by Rex Wockner
National News Briefs
In an effort to balance California’s budget, Gov. Arnold Schwarzenegger used line-item vetoes July 28 to chop more than $50 million in funding from the state Office of AIDS, including critical funding for HIV viral-load testing.
Schwarzenegger decimated AIDS services across the board, leaving full funding in place only for epidemic surveillance and for the drugs that suppress HIV.
Although the cuts curtailed state funding for HIV-related education (an 80 percent cut), prevention (80 percent cut), counseling (70 percent cut), testing (70 percent), primary medical care (50 percent), home care (50 percent) and housing (20 percent), one cut stood out in particular: the termination of all funding for the Office of AIDS’ Therapeutic Monitoring Program.
For some 35,000 Californians whose HIV care is paid for by the state, that program paid for viral-load testing and drug-resistance testing.
Viral-load testing is required in HIV care, as it is the only way to determine if a particular HIV drug cocktail is working in a given patient. Drug-resistance testing comes into play at various junctures, including when a drug cocktail that had been working stops working in a given patient. The two types of testing guide a doctor in prescribing a cocktail that keeps a patient’s viral load undetectable.
Patients whose viral load is undetectable are very unlikely to develop deadly HIV-related infections and are dramatically less infectious than those whose virus is not suppressed.
“These were extraordinarily difficult cuts to make and they are cuts that will have consequences,” said Al Lundeen, spokesman for the California Department of Public Health. “More people will become infected.”
Office of AIDS Chief Michelle Roland, a doctor who treats HIV patients herself, said the Therapeutic Monitoring Program was funded only by state money and, therefore, the program no longer exists. Across the board, the office’s HIV care and support programs now have about half of the funds they had previously, she said.
There are preliminary plans, “which I must emphasize are not final,” she said, to combine the remaining, mostly federal funding of various programs into a single allocation “that can be used flexibly to pay for care and support-related services like medical visits, lab tests, medical case management, etc.”
“So, while there will no longer be a stand-alone TMP program, there will still be on average about half of the funds that have been available to pay for (our) whole array of services,” she said. “Once we figure out how to get this money to the local fiscal agents, they will need to figure out how best to use the money to pay for the most essential services, among them laboratory testing.”
“It’s not quite as dire as no one will have access, but there will definitely be fewer services for people to access,” Roland said.
If some patients no longer have access to viral-load testing or all patients have access to it less often, apart from the impact on an individual’s health, “a population that is less successfully virally suppressed is more likely to transmit,” Roland acknowledged. “We may see an increase in the HIV rate as a result.”
Roland, who co-founded an ACT UP chapter in the 1980s, also lamented the massive reduction in funding for ordinary HIV testing to see if one has become infected.
“There will be fewer people who know their status,” she said.
In the final analysis, if some California HIV patients lose access to viral-load testing, they could get sick and die, despite receiving HIV drugs paid for by the state. And, in the interim, they would be more infectious if, for example, a condom broke during sex.
Advocates expressed extreme alarm over the funding cuts.
“Expecting us to provide appropriate medical care to people with HIV and AIDS without the ability to do viral-load testing is like expecting a surgeon to remove a tumor without being allowed to do an X-ray or MRI to determine its location,” said Lorri Jean, CEO of the Los Angeles Gay & Lesbian Center. “It’s outrageous.”
Equality California called Schwarzenegger’s elimination of monitoring testing “beyond immoral” and “amazingly stupid.”
“To leave hundreds of million of dollars in reserve by cutting an entire program that no one will argue isn’t saving lives is beyond absurd, immoral and unethical,” Executive Director Geoff Kors said. “The governor needs to announce that he’s going to free some money from his reserves to restore the $8 million needed to fund this program. To pay for people’s medicine knowing that the medicine has to be monitored through testing to make sure it’s working, and then to deny those same people the testing, makes one question if the governor and his staff really understood what they were doing or if they are just playing politics with people’s lives to punish the legislature for not giving him everything he wanted. It’s amazingly stupid.”
San Diego blogger Mike Tidmus, who has AIDS and frequently writes about HIV issues, said Schwarzenegger’s move also doesn’t make sense economically.
“If someone loses access to viral-load testing and their virus becomes active again, they’re going to develop an opportunistic infection and end up in an emergency room or hospital bed, costing the state more money,” Tidmus said in an interview.
The California Legislature’s LGBT Caucus said it was “outraged.”
“With the stroke of a pen, he has crippled the Office of AIDS, striking a totally devastating cut to a state-funded infrastructure that took more than two decades to build,” the caucus said.
Los Angeles’ AIDS Healthcare Foundation, the U.S.’ largest AIDS organization, said Schwarzenegger’s “heartless act is not only deadly, but guaranteed to cost California taxpayers millions more in the future.”
“With HIV testing programs sidelined and the state’s ability to prevent new infections stymied, new infections in California will increase – each new infection can mean up to $600,000 in lifetime health care costs,” said AHF President Michael Weinstein. “A 100 percent cut to the Therapeutic Monitoring Program is the definition of penny-wise and pound-foolish – with the ability to monitor the effectiveness of lifesaving AIDS drugs hampered, the state’s already cash-strapped AIDS Drug Assistance Program will only end up spending more for drugs.”
The CEO of The San Diego LGBT Community Center called the funding cuts “devastating.”
“While we all know the state budget is more than a mess, and we knew some HIV/AIDS funding cuts were likely, the depth and scope of the governor’s cuts are unfathomable,” Delores Jacobs said. “Governor Schwarzenegger’s blue-pen frenzy dismantles a system of care that had become a model, not only for other states, but internationally.”