By Karen Ocamb

Carla Bailey, co-chair of the Los Angeles County Commission on HIV, could hardly maintain her professional decorum at the commission's March 9 meeting. She was outraged over the federal government's funding cuts for HIV/AIDS services for the thousands of low-income HIV-positive people the commission is sworn to represent. Bailey and other commission members called for action, hoping to re-invigorate the grassroots HIV/AIDS movement.

On March 14, the Health Resources and Services Administration (HRSA) cut $1.9 million in Ryan White CARE Act Title 1 funds to L.A. County, a reduction of 5.2 percent from last year, down to $34.9 million for emergency, medical, dental, food, nutrition, substance abuse, transportation, housing, mental health, legal, educational and other services "of last resort" for 25,000 of the 55,000 people living with HIV/AIDS in L.A. County. Additionally, the Centers for Disease Control cut $400,000 in prevention funds, a 2.9 percent reduction to $12.8 million.

"These grants support vital HIV/AIDS care and services, and give local communities autonomy to deliver care where it is most needed," said HRSA Administrator Elizabeth M. Duke.

Some commission members felt the cuts were politically motivated after reading a California Capitol Hill news report that North Carolina Sen. Richard Burr told the Senate Health Committee that California received too great a share of funding at the expense of rural states.

"We should feel outrage," said Quentin O'Brien, co-chair of the Finance Committee, who proposed sending protest letters to elected officials.

"We need letters from clients," said Kathy Watt, director of the Van Ness Recovery House. "Until we get people who are affected -- the people who have the loudest voice -- it'll be hard to be heard."

"I'm not waiting for somebody else to fight for me," said Bailey, an African-American woman, angrily. "I am infected. Why they cut, how they cut -- I don't care. They cut it!"

"I'm not sure why the cuts have happened, but L.A. County certainly seems to have received a disproportionate share of CARE Act funding reductions in the last three years," Craig Vincent-Jones, executive director of the HIV Commission, told IN Los Angeles magazine. "But we've been scoring really high on our applications. I personally attribute it to a formula they use to work funding that is predisposed against jurisdictions like L.A. County that are actually achieving good healthcare outcomes with CARE Act funds -- and have newer epidemics."

Currently, the HRSA formula is based on AIDS case reports, which means, Vincent-Jones said, that L.A. County is grossly under-funded. He submitted a Freedom of Information Act request to HRSA to review all documentation that led to HRSA's decision. Vincent-Jones is also concerned about the CDC-mandated switch to HIV names-based reporting this October because it does not appear the federal government has a "transition plan" and it will take the county about three years to make the shift. (As IN goes to press, the California HIV Names reporting bill, SB 699, is awaiting a third hearing on the Assembly floor.)

Meanwhile, in anticipation of projected cuts, the HIV Commission last year voted to authorize a 5 percent cut "across the board" if federal reductions reached a certain level. (The state has not yet announced their 2006 awards.) The cut affects the HIV Commission, contracted AIDS service providers, and the County Office of AIDS Programs and Policy (OAPP).

The commission announced it would voluntarily take a $100,000 cut, "to help preserve continued levels of service delivery and to acknowledge the additional burden these reductions will place on contracted providers. The commission anticipated that OAPP would respond commensurately by finding additional administrative savings cutbacks," Bailey, Vincent-Jones and commission co-chair Anthony Braswell wrote in an official five-page memo to Chief Operating Officer of Public Health John Schunhoff, immediately following the March 9 meeting. The memo strongly urged Schunhoff and OAPP to comply with an Oct. 25, 2005, Board of Supervisors' motion to "disclose all budgetary and expenditure information, regardless of funding source, to the commission," which sets priorities for how OAPP distributes CARE Act funds, only one funding stream of OAPP's $82.5 million budget. (As IN goes to press, OAPP has not provided that financial breakdown, for which IN has filed a Public Records Request.)

OAPP sparked controversy last year with an Oct. 5 letter to service providers proposing $1.6 million in cuts to accommodate OAPP administrative expenses, including expanding to two additional floors. After the subsequent uproar, the board ordered a suspension of those proposed cuts, as well as other changes that have yet to be implemented. The snails-pace of addressing the issue while providers take cuts has infuriated many.

"In absorbing the $1.9 million Ryan White CARE Act Title I funding cut, the county should consider all alternatives to cutting services, including looking at administrative cuts," said Bienestar Executive Director Oscar De La O.

L.A. County has "lost 12 percent of our CARE Act funding since 2003. The only growth we've seen is in demand for services, the cost of providing care and the county bureaucracy,' said, AIDS Project Los Angeles Executive Director Craig E. Thompson. "From budget charts, it appears that OAPP now spends over 20 percent of the county's AIDS budget internally, but the allocation process is far from transparent."

Mario Perez, OAPP's interim director, did not return calls before IN went to press. But he told the Los Angeles Times, "We took a hit ... We need to take a hard look at the investment in HIV programs at the federal level. For many years, we think we've been grossly under-funded."

In response to complaints from AIDS Healthcare Foundation President Michael Weinstein that federal flat funding coupled with OAPP's insensitive administrative costs result in "fewer people in treatment and people getting treated later," Perez told the Times, "We run a pretty lean program ... Sometimes it may be difficult to understand how our investments work."

"This is outrageous," Weinsten told IN. "If we let them get away with this, then AIDS activism is officially dead in Los Angeles."