrative slides.

Part 1 was the overview: Deficit Reduction and the Budget Control Act of 2011.

So why does the U.S. have a deficit when, as George W. Bush took over the White House in January 2001, the federal government had a surplus of more than $237 billion? The answer is a trifecta: Bush-era tax cuts (“It’s your money!”), war in Afghanistan (“Gotta get al-Qaida!”) and war in Iraq (“Weapons of mass destruction!”). Thus, in a single decade, we went from the largest surplus in U.S. history to the largest deficit.

The fiscal woods thicken here, so let’s just note that Congress has passed and the president has signed the Budget Control Act of 2011. The act pledges the federal government to sharply reduce the deficit over the next 10 years.

What will such deficit reduction mean for HIV/AIDS programs? According to the webinar presenters, if there is no agreement on revenue increases and the deficit reduction comes solely through spending cuts, it will severely impact three programs of interest to many of us: Ryan White, prevention funding and two so-called entitlements, Medicaid and Medicare.

­THEN AND NOW  |  When George W. Bush took over the White House in January 2001, the federal government had a budget surplus of more than $237 billion. In 2011, the deficit stands at $1.3 trillion.

­THEN AND NOW | When George W. Bush took over the White House in January 2001, the federal government had a budget surplus of more than $237 billion. In 2011, the deficit stands at $1.3 trillion.

A spending-cuts-only approach would affect the HIV/AIDS community in several ways. First, cutting prevention efforts would mean higher rates of infection, worse health outcomes and higher long-term health care costs.

Since Medicare and Medicaid help millions living with HIV/AIDS, cutting the former would likely cause more physicians to drop Medicare patients, and cutting federal funds for the latter would shift the cost to treat very low-income persons to the states. (Good luck with that, Texans.)

Cuts to general health care reform efforts would virtually assure higher costs going forward.

Still with me? Good.

So when the Congress and President Obama could not come to any fiscal agreement, they punted to the Super Committee. The Super Committee was tasked with recommending huge changes to taxes, entitlement programs (including Social Security, Medicare, Medicaid) and discretionary spending (including Ryan White).

The SC came up with nothing. Nada. Zilch.

That means there will be no immediate spending cuts to entitlement programs. But automatic spending cuts  — sequestration — will kick in January 2013 for both defense and non-defense programs.

According to the nonpartisan Congressional Budget Office, without new revenues, domestic spending will drop from about 4.4 percent of Gross Domestic Product this year to about 2.7 percent in 2021. It will then be much lower than it has been since the end of WWII.

Looking at appropriations for the year we’re entering now, suffice it to say that the differences between what the HIV/AIDS research and health care community is seeking and what the Congress is proposing are huge.

Also, the community “vehemently” opposes two policy riders added by Republican members of Congress. The first bans the use of federal funds for syringe exchange programs. The second funds abstinence-only programs.

The webinar ended with a plea for advocacy. Here are the talking points the experts hope we will use:

• The Super Committee actually succeeded in one area: It prevented major cuts to Medicare, Medicaid, Social Security and other essential programs.

• The president and Congress must stick to their promise to cut defense and non-defense spending equally; no caving to deep-pocketed militarists.

• New revenue is essential; without it, HIV/AIDS outreach, prevention, education and treatment programs are lost.

• Preventing new HIV/AIDS cases, providing early treatment for those who do get infected, and funding support services such as housing are not just humane; they are cost-effective.

HIV/AIDS is still running rampant, and no magic cure is in sight. Call, fax, email and snail mail every member of Congress as well as the president.

Work with other activists. Think of other things to do, and do them all. Jan. 2 is not too soon to begin.

Phyllis Guest is a longtime activist on political and LGBT issues and is a member of Stonewall Democrats of Dallas. Send comments to editor@dallasvoice.com.

This article appeared in the Dallas Voice print edition December 23, 2011.

—  Michael Stephens

Local Briefs

S. Dallas AIDS Walk orientation set

Volunteer orientation for the South Dallas AIDS Walk takes place on March 15 at 10 a.m. and 2:30 p.m. and on March 16 at 6:30 p.m. at Sanford Brown College, 1250 W. Mockingbird Lane.

The walk will be on March 19 and benefits the Anthony Chisom AIDS Foundation and other South Dallas AIDS service providers. Auntjuan Wiley is the event chair. To volunteer, contact Ray Jordan at 214-491-8028.

LGBT Lobby Day set in Austin

The LGBT community will gather in Austin this weekend for several conferences that culminate in lobby day at the state capitol on Monday, March 7.

Registration for lobby day begins at 7:30 a.m. at First United Methodist Church Family Life Center, 1300 Lavaca St. in downtown Austin.

At 9 a.m. Equality Texas will hold a press conference on the south steps of the Capitol. Rep. Garnet Coleman of Houston and the parents of suicide victim Asher Brown will speak. Brown would have celebrated his 14th birthday on March 2. Joel Burns has been added to the speakers line up. After a training session, lobbying begins at 11 a.m. Lunch will be served at the church at noon with lobbying continuing another two hours on Monday afternoon.

DBA offering free LegalLine

The Dallas Bar Association will offer two LegalLine call-in programs in March, in which volunteer attorneys will answer legal questions free of charge. The programs will be held from 5:30 p.m. to 8 p.m. on Wednesday, March 9, and Wednesday, March 16.
For LegalLine assistance, call 214-220-7476 between 5:30 p.m. and 8 p.m. on the designated days.

