California Budget Cuts & Consequences for People With HIV

Governor Brown calls his newly released budget proposal "a tough plan for tough times." In fact, it's worth noting that our new Governor is tasked with digging out of the largest financial deficit in the history of our state. That's no small task. We acknowledge these are difficult times for California and the entire nation, and that the road ahead is not easy. But we urge the governor and all legislators to re-examine proposed cuts to programs that are essential to Californians living with or at risk for HIV.

Among the programs targeted for cuts is the AIDS Drug Assistance Program, or ADAP, which provides life-saving medications to more than 37,000 low-income, uninsured, and underinsured Californians living with HIV/AIDS. Since its inception, ADAP has been the cornerstone of our state's HIV/AIDS prevention efforts. The governor's plan would impose cost-sharing on HIV-positive participants in ADAP with incomes over 100% of the federal poverty limit, or about $11,000 per year. Requiring co-payments to receive life-saving HIV medications will have devastating short and long-term consequences for HIV/AIDS prevention and care in California.

Ultimately, the proposed ADAP cuts will result in many HIV-positive people dropping out of the program altogether, in effect denying them the very medication they need to stay healthy. Generating savings for California by creating a system that denies medication to the most vulnerable among us is unjust, and certainly not the most effective way to deal with tough economic times. Balancing a budget on the backs of people with HIV/AIDS has always been bad policy, and it remains bad policy today.

And what happens down the road? Most HIV-positive Californians forced out of the program will inevitably reenter the health care system elsewhere. At that time, they will be less healthy from lack of medication that keeps their virus in check, and their health care needs will have increased. Evidence shows untreated HIV virus leads to higher rates of transmission and more HIV cases. By implementing cost-sharing in ADAP, we will be losing people we've worked very hard to get into the program. We would be taking a step backward in our states efforts to fight HIV/AIDS, while at the same time jeopardizing the health of people who need assistance the most.

The governor's budget also proposes cuts to Medi-Cal, including limiting coverage of services and medications and decreasing provider rates. This would destabilize the program at the very time when it should be preparing for an expansion with the implementation of the federal Affordable Care Act in 2014. This proposal is short-sighted. The whole point of national healthcare reform was to remove barriers that obstruct Americans' access to the healthcare system. Instead, this proposal suggests we fortify and expand the very barriers we purported to want to remove.

For a state in total fiscal crisis, there are no easy answers. But there are likely better answers when it comes to containing costs in our state AIDS programs. We must work collaboratively with state public officials and explore alternative solutions to ensure that the burden of these cuts don't fall on people without the political power to fight them. As the legislature holds budget hearings in the coming weeks and months, San Francisco AIDS Foundation will play a leadership role in voicing the concerns of our clients and HIV-positive people throughout California to ensure everyone has access to proper care and treatment. We're looking forward to an ongoing dialogue and active collaboration with the Brown Administration and legislators.

More than 160,000 Californians currently live with HIV or AIDS, and another 7,000 are newly infected each year. In 2010 we saw significant progress in the fight against a 30-year old foe, including a new national strategy to fight HIV/AIDS within our borders, and exciting breakthroughs in HIV prevention. Indeed the year was a sea change in our efforts to end HIV/AIDS. However, we will never fully realize this potential moving forward if the poorest in our state do not get the critical medications they need to stay healthy and protect others. Now is not the time to stop the momentum.

Courtney Mulhern-Pearson is the Director of State & Local Affairs at San Francisco AIDS Foundation.