GOP lawmaker wants to end HIV prevention funding

LANSING — A bill submitted by state Rep. Dave Agema (R-Grandville) that would eliminate state funding for HIV prevention and other important health initiatives, is raising alarms in the public health community.

Agema has proposed eliminating the Michigan Health Fund Initiative (MHFI) which is a special Michigan Department of Community Health fund created by law by diverting a small percentage of sales tax revenues into the fund.

“This is almost like double-dipping,” Agema told Michigan Messenger in a phone interview. He said the program funded by the MHFI was funded in other areas of the Michigan Department of Community Health budget.

The fund currently has about $9 million used to fund HIV prevention, testing and care programs in the state, as well as funding prevention programming for chronic disease such as heart disease and diabetes. In addition, the program funds sexually transmitted disease field support in tracking down patients, research into effective health promotion programming and laboratory services for the City of Detroit Health Department.

The funds are distributed to various county health departments, hospitals, churches and other private agencies, including the Michigan Public Health Institute.

Agema says he is recommending the shift of money to the Michigan Aeronautics Fund (MAF) because that will help pay for upkeep and expansion projects at Michigan airports. The fund would pay for runway upkeep, building upkeep and expansion of airports to accommodate more shipping and receiving into airports.

“This is so we don’t have to raise the fuel tax on our airplanes,” says Agema, a former airline pilot.

He said the federal government will give the state $9.50 for every one dollar it puts up for airports.

“There’s not a better job creator,” Agema said of the fund shift.

Agema also questions the spending of the fund, which shows $5,693,192.89 in administration costs. A spokesperson for the Michigan Department of Community Health was not available Friday to comment on the administration costs for the program.

Bill Anstey, deputy health officer at the Kent County Health Department, says the funds from the MHFI are used to pay the salaries of the employees of the health department who conduct HIV tests. Those people not only do the tests, but they provide essential risk reduction education and counseling about risk behaviors to clients which helps reduce the risk of infection, Anstey says. Those employees also assist those who test positive in notifying sexual and needle sharing partners that they have been exposed to HIV.

The elimination of the funding would lead to the elimination of the positions, making the free and confidential HIV testing conducted at the department less likely to happen. That, he says, could have a huge impact on the epidemic’s growth. The department performs about 3,300 free confidential or anonymous HIV tests a year, Anstey says.

“It makes it hard if people don’t know they have this disease, they will continue to engage in behavior and it will continue to be passed person to person,” Anstey says. “It is a concern anytime public health funds are reduced, whether its to fund airport maintenance or water system upgrades, anytime the county has a reduction in the money it receives it makes it more difficult to protect the public health.”

That kind of impact has those living with HIV raising the alarm.

“However, cutting the Michigan Health Initiative Fund is short-sighted. The only way to save lives, keep people healthy, and reduce new infections — thus keeping health care costs down — is to invest in the kinds of prevention work and research that the Michigan Health Initiative Fund makes possible,” says Laurel Sprague, who is with the Global Network of People Living with HIV, North America (GNP+NA) and a member of Michigan Positive Action Coalition.

“Unfortunately, as a nation we stopped investing in HIV prevention over the last decade, with a resulting increase in new infections, especially among our young people,” Sprague said. “Since people who do not know their HIV status are responsible for the majority of new infections, Michigan’s HIV counseling and testing programs are of critical importance in stopping new infections and getting those who are already infected into appropriate care programs. If anything, the responsible thing for lawmakers, and I hope Representative Agema will agree, would be to increase funding for Michigan’s counseling and testing programs.

Those running programs doing testing and care management are also worried about the Agema proposal.

“I am truly dismayed that Representative Agema has proposed eliminating the Michigan Health Fund Initiative to shift the funding to aeronautics,” said Helen Hicks, chief executive officer of the Michigan AIDS Coalition (MAC). “Evidently Representative Agema believes that a human life is so insignificant that he would rather channel the $9 million dollars that is currently being used to save lives toward repairing airports.”

With the state already reporting 14,371 cases of HIV in Michigan, the costs to the state for health care for this group are staggering.

A report released by the federal government in 2006 found that the lifetime cost of living with HIV was $618,900, over the course of an average life expectancy of 24.2 years. Those costs break down as follows: 73 percent of the cost is antiretroviral medications, 13 percent inpatient care, 9 percent outpatient care, and 5 percent other HIV-related medications and laboratory costs. Most people with HIV in Michigan qualify for Medicaid coverage or the AIDS Drug Assistance Program.

In short, if there are no new HIV infections in Michigan, the state will like spend nearly $8.9 billion over the live spans of the already infected and identified 14,371 HIV-positive people in the state.

“While I understand that difficult budget decisions will need to be made as we work to turn Michigan around, cutting programs that are in place to either serve our most vulnerable citizens or prevent the creation of disparities is neither a socially or economically responsible choice,” says Emily Dievendorf, policy director of Equality Michigan. “HIV, STI, and pregnancy prevention fall into an area of community health that is already grossly underfunded even while the need for such prevention programs fails to diminish.”

Nick Johnson, director of the state fiscal project for the Center on Budget and Policy Priorities questions the wisdom in shifting funding as Agema’s bill proposes.

“I do think from a budgetary perspective, it makes more sense for airport construction to be financed by airlines and air travelers than by HIV patients (or the state’s general fund, which I’m guessing was the source of the money in that fund). Presumably airlines and air travelers are the beneficiaries of those expenditures. It is very common for infrastructure projects to be financed by user fees or fee-like taxes, e.g. gasoline taxes to pay for roads,” Johnson said in an email to Michigan Messenger. “Incidentally, if the goal is to maximize federal dollars, Michigan should be maximizing the services it provides through the Medicaid program. That, too, brings in more federal dollars and thereby creates jobs – and it provides an important benefit (better health care) across a wide range of Michigan residents.”

Hicks, the MAC CEO, concurs with Johnson on the impacts of the proposed shift.

“While a cut in prevention dollars would have a significant impact on MAC’s budget, it would ultimately be most devastating to those we serve. There is no way you can put a value on a human life. Representative Agema is bargaining with human lives,” says Hicks. “He can’t have it both ways. He can’t out of one corner of his mouth preach that he values life when, out of the other corner he suggests taking lives – which is exactly what this bill will do. Perhaps the representative should search for another cut in another area of the budget where real people’s lives are not snuffed.”

A spokesperson from Gov. Rick Snyder’s office tells Michigan Messenger the Republican governor has not had a chance to review the specific language, thus cannot say whether or not he will support the proposal.

“It’s too early in the budget priority setting process to make a decision/determination and we haven’t yet seen any of the specifics in this bill,” says Geralyn Lasher, Snyder’s director of communications. “Preventing the spread of HIV and ensuring Michigan draws down its fair share of federal dollars are both important priorities for the State.”

“The idea of taking money away from helping people with HIV and giving it to airports is morally bankrupt and will kill people and end up costing all of us in the long run because of increased health care costs,” said David Holtz, executive director of Progress Michigan.