Oakland battles AIDS gap among blacks with less funds (AEGiS.org) - Oakland battles AIDS gap among blacks with less funds
Bay Area Reporter - December 31, 2009 Seth Hemmelgarn, s.hemmelgarn@ebar.com
http://www.aegis.org/news/bar/2009/BR091208.html 

With huge HIV/AIDS funding cuts and a continuing prevalence of the disease among African Americans, Oakland continues to battle HIV/AIDS as officials worry the disease could spread.
In 2007-08, the budget for education and prevention in Alameda County was $1.5 million. That included money from the state general fund.
Now, the general fund money is gone, leaving $661,000, which comes primarily from Ryan White Part B funds ? federal money that's distributed by the state. That funding is only for education, prevention, counseling, and testing, according to Kabir Hypolite, director for Alameda County's Office of AIDS Administration.
The county's budget allocation from the state AIDS office for care and treatment services this year is $1,190,000, according to Hypolite.
He said the cost of providing care for someone with AIDS can be as much as 10 times as providing HIV care.
At the state policy level, "We are, in essence, gambling now with thousands of people's lives, and we may wind up paying a far, far greater price in the very near future if we don't restore these cuts," he said.
In a statement provided to the Bay Area Reporter by a state health department spokesman, Dr. Michelle Roland, chief of the state Office of AIDS, said, "Fortunately, California still receives federal funding for prevention and care activities, the two areas that experienced significant reductions in state funding this fiscal year. ... These state budget reductions to HIV/AIDS related funding reflect the unprecedented fiscal challenges the state is facing."
In her statement, Roland pointed to program guidance documents that "aim to maximize the local availability and effective use of these federal resources."
Disparity
As of mid-year 2008, non-Hispanic blacks made up 12.2 percent of Alameda County's population, but they represented 44.6 percent of the cumulative HIV/AIDS cases as of the end of that year, according to data from Barbara Green-Ajufo, director of the county's HIV/AIDS epidemiology surveillance program.
She said that most of the cases occur in Oakland, which she called the "epicenter."
Her data also showed that Hispanics/Latinos were 22.6 percent of the Alameda County population in mid-year 2008 and represented 11.6 percent of HIV/AIDS cases as of the end of 2008. For non-Hispanic Asians and Pacific Islanders, those numbers were 24.4 percent and 3.4 percent, respectively.
Green-Ajufo's data are accompanied by caveats that include explanations about delayed reporting and surveillance data only representing cases that have been diagnosed, identified, and reported.
Hypolite said that in communities such as Asian and Pacific Islanders, "The total numbers today might be small but the rates are high, and our ability to actually do education, outreach, prevention, planning, care, and treatment services are threatened by those cuts."
Late testers are another cause of concern. Late testers are cases that progressed to AIDS within a year of their HIV diagnosis. Fifty-seven percent of late testers were simultaneously diagnosed with HIV/AIDS.
Get Screened Oakland is a public health initiative of Mayor Ron Dellums that started in 2007. The city has been encouraging people to know their status.
Marsha Martin, Get Screened Oakland's director, said the concern in Oakland, regardless of rates among different demographic groups, is "people are showing up late, and that means we are missing people and our messages aren't reaching people."
Changes
Hypolite said that out of the $661,000, the county's entered into nine contracts for testing and counseling activities. Last year, the county had 13 such contracts.
As far as care and treatment, Alameda County has combined programs that it typically wouldn't have been responsible for in the past, he said.
Historically, the state had funded early intervention programs through local, community-based organizations, and the county monitored the money. Now, those programs have been terminated, he said.
Some of the programmatic activities continue, in addition to a Ryan White-funded services program, which had been funded separately.
That leaves the county with an HIV care program that combines several programmatic elements, but overall there is a 64 percent cut in funding from the state for care and treatment services, said Hypolite.
In terms of counseling and testing, Martin said the funding troubles have already started to have an effect.
The city doesn't offer testing itself. Instead, it subcontracts and partners with the existing AIDS service organizations. Many counseling and testing agencies have reduced staff and hours, and more narrowly defined their program target areas, she said.
"The resources for supporting outreach and education have gone away," said Martin, so Get Screened Oakland has applied for funds to help offset some of the loss.
She said the program wants to provide more support through condom distribution. The organization they depend on for condoms is running out and can't afford to reorder them, so she and others want to create a citywide condom distribution program, with the help of corporate business partners.
Factors
Various factors are given as possible reasons for the disparity between African Americans and other groups. Among them is a lack of funding to address the problem, complacency brought on by antiretroviral drugs prolonging life for many people, and whether prevention messages have been targeted and culturally appropriate.
Green-Ajufo said there's been an attempt to address factors such as structural racism, housing, and education.
"If you're in a community where resources have been low or non-existent for a long time, or quality education has been an issue for a long time, it just becomes the way things are," she said. "... The higher your education, the healthier you're going to be."
Jesse Brooks has lived in Oakland since 1968 and was diagnosed with AIDS in 1993. Brooks, who's African American, said, "I would love to talk to [President] Obama about a federal state of emergency in the black community," because Oakland "is just one and a mirror of numerous cities across our nation [where] African Americans are being affected disproportionately."
He added, "I feel like no one's really paying attention."
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