National Minority AIDS Council Building Healthier Communities

September 23, 2009

California Update

Things are tough in California right now.  Below are two reports I wrote based on some initial calls and visits with constituents in California.  I will visit Southern California next week, but thought it would be important to highlight some of the strategies that NMAC and others are considering as we look to support California.

• Conference Call

• FAPP Update

• USCA Host Committee Meeting

• Other Options

October Stakeholder Conference Call

 Our October call will be on “State Budget Cuts:  Is California Our Future?”.  Please join us on Tuesday, Oct. 20th at 1:00 p.m. (Eastern)/10:00 a.m. (Pacific).  The call in number is 1-605-475-6333; code: 481162. You may e-mail your questions to info@nmac.org or send them through Twitter: twitter.com/NMACCommunity or twitter.com/Cressycat.

We hope to be joined by Anne Donnelly, from Project Inform;  Julie Cross, a Health and Disability Policy Consultant; and a representative from the National Alliance of State and Territorial AIDS Directors (NASTAD) who has done a summary of all 50 states and their HIV/AIDS state budgets.

FAPP Update

At the next Federal AIDS Policy Partnership (FAPP) meeting on Thursday, Oct. 8th one of the critical discussion points will be state budget cuts. Bill Smith from SIECUS and a representative from NASTAD will lead a strategic discussion on “What to do about states budget cuts?”  We will strategize on whether there is anything to be done at the Federal Level.  We will showcase 3 or 4 states. Also the role of health care reform vs. state budget cuts.

2009 USCA Host Committee Meeting

The 2009 United States Conference on AIDS (USCA) host committee will have a meeting on the California Budget cuts on Thursday, October 29th in  San Francisco.  We hope you can attend this critical discussion on the impact of the cuts on services and prevention in California. They will be joined by a variety of leaders including Michelle Roland from the State Office of AIDS.  

Other Options
NMAC is looking at a variety of options on how we can support our constituents in California.  If you have any thoughts or recommendations, please email me pkawata@nmac.org  

Management By Walking Around

California Update II
August 24, 2009 ~ Every year the National Minority AIDS Council’s (NMAC) sends out senior staff for “Management By Walking Around” meetings with constituents, community based organizations (CBOs). We document the state of our movement and/or look for trends that are impacting CBOs.  This year I visited California the week they announced a $53 million cut to their HIV/AIDS programs.  On August 3-6 I visited with county health departments (HDs), community based organizations (CBOs) and hospitals in the following Northern California counties:  Alameda, Contra-Costa, Napa, Solano, Sacramento, San Francisco, and Santa Cruz.   Our intention is to document the impact of these state cuts on our constituents.  At the end of this report is my first report written on Aug. 2nd.

During the week of Aug. 10th, counties got their final numbers.  For those HDs who still get AIDS funding, reductions were between 33% and 66%.  Alameda County/Oakland got a 51% cut.  Alameda let their CBOs know how much they will reduce their contracts the week of August 17th.  In private discussions with CBOs in Alameda, we’ve heard the cuts were around 50% of their county funds.  Since CBOs just found out about these cuts, our follow-up report will look at how they will modify their budgets, let go of staff, merge and/or close their doors.  

San Francisco has given itself until Oct. 15th to determine the final cuts for specific CBOs, but they let CBOs know they will back-fill their funding until that date, but cuts will commence on the 15th.  I am waiting to hear back from other counties.  To say this is devastating would minimize the problem.  

None of the HDs I visited have funds to permanently back-fill any of the state cuts.  These counties are also dealing with non-HIV/AIDS programs cuts that will remove 80,000 kids off the "Healthy Families" health insurance, eliminate funding for domestic violence programs, eliminate all adult dental services from Medicaid, among other cuts.  Basically, these cuts have undermined the entire security net of social services for poor people.

Some of our constituents will not survive, and those that survive this year still have an unknown future. Next year, the California budget will have to address an additional $25 million short-fall in their ADAPT program.  This year’s reduction comes on top of a $30 million cut in the 2008-2009 budget.  Over a two year period, the State Office of AIDS has been cut by $82 million.  Yet in San Francisco alone they add 900 new clients each year.  

One of the counties I visited 4 years ago had 8 HIV specific agencies. Last year, it was 5, now it’s 0.  For CBOs to survive, they must show outcomes.  The movement is away from Identity Politics to Measured Outcomes.  Many of the individuals interviewed said the next two years look very grim.  Ultimately, they believe California will see an increase mortality rate for people with AIDS.

Without funding, many counties will not be able to support their most vulnerable citizens.  They cannot even meet basic needs, such as blankets and coats for this winter.  Some counties hope to use volunteers to run programs such as testing and counseling. Yet even if they are successful at getting volunteers, they do not have funds to purchase rapid test kits.  Some CBOs are looking at merging and/or greater collaboration.  Most are just waiting to see where the other shoe will fall.  

I met with individuals who worked in HIV/AIDS for 10 to 20 years.  For them, this is not a career: this is their passion.  As difficult as it is to be terminated, it also feels difficult for those who stay.  Not only are they losing their colleagues, but they also have to provide services with significantly fewer staff. They continue to fear that next year’s California budget cuts could mean the end of their program and/or agency.  

Those that get riffed first tend to be the last hired.  Often that is the bilingual staff.  Without bilingual staff, the county’s ability to reach Latinos is severely compromised.  Given the large monolingual Spanish speakers in some of these counties, I have real concerns about both the impact on HIV prevention programs and the ability to provide services to monolingual clients.  

