Ambitious goals of Obama’s HIV plan raise budget concerns

LANSING — While an ambitious national plan to reduce new HIV infections by 25 percent by 2015 has generally garnered praise, advocates and lawmakers say the increased testing and access to anti-retroviral medications come at a high price tag at a time when states can least afford it.

That is a problem for Michigan, which faces over $1 billion in deficits for the second year in a row and a legislature that (so far) refuses to raise any new revenues. That reality, advocates say, underscores the need for more federal funding.

“A prevention strategy based on test and treat with no additional funding support for testing or treatment isn’t a national strategy,” says Mark Peterson of the Michigan Positive Action Coalition. “It is a cruel statement to make in the face of growing numbers of cases and growing ADAP waiting lists.”

ADAP is an acronym for the AIDS Drug Assistance Program. That program is funded with federal money out of the Ryan White Fund, and provides subsidies and the purchase of the anti-retroviral medications needed to battle HIV infection. The program in Michigan costs just under $26 million, funding medications for nearly 3,000 people with an average annual cost of $11,000 a year per patient.

The medications are a key weapon in the fight against HIV, according to the report from the Office of National AIDS Policy. Recent studies have found that reduction in viral load — the measure of virus in the blood — results in a corresponding reduction in the infectiousness of those living with HIV. Studies have also found that the sooner a person infected with the virus starts treatment, the better their long term outcome is.

As a result, in December the Centers for Disease Control and Prevention announced a change in guidelines for when Americans should start medications. The government now says people infected with HIV should start medications before their CD4 count — the blood cell the virus hijacks in order to replicate itself and key component of the immune system — drops below 500. The average CD4 count for a healthy person is between 800 and 1200.

That information, combined with the viral load studies, have resulted in the development of a controversial new HIV fighting strategy called test and treat. The program is being piloted in Washington DC and Brooklyn, NY. Under this strategy, which is supported in the National HIV/AIDS Strategy, those who test positive for the virus are encouraged to enter into viral treatment as soon as possible.

The plan is considered controversial because the medications have serious side effects, with many activists calling it chemotherapy. Many people with HIV do not have the requisite medical literacy to make an informed decision about taking the medications, activists like Sean Strub, who is founding publisher of POZ magazine, have said.

But Debra Szwedja, acting director of the MDCH’s Division of Health, Wellness and Disease Control, says increased access to medications is about improving the quality and quantity of life for those infected with HIV.

She called the reduced viral load, and the subsequent decrease in infectiousness “a welcome side effect.”

Studies have shown that those who know their HIV status are less likely to spread the infection, according to the plan. That means those who do not know their status but are infected are more likely to be infecting others.

In Michigan, health officials say the state conducts between 70,000 and 80,000 HIV tests are year — less than one percent of the state’s population. Officials say that another three or four percent of the state is tested through private medical facilities, such as doctor’s offices, hospitals and clinics. In response to a Freedom of Information Act request earlier this year, however, the state could not verify those numbers.

Michigan Department of Community Health records show there are about 14,000 Michigan residents who know they are infected with HIV, and the state adds an additional 25 percent to this number to estimate there are 18,000 cases of the virus in Michigan. This additional cases are an estimate based on a complicated formula developed by the CDC.

But the increase in testing and putting people on medications may be an academic controversy given Michigan’s difficult budget crisis.

“Certainly additional resources would help us achieve those goals,” says Szwedja.

Lawmakers, however, aren’t sure where that money will come from. The state is already facing a massive budget deficit and haggling over Medicaid extensions in Washington could result in the state losing an additional $500 million.

Rep. Mark Meadows (D-East Lansing), chair of the House Judiciary, says increasing funding is essential to fighting HIV.

“We need to put our resources in public health,” he said. He took the Bush administration to task for spending billions on the African AIDS crisis, while ignoring the problem at home. As a result, Meadows said, HIV “fell off the radar” in the U.S.

“An unchecked crisis in HIV will result in more money being forward for care, such as end of life care, which is much more expensive,” said Meadows. “When you put money into prevention, it pays off. You spend less money in the long run.”

But House Speaker Andy Dillon (D-Redford Township) says he is uncertain where that funding will come from. He said the House is constantly looking at priorities and how to fund them with dwindling state resources.

“It’s our life with the budget,” says Dillon, who is a Democratic candidate for Governor.

Other House Democrats echoed Dillon and Meadows in their concerns about the financial impact of pursing the goals laid out by Obama’s HIV plan, while facing a state budget crunch, again.

And State Sen. Tom George (R-Texas Township) shares those budget concerns.

“This is a big question with the other health insurance reform measures — who’s going to pay and can the state’s afford it?” says George, who is a Republican candidate for governor.

He says there are benefits to increased testing and access to medications, and says an argument might be made that it makes economic sense to put the money out front now for medications and increased testing rather than wait for more people to become infected with the virus.

However, George says, “The state’s broke. Do I favor more funding? Yeah. I also favor winning the lottery, but it ain’t going to happen.”