Schwarzenegger decimates AIDS services
Eliminates funding for viral-load testing'Beyond immoral,' 'Amazingly stupid,' 'Deadly'
by Rex Wockner
In an effort to balance California's budget, Gov. Arnold Schwarzenegger used line-item vetoes July 28 to chop more than $50 million in funding from the state Office of AIDS, including critical funding for HIV viral-load testing.
Schwarzenegger decimated AIDS services across the board, leaving full funding in place only for epidemic surveillance and for the drugs that suppress HIV.
Although the cuts curtailed state funding for HIV-related education (an 80% cut), prevention (80% cut), counseling (70% cut), testing (70%), primary medical care (50%), home care (50%) and housing (20%), one cut stood out in particular: the termination of all funding for the Office of AIDS' Therapeutic Monitoring Program.
For some 35,000 working- and middle-class Californians whose HIV care is paid for by the state, that program pays for viral-load testing and drug-resistance testing.
Viral-load testing is mandatory in HIV care, as it is the only way to determine if a particular HIV drug cocktail is working in a given patient. Drug-resistance testing comes into play when a drug cocktail that had been working stops working in a given patient. The two types of testing together guide a doctor in getting a patient on a new drug cocktail so the patient's viral load again becomes undetectable.
Patients whose viral load is undetectable are very unlikely to develop deadly HIV-related opportunistic infections, and they are dramatically less infectious than those whose virus is not suppressed. The Swiss government has said that an HIV-positive individual whose viral load has been undetectable for six months in a row is essentially unable to transmit HIV sexually.
"These were extraordinarily difficult cuts to make and they are cuts that will have consequences," said Al Lundeen, spokesman for the California Department of Public Health. "More people will become infected."
Office of AIDS Chief Michelle Roland, a doctor who treats HIV patients herself, said that state funding of the Therapeutic Monitoring Program made up only 50 percent of its funding, with the rest coming from the federal government, so not everyone will lose access to the two critical types of testing. She also expressed hope that counties would somehow be able to come up with some funding for the tests.
"We'll have half of the resources that we have now, so it's not quite as dire as no one will have access, but there will definitely be fewer services for people to access," Roland said in an interview.
She added: "A population that is less successfully virally suppressed is more likely to transmit. We may see an increase in the HIV rate as a result."
Roland also said the massive reduction in funding for ordinary HIV testing (to see if one has the virus) means "there will be fewer people who know their status," which also will increase HIV transmission.
In the final analysis, if some California HIV patients lose access to viral-load testing, they could get sick and die, despite receiving HIV drugs paid for by the state. And, in the interim, they would be much more infectious if, for example, a condom broke during sex.
Equality California called Schwarzenegger's elimination of monitoring testing "beyond immoral" and "amazingly stupid."
"To leave hundreds of million of dollars in reserve by cutting an entire program that no one will argue isn't saving lives is beyond absurd, immoral and unethical," Executive Director Geoff Kors said in an interview. "The governor needs to announce that he's going to free some money from his reserves to restore the $8 million needed to fund this program. To pay for people's medicine knowing that the medicine has to be monitored through testing to make sure it's working, and then to deny those same people the testing, makes one question if the governor and his staff really understood what they were doing or if they are just playing politics with people's lives to punish the Legislature for not giving him everything he wanted. It's amazingly stupid."
San Diego blogger Mike Tidmus, who has AIDS and frequently writes about HIV issues, said Schwarzenegger's move also doesn't make sense economically.
"If someone loses access to viral-load testing and their virus becomes active again, they're going to develop an opportunistic infection and end up in an emergency room or hospital bed, costing the state more money," Tidmus said in an interview.
The California Legislature's LGBT Caucus said it was "outraged by the governor's line-item vetoes to eliminate state funds that support critical HIV/AIDS-related programs."
"With the stroke of a pen, he has crippled the Office of AIDS, striking a totally devastating cut to a state-funded infrastructure that took more than two decades to build," the caucus said.
"Given that the governor has chosen to eliminate support for HIV/AIDS early intervention, treatment, education and prevention programs, we wonder how many new HIV infections the governor has projected for this year and next, and whether he really thought through the additional costs, in both fiscal and human terms, these cuts will have on people across this state."
Los Angeles' AIDS Healthcare Foundation, the U.S.' largest AIDS organization, said Schwarzenegger's "heartless act is not only deadly, but guaranteed to cost California taxpayers millions more in the future."
"With HIV testing programs sidelined and the state's ability to prevent new infections stymied, new infections in California will increase -- each new infection can mean up to $600,000 dollars in lifetime health care costs," said AHF President Michael Weinstein. "A 100% cut to the Therapeutic Monitoring Program is the definition of penny-wise and pound-foolish -- with the ability to monitor the effectiveness of lifesaving AIDS drugs hampered, the state's already cash-strapped AIDS Drug Assistance Program will only end up spending more for drugs."