Raw Story: 'Shocking' Program Could Carve $60 Mil From HIV/AIDS Prevention Budget

[Hissyspit]

http://www.rawstory.com/news/2007/Shocking_program_could_carve_60_million_0302.html

'Shocking' program could carve $60 million out of HIV/AIDS prevention budget over next three years Julie Weisberg
Published: Friday March 2, 2007

Since no states qualify, program could fund nothing

A little-known initiative added to the recently-renewed Ryan White HIV/AIDS Treatment Act will divert $60 million from the Center for Disease Control’s HIV/AIDS prevention budget over the next three years into a fund for which no states actually qualify.

CDC officials say that if no new money is appropriated to offset the annual funding loss, the agency will be forced to make cuts in its support for state HIV programs to make up the difference.

- snip -

Coburn’s HIV Early Diagnosis Grant initiative mandates that $30 million in CDC's HIV/AIDS prevention dollars be set aside annually to fund grants for states that meet a specific set of qualifications regarding HIV testing.

The problem, according to HIV/AIDS community advocates, is that no states currently qualify for the grant program. However, the CDC’s prevention budget will still lose that $30 million annually, whether any state qualifies and applies or not.

MORE

[pinto]

1. Here's the language in the Bill, (H) Sec. 2625 Early Diagnosis Grant Probram

http://thomas.loc.gov/cgi-bin/query/F?c109:6:./temp/~c109iZzcfG:e111386:

House Report 109-695 - RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006

SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.

(a) IN GENERAL- In the case of States whose laws or regulations are in accordance with subsection (b), the Secretary, acting through the Centers for Disease Control and Prevention, shall make grants to such States for the purposes described in subsection (c).

(b) DESCRIPTION OF COMPLIANT STATES- For purposes of subsection (a), the laws or regulations of a State are in accordance with this subsection if, under such laws or regulations (including programs carried out pursuant to the discretion of State officials), both of the policies described in paragraph (1) are in effect, or both of the policies described in paragraph (2) are in effect, as follows:

(1)(A) Voluntary opt-out testing of pregnant women.

(B) Universal testing of newborns.

(2)(A) Voluntary opt-out testing of clients at sexually transmitted disease clinics.

(B) Voluntary opt-out testing of clients at substance abuse treatment centers.

The Secretary shall periodically ensure that the applicable policies are being carried out and recertify compliance.

(c) USE OF FUNDS- A State may use funds provided under subsection (a) for HIV/AIDS testing (including rapid testing), prevention counseling, treatment of newborns exposed to HIV/AIDS, treatment of mothers infected with HIV/AIDS, and costs associated with linking those diagnosed with HIV/AIDS to care and treatment for HIV/AIDS.

(d) APPLICATION- A State that is eligible for the grant under subsection (a) shall submit an application to the Secretary, in such form, in such manner, and containing such information as the Secretary may require.

(e) LIMITATION ON AMOUNT OF GRANT- A grant under subsection (a) to a State for a fiscal year may not be made in an amount exceeding $10,000,000.

(f) RULE OF CONSTRUCTION- Nothing in this section shall be construed to pre-empt State laws regarding HIV/AIDS counseling and testing.

(g) DEFINITIONS- In this section:

(1) The term `voluntary opt-out testing' means HIV/AIDS testing--

(A) that is administered to an individual seeking other health care services; and

(B) in which--

(i) pre-test counseling is not required but the individual is informed that the individual will receive an HIV/AIDS test and the individual may opt out of such testing; and

(ii) for those individuals with a positive test result, post-test counseling (including referrals for care) is provided and confidentiality is protected.

(2) The term `universal testing of newborns' means HIV/AIDS testing that is administered within 48 hours of delivery to--

(A) all infants born in the State; or

(B) all infants born in the State whose mother's HIV/AIDS status is unknown at the time of delivery.

(h) AUTHORIZATION OF APPROPRIATIONS- Of the funds appropriated annually to the Centers for Disease Control and Prevention for HIV/AIDS prevention activities, $30,000,000 shall be made available for each of the fiscal years 2007 through 2011 for grants under subsection (a), of which $20,000,000 shall be made available for grants to States with the policies described in subsection (b)(1), and $10,000,000 shall be made available for grants to States with the policies described in subsection (b)(2). Funds provided under this section are available until expended.

[pinto]

2. I think the primary issue here is "informed consent".

It's a basis for HIV testing here in CA.

There is a mandate here that pregnant women be *offered* HIV testing, i.e. that the issue be addressed and the option of testing be presented.

The CDC wants to see HIV testing a *routine* part of pre natal care, i.e. that an antibody screen be a part of routine blood work with pregnant women.

CA law requires specific, separate consent for HIV testing, beyond routine consent for health care. This is true for all people seeing a health care provider.

In this instance it would seem that CA could meet the federal law's standard for pregnant women by offering an HIV consent form as an "opt out". If it remains unsigned, there is no HIV antibody screen included in the pre natal blood work. Seems a compromise that would meet both our State and the Federal standard.

There are important side issues - pre and post test counseling standards, risk assessment to help clients ascertain the need, if any, of an HIV test, and varying State and Federal approaches to testing and prevention overall. This has been an ongoing debate in the HIV care community for a while, and is nothing startling in the scheme of things.

The issue of mandatory testing of newborns is another matter. And is complicated in that newborns may not present an accurate test for up to 18 months after birth.

I see the law has separated the funds, so it's conceivable a State could qualify for the pre natal testing funds but not the newborn testing funds.

Raw Story is overstating the issue, somewhat, as a crisis. I don't think we're there yet. And we have a year to discuss this provision from the Federal level to the State level...

One important side note, *all* prevention funding has been scaled back. Local State funded programs have been given clear direction to target efforts with those most at risk to make the best use of available funds. And, in CA, State funding has been reallocated at the County level to more closely match known HIV incidence.

Money, health care policy and local implementation are often very different spheres, yet one depends on the other depends on the other...