Home care services for people with AIDS were also eliminated.  Now their only option is to move clients into nursing homes, if accepted.  As one of the case managers told me, “Most of my clients who need home care services will not go to nursing homes. Instead, they will become homeless on the street.”  Needless to say, living on the streets will increase the difficulty in taking medications, decrease making health choices on condom use, and could effect life expectancy.  

I will visit Southern California the week of September 28th to document their issues.  I thought it might be helpful to read comments from other California activists.  

From Hilary McQuie, The Harm Reduction Coalition
None of the syringe exchange programs that previously received any California state funding either directly or via their counties will now be able to access any money at all since the remaining for prevention are from the Centers for Disease Control and Prevention (CDC) and the federal ban is still in place. This is quite devastating to us.

From Walt Senterfit
Some other less well known projects that blend care-prevention are wiped out unless alternative funding can be found, such as the Bridge Project and the Prevention for Positives (a kind of time-limited, intensive prevention case management/counseling) projects associated with the state-funded Early Intervention Program clinics (that tend to serve key, but somewhat out-of-the-way locations like Oakland, south Los Angeles, and Long Beach) also will have to close unless costs can be shifted to RWCA or County/City direct funds.  

There are other hits from not only the governor's line item vetoes; but his and the legislature's earlier cuts that are just as or more devastating to the health and welfare of vulnerable people in the state than the HIV-specific cuts are, such as lopping 80,000 kids off the SCHIP-type "Healthy Families" health insurance, eliminating funding for domestic violence treatment and prevention, eliminating all adult dental services from Medicaid, etc.  I am distressed that the HIV community's response seemed to almost entirely continue the silo-type organizing that has kept progressive forces separated, of fighting just for ourselves and our programs, without seeking and finding ways to build new coalitions and struggle strategies, and to realize that others are hit just as hard or even harder, and that a "just find some way to save MY/OUR programs, I am not concerned with how you do it or where the money comes from" message to the governor and the legislators is not really ethical, or in the long run smart or sufficient or effective.

I wonder if Californians are ready to be the Mississippi of care and social services.  This is not to speak bad of Mississippi, only to point out that like Mississippi, Californians will now rely mainly on federal funds to support their programs.  All of the things that made California a leader will now be reduced to a Mississippi level of services.  The years it took to build this infrastructure will be decimated within six months.

California: An Outsiders Perspective
August 2nd, 2009 ~ I am writing to update you on the imminent disaster coming to the California HIV/AIDS Budget.  The state legislature just passed a budget with a $1.1 billion gap.  In order to balance the budget, the Governor cut $52 million out of HIV/AIDS programs.  The only HIV/AIDS line items to not get significant cuts were the ADAP and the epidemiology/surveillance division.  

 

These cuts are devastating to NMAC’s constituency.  The state’s 2008-9 HIV prevention budget was $31 million, after the cut only the federal dollars remain, around $6.4 million.  The $24.6 million reduction will force cuts to counties and community based organizations (CBOs).  Our constituents will have to lay off staff and cut services, ultimately people with AIDS will suffer.  To make matters worse, the state budget began July 1, 2009.  It is not clear if counties will have to pay back the money they have already expended.  

 

Prevention is not the only program to receive significant cuts. Also on the chopping block are counseling and testing ($8 million cut), early intervention ($7.4 million cut), housing ($1 million cut), and home and community-based care ($6 million cut).  The entire therapeutic monitoring program was cut out of the budget ($8 million).

 

So I am off to meet with constituents to document their losses, to meet with county health officials to advocate for CBOs and to meet with the State Office of AIDS to see if we can help.  Thousands of people will lose their jobs, some agencies may close their doors, and PWAs across the state will hurt.  A $1 million cut to housing mean beds will not available.  Studies show that without housing, some PWAs stop taking their meds, as a result, some die.  

 

At this time, USCA is the least of our constituents concerns.  We will figure out how to address this issue at USCA; however, right now we need to focus on community.

 

Like Katrina before this, NMAC needs to be there for our constituents in California.  In some ways, this is an economic Katrina for the state.  Unfortunately, in order to balance the $1.1 billion gap, HIV/AIDS programs were not the only ones to receive significant cuts.  The cuts have devastated the entire social service and education safety net of the state.

 

While our constituents are trying to raise nongovernmental funds to back fill their funding, so are a variety of other critical issues.  I don’t see how foundations, corporations and individuals will be able to make up this gap.  

 

Every California activist I talked with had no solution to the problem, short of raising taxes. Unfortunately, due to previous California ballot initiatives, it takes 2/3 of the legislature to raise taxes. Twelve Republican members have signed an oath saying they will never raise taxes. The entire state is being held captive by these twelve individuals; thousands will suffer as a result.  

 

I will be in Northern California this week.  I hope to visit Southern California in September.  I am not sure if we can do anything, but we will try.  As with our Katrina Initiative and our work in Puerto Rico, NMAC will be there.  Not as a white knight, more as a worker bee.  We want to be part of their solution.

They don’t need us to figure it out, if there is a solution they are perfectly capable of figuring it out themselves.  Our constituents need to know that someone in Washington cares about their plight and will fight  for them in D.C. 

Yours in the struggle,

 

Paul Kawata

 

Executive Director

National Minority AIDS Council