How To Hollow Out A Public Health Success: The D.C. HIV Edition

Suppose from 2007 – 2014, the number of HIV/AIDS patients in your state dropped by seventy percent due to solutions such as needle exchange and making antivirals readily available and affordable for those who need them. Now imagine what happens when the lights get turned off on a incredible public health story because funders, both private and public, have ‘moved on.’ Well, you need not imagine, since it looks like D.C. will be part of a perverse experiment in what happens when a public health success is demolished (boldface mine):

And as D.C.’s HIV/AIDS administration has grappled with a per-capita HIV rate higher than parts of West Africa—as of 2013, 2.5 percent of District residents have the virus—it began to seem like HOPWA would never beget change.

But the last few years have seen startling breakthroughs: Mayor Muriel Bowser’s administration announced in June 2015 that, thanks in large part to robust diagnostic efforts and a needle exchange program, newly diagnosed cases of HIV had declined by almost 60 percent between 2007 and 2013. (Interim data from 2014 shows that percentage has grown to more than 70 percent.) In a huge coup for HOPWA, 74 percent of the program’s beneficiaries were virally suppressed, taking the antiretroviral drugs necessary to render HIV nearly impossible to transmit.

But that astonishing progress is, in some ways, a new kind of challenge for a city that relies so heavily on need-based federal grant programs.

Since 2012, the Washington region’s overall HOPWA budget has decreased by $3 million. Almost two-thirds of that, $1.7 million, was slashed from the District itself. A reduction in that grant has forced HAHSTA to “scale back some of [its] other programs, because of this reduction in the available funding,” Kharfen says.

Simultaneously, wealthy financiers and banking agencies—those once willing to host lavish fundraising events and bankroll innovative health programs—moved on from the cause and pulled the plug on funding; some optimists might argue that, given recent successes in managing transmission rates, charities felt they’d done their jobs.

Altogether, the slowed trickle of public and private funds out of the city has spurred concern among advocates and city officials alike. They worry that decreasing funds for HIV initiatives will sacrifice the progress that’s already been made, and that the cuts will take effect just as D.C. hits its stride in patient care.

“It’s an unfortunate reality, and that’s part of the story. HIV is no longer a new and exciting issue,” says Channing Wickham, executive director of the Washington AIDS Partnership. “And it’s frustrating because… D.C. is turning a corner in terms of its prevention efforts. So now is not the time to slow down or budge, but the resources are diminishing. And that’s the challenge.”

…. Worse yet, diminished public funds could threaten the success of the program that has been highly effective in reducing new HIV initiatives: needle exchange, which is responsible for reducing the number of new HIV transmissions via drug injections by 87 percent between 2007 and 2013.

Clay says HIPS alone has seen a 25- to 50-percent increase in the number of needles it has exchanged in the last year. But it’s received level funding—$180,000—for three consecutive years.

“This year, it’s gotten to the point where we’ve tried to absorb the cost of [the increase in needles], we’ve tried to absorb the cost, but we’re running out of needles. And that’s the least expensive part of the whole intervention. Time, space, people—that’s the expensive part,” Clay says.

She says that HIPS has requested additional funds from HAHSTA each year it reapplies for syringe exchange money; the cumulative $10,000 to $20,000 it requested would pay for more needles, to “shore up the program,” and to keep from operating at a loss. But the agency has given them level funding each year. Clay says that at HIPS’ current rate of exchange, the organization will run out of needles in July if it doesn’t limit exchanges or start turning people away.

“We’re victims of our own success, in a sense,” Clay says. “And if we don’t continue to invest money in this program, even in times where it’s not a crisis, we’re never going to meet the goal of the national HIV/AIDS strategy.”

This is typical of public health: huge fanfare–and funding–but once some success is achieved and the excitement (and panic) dies down, these programs are neglected. Someone–many someones–need to step up here and fund this stuff.

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