Words of Women celebration set

The 9th Annual Words of Women, a Dallas Celebration of International Womens Day, will be held at The Women’s Museum: An Institute for the Future, 3800 Parry at Exposition in Fair Park, on Sunday, March 13, from 12:30 p.m. to 4 p.m.

The event will feature the Words of Women Essay of the Year Presentation, speakers addressing issues of important to women, music and entertainment, an information table and food.

One of the main topics will be the women of Egypt.

Dallas County Sheriff Lupe Valdez will attend.

Suggested admission is $10. Parking is free. For more information, call Christine Jarosz 214-319-6696 or Linda Evans at 214-660-1820, or e-mail Teresa Nguyen at teresa@redidagency.com.

This article appeared in the Dallas Voice print edition March 4, 2011.

—  John Wright

Dallas ASOs win fight to keep client info off Web

DSHS wanted patient notes added to secure online server to help in audits; agencies say risk to confidentiality was too great

DAVID TAFFET  |  Staff Writer taffet@dallasvoice.com

Raeline Nobles
LEADING THE FIGHT | Raeline Nobles, executive director of AIDS Arms Inc., took the lead in negotiating with DSHS to keep AIDS service organizations from being forced to put confidential client information on an online server.

Local AIDS agencies have prevailed over a Department of State Health Services mandate to post all confidential client notes on an Internet database.

The agencies began battling the mandate after state officials claimed that ARIES, the new database, would be secure but could not provide a list of who would have access to the system to the agencies.

“That hit me like a brick,” said Don Maison, executive director of AIDS Services Dallas.

He said immigration status, incidents of domestic violence and other personal information would all become public. He sent his staff for training on the system but instructed agency employees not to enter any information.

Bret Camp, associate executive director of health and medical services at Nelson Tebedo Clinic, said, “We have information available for review. We will not be entering information in ARIES.”

Dallas County sided with local AIDS service providers. After almost a year of negotiations, the state compromised and will allow agencies to provide the data needed by the state without posting confidential notes on line.

The only objections to using the system came from Dallas.

Raeline Nobles, executive director of AIDS Arms, said all agencies funded by Ryan White Part B money in Texas would be affected.

Houston doesn’t receive this type of funding. Agencies in other parts of the state told Nobles they were too small to fight the new mandate.

That left Dallas organizations to lead the fight to protect personal information from being compromised on line.

“We were successful,” said Nobles, who led the opposition and negotiated with the state on behalf of the county and Dallas AIDS service providers.

“DSHS has come back and decided to negotiate a fair and equitable deal,” she said. “Austin has done the right thing on behalf of clients and agencies.”

The state agency told both Nobles and Maison that it needed all of the client notes to audit the agencies. They said allowing state officials to examine the agencies without traveling to the various locations across the state would save money. The state, however, pays the county to review agency records.

Greg Beets, DSHS public information coordinator for HIV/STD programs, said that the reason behind ARIES is to codify and evaluate HIV services across the state. He said confidentiality was the state’s biggest concern as well.

“The data helps provide a snapshot of what services are being provided and identify unmet service needs,” Beets said.

Beets said that the system met standards developed at a national level and a series of measures would ensure security. Those measures included limited access to the information on a need-to-know basis, security at the building in which the computer was housed and encrypted information.

Those assurances did not satisfy Dallas AIDS agencies. Nobles pointed out that from time to time information is compromised from financial institutions that spent quite a bit of money on their technology.

“If information ever got out to the public, we’d be liable,” Nobles said.

Several years ago, the state required AIDS organizations to invest millions in new computer record keeping systems. She said all of the information is currently kept on a secure computer database within the agency. That computer system is not Internet-based.

Nobles’ agency raised several hundred thousand dollars to satisfy the unfunded mandate to build their database, and, she said, Parkland spent more than $1 million on their system.

To move the information to the new state computer system would be a complete waste of that money the state required her to raise from local donors, Nobles said.

She explained she feared moving the information off the database to a state system would compromise her credibility with her agency’s donors.

“But privacy is the number one issue,” Nobles said. “We can’t build a reliable relationship with clients if they don’t believe it’s confidential.”

Maison was even more adamant.

“This agency would be in court,” Maison said. “It wouldn’t take a rocket scientist to see what this policy does to make people run from care.”

Maison said people with HIV who use public services give up quite a bit of their privacy, “But to invite the government into your daily life is not acceptable.”

Nobles said she was never arguing about the state’s right to see AIDS Arms’ records. “Any time a government public health funder needs to audit, they can do so,” she said. She said that the information the state needs is statistical information.

But, Nobles added, she couldn’t imagine what use the client notes would have been.

The state will maintain the ARIES system. Nobles said smaller agencies, especially in rural areas that could not afford their own database, might want to use it.

Maison was happy with the outcome.

“I don’t recall being on the same side as the county before,” said Maison, who has headed ASD for more than 20 years.

Camp was also pleased with the outcome. “I’m very pleased Dallas County understood the importance of client confidentiality and backed the service providers,” he said.

This article appeared in the Dallas Voice print edition August 13, 2010.

—  Kevin Thomas