The Governor’s 2013 AIDS budget request is a “Death Budget.” Why? It provides not one penny more than last year, yet each year in Massachusetts there are at least 1000 new cases of either HIV infection or clinical AIDS.
How can the needs of these new cases be met with a flat-funded budget? Project ABLE’s $4 million increase request, while it would provide more resources, is insufficient. ACTUP/Boston is requesting. On the other hand, our $12 million HIV line item request and our $58 million END AIDS Budget request is the commonwealth’s best bet for ending AIDS. That budget request raises the total level of annual HIV related funding to $90 million. $90 million will save lives and save the state hundreds of millions each year.
The breakthrough “Treatment as Prevention” study (HPTN 052) proves that those with HIV who stay on treatment reduce the risk of transmitting the virus to others by up to 96%. This “treatment as prevention” approach shows that if infected people are on medications, the virus won’t spread! Studies such as an important and just published African study also show this to be true when treatment benefit is measured on a community wide scale.
Finally, studies clearly demonstrate that housing, and other practical supports are very predictive of HIV treatment adherence, critical to ending the epidemic. While research on vaccines needs to continue, a future “AIDS-free” generation is within our grasp, if only we had the resources to implement universally programs that work. The “End AIDS” budget, parts of which are highlighted below, will put in place resources to link thousands of infected people to care and medications that will vastly reduce new infections.
End AIDS Budget
Ryan White Services Rationale
ADAP (AIDS DRUG ASSISTANCE PROGRAM) AND LIFESAVING MEDICATIONS: On March 1st the Federal Government will cut $2 million in funding for Life saving HIV medications. It is not an exaggeration to say that people will die without their HIV medications, so we are asking the state for an additional $2 million to close this gap.
END AIDS Request: $2 million
MEDICAL CASE MANAGEMENT: Case managers provide HIV+ clients with many levels of support and can link them to many different services. Too many HIV medical case managers have already been cut. Of the $95 million, 1 million will insure that there are enough case managers to help those with HIV survive and thrive.
END AIDS Request:$5,000,000 (100 new full time medical case managers)
HOUSING: housing vouchers and rental assistance is desperately needed to provide shelter to the over 1000 infected people who live in this state who are homeless. ACT UP’s END AIDS budget request asks for $30,000,000 to subsidize 250 project based vouchers to begin the task of providing housing to all the HIV homeless.
END AIDS Request: $30,000,000 (2500 annual housing subsidies)
MEDICAL TRANSPORTATION: transportation support is needed to assist people with infirmities to make their medical appointments. We seek $4 million to cover the cost of medically assisted “MART” rides, cab vouchers and trips with the MBTA’s “RIDE” (the cost of which doubled last year).
END AIDS Request: $400,000 (additional 4000 round trip rides)
SUBSTANCE ABUSE SERVICES: Substance abusers with HIV need to prioritize HIV treatment so they do not transmit the virus to others. Our budget request provides detoxification services for an additional 150 clients every year ($30,000) and long term recovery housing for an additional 300 people who would otherwise be on waiting lists and who might very well otherwise become homeless.
END AIDS Request: $30,000 (60 additional bed nights)
PSYCHOSOCIAL SUPPORT FOR TREATMENT ADHERENCE: When people take meds, they become very non-infections. When people fail to take their meds they become more infectious. Adherence Case Managers are needed.
End AIDS Request: $100,000 (5 additional part time case workers)
FOOD AND HOME-DELIVERED MEALS. Food and nutrition are essential to maintaining good health. Many people with HIV lack the ability to access or prepare regular meals. Congregate meals and food banks have been cut dramatically. For the very many people with HIV who are below poverty level, food insecurity is real.
END AIDS Request: $500,00 (to restore meals and food banks that have been eliminated)
CDC Prevention Programs Rationale
HIV (AND HCV) COUNSELING AND TESTING: Twenty percent of those with HIV don’t know they have the virus. They are a significant driver of the epidemic. Studies also show that people who know have the virus protect their sexual partners in 2/3 of exposure encounters. If everyone with HIV knew they were positive, just protecting their partners at that rate could reduce new infections “below epidemic” levels. The HIV/AIDS epidemic is a public health emergency. The old model of waiting for people with the virus to find out their status on their own has been a failure. New research on “treatment as prevention” shows that aggressive approaches to seek out, test, and direct infected people into treatment could end the epidemic. New resources will mean testing people where they live, work, congregate, and play. Counselors can then direct those with the virus to where they can get immediate treatment. All this will significantly slow the spread of HIV in Massachusetts.
END AIDS Request:$5.6 million (50 counselors)
GROUP LEVEL INTERVENTIONS: Behavioral interventions endorsed by the CDC are scientifically proven to reduce risk behavior. Many of these have been cut and need to be restored.
END AIDS Request: $515,000 (10 full time group facilitators plus incentives)
Save Lives, Save Money
For every dollar spent on HIV many more dollars are saved. Each prevented infection saves HUNDREDS OF THOUSANDS of dollars in HIV care and treatment! If just HALF of the state’s estimated 750 new infections are prevented the government will save $200 million per year in drugs, treatment and health care costs. And as new infections decrease, the rate of savings increase. 63 million yearly budget increase that that results in a 200 million yearly savings. Over time, if a $63 million increase results in decreasing Massachusetts infection rates by half, it could save BILLIONS of dollars!
Massachusetts can do this. The state can issue revenue bonds to raise money immediately. Or new revenue could be set aside to help fulfil funding for an “End AIDS Budget.” Currently the state has bonding authority for $550 million to build new womens prisons. A priority that is seriously misplaced. And lets not forget the 1.5 billion dollar Rainy Day Fund.
HIV AIDS has already killed over 30 million. Instead of having this pandemic drag on, year after year, we must invest in ending it. We must not listen to the voices saying “be realistic, now is not the time!” The alternative to not making the commitment to ending AIDS are more preventable infections, more lives lost, and many, many more expended dollars. Massachusetts can put an end to AIDS in Massachusetts.