Ask a Policy Wonk: What Do the Sequester Cuts Mean for You?
What does this mean for the hundreds of thousands of people whose health depends on federally funded HIV programs and services? In this Q&A, Ernest Hopkins, San Francisco AIDS Foundation’s director of legislative affairs, lays out the potential impacts on people living with or at risk for HIV, both locally and nationwide.
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BETA: The sequester involves 5.1% funding cuts across the federal budget. How could these cuts affect programs and services for people living with HIV?
Ernest Hopkins: The impact would be swift and deeply damaging. To begin with, the AIDS Drug Assistance Program (ADAP) faces a cut that would result in 7,400 people living with HIV being denied access to life-saving HIV medications. ADAP is a lifeline for low-income individuals who would otherwise go untreated; the sequester would sever that lifeline for thousands of people.
Also, this week the Health Resources and Services Administration announced the distribution of only partial Ryan White Program funding to the most heavily impacted jurisdictions in the United States; the remaining funds are being held hostage, awaiting the final federal budget negotiations. How HIV-positive San Franciscans who rely on Ryan White–funded programs are be able to receive care, treatment, and other essential services will depend on the final budget levels, which will determine the final amount of San Francisco’s award.
In addition, our state of California would see a $12.4 million cut to our substance-use treatment grant, resulting in 9,400 fewer treatment slots. This would have a profound effect on Californians who are working to address their substance use and avoid HIV or stay healthy.
Furthermore, cuts to the National Institutes of Health (NIH) and the Food and Drug Administration’s Center for Drug Evaluation and Research could slow important research and delay new tools for HIV prevention and life-saving new drugs for HIV treatment.
BETA: Will HIV testing and prevention programs be affected?
Ernest Hopkins: The Centers for Disease Control and Prevention (CDC) estimates that 424,000 fewer tests would be provided nationwide. That’s 424,000 fewer chances for people with undiagnosed HIV to learn their status, get the medical care they need to stay healthy, and avoid passing the virus on to others.
We don’t yet know exactly how the cuts would affect San Francisco AIDS Foundation’s own services, but we do know that California faces a devastating $2 million cut to our HIV prevention grant, resulting in 49,300 fewer HIV tests statewide. Again, this cut translates to more undiagnosed HIV infections, more missed opportunities to get into medical care, and more risk for HIV transmission.
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BETA: How are HIV/AIDS advocates responding to this threat to vital programs and services?
Ernest Hopkins: As advocates for clients and community-based providers, San Francisco AIDS Foundation wants to ensure that cuts to the federal budget do the least harm to HIV prevention efforts and patient care. We also want Secretary of Health and Human Services Kathleen Sebelius to have the flexibility to prioritize the allocation and timing of budget cuts so as to avoid negative health outcomes.
But because the cuts are poor policy and set a horrible precedent for the future, our political allies want to ensure that the impacts of the cuts are understood and felt by the general public—lest the impression be left that the cuts really weren’t so bad after all.
This political gamesmanship puts advocates like the foundation in a difficult position. We will always advocate to protect access to care and to preserve the highest level of funding for essential HIV programs like Ryan White and the ADAP program within it.
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BETA: What happens next?
Ernest Hopkins: San Francisco AIDS Foundation is working with the Communities Advocating Emergency AIDS Relief (CAEAR) Coalition to advocate on behalf of federally funded HIV programs like the Ryan White Program, HIV prevention and sexually transmitted disease screening programs at the CDC, Housing for People With AIDS at the Department of Housing and Urban Development, and biomedical and behavioral research programs at the NIH.
As President Obama said in a statement last week, “the whole design of these arbitrary cuts was to make them so unattractive and unappealing that Democrats and Republicans would actually get together and find a good compromise.” The HIV/AIDS advocacy community is joining with other health groups and the nation’s governors and mayors to call on Congress to negotiate a resolution so that the full impact of these dramatic cuts is never felt and essential services continue to help those most in need.
This should be done well before the March 27 deadline for the continuing resolution that keeps the entire federal government funded and operational. This game of “chicken” must end. Real lives are in the balance.
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Reilly O’Neal is a freelance writer and former editor of BETA.