HEALTH-USA: Budget Cuts May Stall Fight Against AIDS

By Farhan Haq Reprint | | Print |

NEW YORK, Nov 29 1995 (IPS) - AIDS remains a major health to millions of Americans and government programmes to fight the spread of the disease may be hit by cuts in funding by the rightwing, budget- conscious U.S. Congress, health experts fear.

Many groups dealing with the problem of the acquired immune deficiency syndrome say that, after some 15 years of public awareness of the AIDS epidemic, popular concern over the crisis has waned. As a result people with AIDS or the human immunodeficiency virus (HIV) are more vulnerable than ever.

“There is a fatigue from people who are hearing, after 15 years, that people are dying,” says Keith Cylar, co-executive director of Housing Works, a New York-based group that provides housing support for people with AIDS. “Now when some people hear that, their reaction is, ‘So what’?”

At a time when Congressional budget-cutting is putting federal medical aid for the poor on the table, that mood is ominous.

The two major national health care programmes, Medicaid and Medicare, are on the chopping block, targeted for cuts of 270 billion dollars and 182 billion dollars, respectively, over seven years.

Although President Bill Clinton has warned Congress not to allow those cuts to fall heavily on the elderly or on children, many activists contend that people with AIDS may still be a major target in budget reductions.

“We are extremely concerned,” says Steven Soba, a spokesman for the lobbying group, Gay Men’s Health Crisis (GMHC). “The cuts would radically affect the lives of people with HIV.”

GMHC contends that, in its effort to preserve programmes supported by politically powerful groups – especially elderly and retired people – the Congress is more likely to limits funds for already-expensive AIDS research and prevention programmes.

In an environment where many different groups are scrambling to maintain their level of federal funds, people with AIDS – disproportionately belonging to poor or minority groups – may get the short end of the stick, Cylar argues.

“The decision has been made to cut programmes that are politically expedient,” says Cylar. Since new AIDS cases fall most heavily on lower-class, black or Hispanic populations, AIDS victims are already politically at a disadvantage in the battle for funding.

There have been 250,000 reported cases of AIDS, and more than one million estimated cases of AIDS-linked HIV infection, in North America from the disease’s first reported cases through 1993. But in recent years, nearly half of all new cases have occurred in the black or Hispanic communities.

In 1993, the U.S. Department of Health and Human Services reported more than 83,000 new AIDS cases, of which some 70,000 occurred among men. Of those, about 36,000 cases were among white men, 23,000 among black men and 10,000 among Hispanic men.

Perhaps more startling is a rise in female AIDS cases. Nearly 13,000 women were reported as new AIDS cases in 1993. The majority of cases – almost 8,000 – were those of black women.

Those statistics dramatise a larger shift in the disease, which in the mid-1980s was regarded primarily as an epidemic spread through sexual activity in the gay community. Over time, health officials say, AIDS has also been spread through heterosexual contact and intravenous drug use which have had a devastating effect on poor and inner-city populations.

Those communities, Cylar said, depend on welfare and public health facilities just to deal with the extremely costly process of living with AIDS.

Housing Works estimates that New York City alone holds some 120,000 homeless people, of which between a third and half are infected with HIV. That group, living in conditions that are already unhealthy, will need assistance to avoid dying from AIDS- related tuberculosis or a host of diseases that prey on the homeless.

Also, a disproportionate number of new AIDS cases will be among people on welfare, Cylar says.

Those people are already the hardest hit by budget cuts at both federal and local level. Many states refuse to provide medication to counter AIDS-related problems under the national AIDS Drug Assistance Programme (ADAP) on the grounds that they don’t have enough money.

Meanwhile, many state- and local-level “managed care” health programmes have begun to limit AIDS services to keep public health costs low. New York’s own department that deals with AIDS has undergone a protracted restructuring, which has left its AIDS hotline out of service for months.

“Managed care, ADAP … all those kinds of cuts that are happening are going to reduce the ability of people with AIDS to survive,” Cylar argues. “It is an indirect attack on poor people, and on a marginalised population.”