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Mass. services for HIV face cuts

Agencies fear rise in infections as US shifts funding

SERVICES IN JEOPARDY Rebecca Haag said the cuts will probably force AIDS Action to shut down its hot line, which it has operated for 25 years. SERVICES IN JEOPARDY
Rebecca Haag said the cuts will probably force AIDS Action to shut down its hot line, which it has operated for 25 years.
By Kay Lazar
Globe Staff / August 15, 2011

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Deep cuts in federal funding will force Massachusetts to immediately slash or eliminate many key HIV and AIDS prevention services, programs that were central to driving down the infection rates in the state by more than 50 percent over the past decade, according to a top Patrick administration official.

The state Department of Public Health began notifying a network of community health agencies on Friday about the $4.3 million reduction, which is roughly one-quarter of the state’s annual AIDS prevention budget.

Services that will be cut back include distribution of free condoms to schools, colleges, and health facilities, and programs that give intravenous drug users clean needles, said Kevin Cranston, director of the state Bureau of Infectious Disease.

A program that sends education counselors to night clubs and other areas frequented by gay men, a population that has historically had the highest infection rates, will be eliminated. Billboards, radio, and other media ads promoting HIV testing and prevention programs will be scrapped. So, too, will be training for community case managers who work directly with AIDS patients.

Fueling the cuts is a dramatic shift in the way the federal Centers for Disease Control and Prevention will be funding state AIDS prevention programs.

The CDC is taking money from states like Massachusetts with lower rates of HIV infection to focus its resources in states, including many in the South, with high or increasing rates. New regulations will also significantly restrict the way Massachusetts can spend its federal HIV prevention dollars, a change that will compound the cuts. It will require the state to shift money from community-based programs that aim to prevent further infections to clinic-based HIV testing and programs targeted to people who are already infected.

We are “ensuring that money actually follows the epidemic,’’ Dr. Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said during a recent press conference.

“As we move forward in these challenging economic times . . . we have to maximize the availability of every dollar,’’ he said.

But Cranston, who has led Massachusetts’s AIDS prevention initiatives for most of the past decade, said he is worried the new federal strategy will backfire by weakening efforts to prevent new infections in high-risk populations.

“Well-trained staff in the field, good information, as well as direct services for HIV-negative and positive people, together, have given us the success this past decade,’’ Cranston said. “I would hate to see a resurgence of HIV in Massachusetts after being so successful this decade.’’

A decade ago, Massachusetts was seeing about 1,000 new HIV cases a year, and that has dropped below 500, Cranston said. Nationally, however, new cases have held steady over that time, and increased among some populations, including gay black men.

The federal cut represents half the federal AIDS prevention money now coming to the state. It is being phased in over five years, but the biggest single reduction - $2.3 million - is required to be completed by January, and the state is beginning immediately by slicing $1 million from contracts with community agencies, Cranston said.

Among those cut are some of the state’s most visible and active AIDS prevention organizations, including Fenway Health and the AIDS Action Committee of Massachusetts.

Rebecca Haag, AIDS Action’s president and chief executive, said the cuts will probably mean the organization will have to shut down its hot line, which it has operated for 25 years.

“We are the sole HIV hot line for the state,’’ she said. “And we actually picked up coverage for Rhode Island when the government chose to not fund its hot line. We can no longer fund two statewide hot lines without any support.’’

Haag, who was briefed by state officials on Friday, said the agency is still trying to sort out precisely which services it will need to cut or scale back.

Fenway Health will be losing about 20 percent of its AIDS prevention funding - which comes as the agency is pioneering research in preventing infection.

Fenway was one of two sites in the United States that recently showed that giving people who are at risk of infection one daily tablet of widely used HIV medications substantially reduced infection rates. The study was published last year in the New England Journal of Medicine.

“There is no question in my mind that these cuts will have an effect on our ability to cut infection rates,’’ said Dr. Stephen Boswell, president and chief executive at Fenway Health and assistant professor of medicine at Harvard Medical School.

At Tapestry Health, which serves much of Western Massachusetts from Springfield to North Adams, president and founder Leslie Laurie said her agency will probably have to ration many of its core services, including its needle exchange program for IV drug users.

The agency also runs a mobile van, which travels to county fairs and community centers in the rural region offering rapid HIV testing that can give results within 20 minutes.

The agency provides services to some of the state’s most hard-hit communities with HIV infections, including Springfield and Holyoke. Laurie said the cuts will probably mean significant delays for more than 100 patients whom the agency helps with getting stable housing, medical care, and health insurance.

“Massachusetts is one of the few states where HIV infection actually went down, so the penalty was to have the support for continuing this both life-saving and cost-saving [services] to get cut,’’ Laurie said.

Kay Lazar can be reached at klazar@globe.com.