"With 50,000 new HIV infections every year and a tough economic environment, the need to do more with existing resources is greater than ever."
"When you get this kind of funding emphasis on single service, the others start to fall by the wayside. Where the rubber hits the road is that small-incidence states still need to provide the same kind of services as high-incidence states."
Iowa is in a similar situation. The state will lose 55% of its government HIV funding by 2016, said Randy Mayer, chief of the Iowa Bureau of HIV, STD, and Hepatitis.
"We are getting out of the behavioral prevention business," he said in an interview. "We had 16 projects focusing on high-risk negative residents, and we won’t be doing that any more. This is a test, treat, and re-engage model, and it’s a very different way of doing things."
With the new testing-focused model, Iowa risks losing some of its ability to prevent new infections, he said. "We already struggle with late diagnoses, and I worry that this might now be exacerbated."
While some states must wrestle with shrinking programs, others will wrestle with expanding programs. Programs and money usually grow in tandem. States that get this quick cash boost will need time to ramp up programming. Jacquelyn Clymore, director of the North Carolina Department of Health’s Communicable Disease Branch, is face-to-face with this very issue.
"We are one of the fortunate states," she said in an interview. North Carolina, with about 25,000 HIV cases, realized a net increase of $626,000 through the redistribution program. "When you get this money, you also receive the burden of spending it wisely. You need an effective infrastructure, and you don’t put that together overnight. It takes time and community trust. It takes investing in getting trained, sensitive field workers. And you have to do all this right to make sure the money is reaching the people at highest risk with the most effective interventions, to get the best outcomes."
Although Ms. Clymore is thrilled with the "desperately needed" funding increase, she said low-incidence states could suffer the double hit of losing money and then seeing cases increase.
"We had that exact scenario with syphilis here," she said. "We had the highest syphilis rate in the country, and CDC poured money into an effort that brought it down radically. Then we lost that money and syphilis rates rose again. When you take your eye off the ball, it tends to bounce back up."
For more information on the program, visit http://www.cdc.gov/hiv/topics/funding/PS12-1201/.