California HIV/AIDS Cuts: Program Overview

The California State Office of AIDS cuts will eliminate state general fund support for the following programs:

Education and Prevention:
HIV education and prevention programs focus on preventing HIV transmission, changing individual attitudes about HIV and risk behaviors, promoting the development of risk reduction skills, and changing community norms. These funds are distributed to local health jurisdictions that provide health education and risk reduction interventions to California’s populations at highest risk for contracting or transmitting HIV.

Two types of prevention activities are funded through education and prevention funding: prevention with high-risk negative individuals and prevention with HIV positive individuals. Education and prevention programs and activities for high-risk negative individuals receive oversight from the Office of AIDS, HIV Education and Prevention Services Branch. These statewide programs/activities include: linkages to HIV counseling and testing (C&T), syringe exchange programs (SEP), training for Comprehensive Risk Counseling Services (CRCS) working with men who have sex with men (MSM), and a prevention with positives (PWP) program. Linkages to C&T ensure that individuals get tested and know their HIV status; SEP reduce HIV infection among injection drug users (IDUs) by increasing access to sterile syringes; CRCS in intensive, individualized, client-centered counseling to promote HIV risk-reduction behaviors; the Gay Men’s/MSM Service Provider training and technical assistance reinforces the skills required to work with MSM; and PWP, within the context of HIV education and prevention programming, supports HIV-positive individuals in their efforts to prevent the transmission of HIV. Two other programs that work with HIV-positive individuals, the Bridge Project and Positive Changes, are conducted within HIV care settings at select EIP sites. The Bridge Project reaches HIV-positive individuals who are out -of -care and links them to care. It provides services to 1,120 clients via 29 sites located in 23 counties, serving 27 counties. Positive Changes provides an intensive transmission risk -reduction intervention by Risk Reduction specialists to 670 HIV-positive individuals at very high risk of transmitting HIV. The program is located in 12 counties, and serves 13 counties.

All state general fund support for this program ($24,628 million) were eliminated in this budget and only federal funds ($6,416 million) remain.

HIV Counseling and Testing (C&T):
The C&T program seeks to prevents the spread of HIV by supporting comprehensive HIV prevention programs that provide effective client-centered HIV counseling and testing services. The services are provided by 54 local health jurisdictions (LHJ) and their subcontractors at both confidential and anonymous test sites throughout the state. In 2005, there were 39,880 HIV infected positive individuals in California. Each year there are about 3,312 newly diagnosed HIV cases, of which 1,510 of these cases are identified and reported through the counseling and testing program.

NIGHT – The program targets HIV counseling, testing, and referral activities to high-risk populations in venues they frequented. The goals of NIGHT Outreach Program are 1) reach high-risk individuals who do not seek HIV testing, 2) encourage clients to receive HIV counseling and testing, 3) increase clients’ knowledge of HIV-related risks, 4) provide targeted educational material and condoms, and 5) provide clients with appropriate referrals to other social support and/or medical services.

HIV Counselor Training – The program provides oversight and funding for certification training to HIV test counselors that work in confidential and anonymous test sites. HIV test counselors are trained to provide high-quality prevention counseling that assists at-risk individuals reduce their risk for acquiring or transmitting HIV and learn their HIV status. The state also purchases and distributes HIV test kits to local health jurisdictions at no cost. These test kits are made available to all anonymous and confidential test sites receiving Office of AIDS funding and technical assistance and to the NIGHT programs. Last year the state purchased and distributed approximately135,000 HIV test kits.

All state general fund support for this program ($8.225 million) was eliminated in this budget and only federal funds ($2.534 million) remain.

Early Intervention Program (EIP):
EIP sites provide HIV medical care and treatment as well as transmission prevention interventions for HIV-positive persons within the context of their clinical care. There are 36 EIP clinics statewide that serve 8,000 clients. The goals of the program are to prolong the health and productivity of HIV-positive persons and to interrupt the transmission of HIV. In addition to ongoing medical care, periodic client assessments, case conferencing, and individual services plans are utilized to tailor services to meet individual client needs and to maximize successful client outcomes.

All state general fund support for this program ($7.433 million) was eliminated in this budget and only federal funds ($6.983 million) remain.

Therapeutic Monitoring Program (TMP):
TMP provides access to scientific laboratory tests (viral load and resistance testing) for low-income, HIV-positive Californians who are uninsured or underinsured. These tests are part of the Standard of Care, as defined in federal guidelines. HIV therapeutic monitoring provides clinicians with objective tools to measure the efficacy of a particular course of highly active antiretroviral therapy. Viral load testing is a tool used by clinicians to routinely monitor response to HIV treatment. HIV resistance testing measures the degree to which an individual’s HIV strain is resistant, or less responsive, to antiretroviral drugs. In FY 2006-07 the actual number of clients served was 18,663.

All state general fund support for this program ($8 million) was eliminated in this budget and there are no federal funds to support this program.

Home and Community Based Care:
AIDS Case Management Program (CMP) provides comprehensive case management and direct care services to over 1,300 persons with AIDS or symptomatic HIV disease to allow individuals to remain in their homes while receiving necessary care. Forty-four agencies receive funding to provide case management services.

All state general fund support for this program ($6.327 million) was eliminated in this budget and only federal funds ($5.426 million) remain..

AIDS Housing:
The housing program assists with the stable housing needs of persons living with HIV/AIDS and their families through the development of rental housing projects and long term affordable housing units. This program works in conjunction with the federal Housing Opportunities for Persons with AIDS (HOPWA) program. The HIV Housing Program contracts with Fresno and Solano Counties to assist with the stable housing needs of 286 clients and their families.

The Residential AIDS Licensing Facilities (RALF) program is designed to help address the ongoing operational subsidy needs of currently-licensed Residential Care Facilities for the chronically ill that serves clients with HIV disease. Currently the funds for RALF are allocated based on the number of bed nights each facility has available for chronically ill individuals with HIV/AIDS. Each licensed facility is given an opportunity to compete for these funds. RALF funds approximately 17 sites located in the following areas: Los Angeles, Santa Barbara, San Francisco, Sacramento, Alameda, Riverside, and San Diego. The program serves 270 clients with 98,550 bed nights per year.

All state general fund support for this program ($1.093 million) was eliminated in this budget and only federal funds ($3.540 million) remain.

HIV/AIDS Surveillance:
The Office of AIDS provides support for epidemiologic studies and surveillance program activities including:

Maintaining HIV/AIDS Case Registry, a confidential, central registry of demographic and clinical information on all reported (approximately 170,000) California HIV infections and AIDS cases. The Registry provides all California local health departments with support and training for developing, maintaining, and enhancing surveillance programs.
Providing epidemiologic data to guide resource allocation and program strategies for HIV/AIDS education, prevention, care and treatment. HIV/AIDS epidemiologic research helps public health public health officials and statewide stakeholders monitor and project the extent of the epidemic in California;
Promoting the effective use of available resources through research, planning, coordination, and evaluation; and
Identifying the scope and extent of HIV infection and the needs that it creates, and disseminating timely and complete information.

This program received a $1 million state general fund reduction, leaving $7.651 million. This program also receives $1.578 million in federal funds. The remaining funding level will enable surveillance activities performed by local health departments to continue, ensuring that CA remains competitive for federal funding and maintains the ability to map its HIV burden.