Bush’s
proposed budget falls short in meeting needs of HIVers

President Bush's proposed $2.77 trillion budget proposal is a mixed bag for HIV-positive Americans, say AIDS and health groups. The budget, unveiled Monday, seeks to reduce most government-funded programs to deal with lingering budget deficits. Almost one third of the 141 federal programs that will be cut are in education, but many health programs are also targeted. Defense spending gets a big boost in the budget.

"My administration has focused the nation's resources on our highest priority--protecting our citizens and our homeland," Bush said in his budget message.

The San Francisco AIDS Foundation says that while Bush's budget proposal does aim to increase access to antiretroviral medications through additional funding to state-run AIDS Drug Assistance Programs, boost HIV testing efforts, and reverse recent cuts in funding for AIDS housing, it still is problematic for HIVers.

According to SFAF, other than a proposed $70 million increase in funding to help eliminate ADAP waiting lists in some states, Bush's budget proposal funds virtually all other AIDS programs supported through the Ryan White CARE Act at 2005 levels, which were reduced from 2004 levels as part of a 1% across-the-board spending cut enacted by Congress.

Bush's proposed budget does include a $14 million funding increase for the Housing Opportunities for People With AIDS program to a total of $300 million, and it includes funding to help provide rapid HIV antibody testing to an additional 3 million Americans.

But it also proposes additional cutbacks to Medicaid, which is the single largest payer of AIDS care in the country. This comes on the heels of the successful passage of a congressional budget resolution that already cuts federal Medicaid funding by $4.8 billion over the next five years. The budget also includes a $15 million funding cut for AIDS research at the National Institutes of Health. At the same time, abstinence-only sex education spending is slated for a $28 million funding increase, to $191 million.

"While the president's targeted funding initiatives are welcomed, they are insufficient given the more than 1 million Americans living with HIV/AIDS today," says Mark Cloutier, SFAF executive director, in a press statement. "The flat or reduced funding levels provided over the last five years for the Ryan White CARE Act combined with both rising caseloads and medical inflation have resulted in reduced access to care throughout the country. This budget does not make up for those significant shortfalls."

The American Public Health Association, the nation's oldest organization of public health professionals, also slammed Bush's budget proposal, saying it will put the health of millions of Americans at risk. The budget "calls for devastating funding cuts in health programs and, in some cases, eliminates programs entirely, such as the Preventive Health Services Block Grant at the Centers for Disease Control and Prevention that enables states to implement innovative health-promoting initiatives and creates a response mechanism to address health emergencies, such as West Nile virus and natural disasters," APHA says in a statement. "Under the president's plan, the CDC's budget would lose 2.1% in 2006 appropriations to fall to $5.8 billion, and the Health Resources and Services Administration's budget would be cut 4.8% to $6.31 billion."

"This Administration has emphasized the importance of protecting our nation's citizens but, ironically, has put the well-being of millions at risk with cuts to programs designed to improve health and save lives," says Georges C. Benjamin, APHA executive director, in a press statement. "While controlling federal spending is critical, it is also imperative that our nation's government do whatever it can to protect the public's health. Shortsighted and short-term savings will lead to greater health and medical expenditures in the long term."

AIDS Project Los Angeles welcomes Bush's pledge for additional ADAP, HIV testing, and HOPWA funds but says the overall increase only helps to offset several years of funding cuts and includes no new real contributions. "The number of people living with AIDS has gone up by 12% since 2001, while funding to the Ryan White CARE Act has been cut by nearly 2.5%," says APLA executive director Craig E. Thompson in a press statement. "When you factor in the ever-rising costs of health care and HIV/AIDS drugs, you understand why programs serving people living with HIV/AIDS are feeling the squeeze."

The HIV Medicine Association says that while it applauds Bush's commitment to HIV antibody testing and treatment, "we are concerned that even with the modest increases proposed for the Ryan White program--an important source of federal funding for HIV care--we will not have adequate capacity to provide medical care and treatment to those newly identified." HIVMA also opposes any further cuts to Medicaid or Medicare, which the organization says in a press statement are vital in protecting the health of low-income Americans, including those who are HIV-positive.

The National Association of People With AIDS also worries that Bush's budget places too much emphasis on HIV testing and treatment. "HIV testing alone is not a substitute for a comprehensive, scientifically based national prevention strategy," says NAPWA executive director Terje Anderson in a press statement. "And you can't get into care when you test positive if the test counselor cannot link you to an HIV specialist. You can't take your medicine if you can't see a provider, and you can't see a provider if you can't get transportation to the office. The Ryan White CARE Act must be fully funded to support comprehensive care and treatment. Nothing less will get the job done." (Advocate.com)