AIDS Patient Funding Cut But Money For Computers Kept
By Karen Nakamura
As of July 1, those with HIV/AIDS in Marin have been denied part of a step in the complex medical regiment that keeps them alive. Many of them are among the longest survivors of a disease ravaging the world. The survival of these human guinea pigs gives hope to millions.
As the economic bubble burst and donations disappeared, the scramble has been on in charity organizations for the last five months to save programs. In individual groups, department heads raced to save as much of his/her department as feasible.
This was as true in the AIDS community as any other. If cuts weren't enough, in the haste to adjust to the loss, a serious mistake in priorities may have been made within the Marin community that could upset the balancing act that keeps these people alive. Were computers and administrative costs important enough to cut almost half of a direct-services budget?
Federal AIDS funds, in particular Ryan White grants, usually end up as vouchers that cover portions of individual vitamin and alternative treatment costs. Funds are distributed through the San Francisco AIDS Foundation then redistributed to Marin and San Mateo counties.
The SFAF saw a $2.5 million budget shortfall. As of July 1, it laid off almost a quarter of its staff, its executives took pay cuts, services, education and prevention campaigns were cut back. While San Francisco was seen as sharing the pain, Marin took a different path.
These different solutions don't reflect on the greater picture of the Marin AIDS agencies. Overall, they have done an incredible job. Their patients are still alive. They're getting something right. That's the rub to AIDS sufferers. Decisions by a few seem to have led to a reduction of direct client services while administrative needs were covered with little more than a 10% cut.
The long and short of it is the Marin Treatment Center's specialty clinic, which provides primary care for AIDS patients, was cut from $522,689 to $487,809, However, it also received approximately $19,500 for new computers and other office upgrades from the Ryan White funds. Correspondingly, the Marin AIDS Interfaith Network's (MAIN) direct client services program which provides alternative therapies, was cut by almost the same amount as was granted for computers.
Keep in mind that of the 500 patients seen by the Marin Treatment Center, 73% are living on a gross monthly income of $1,200 or less. These patients are often also served by "MAIN." Before July, they used to get vouchers for up to four visits to an acupuncturist per month. They now get two. Before the July cuts, vitamin vouchers used to run at $35 a month with $40 when possible. Now, patients receive $30.
At the same time, case management had a budget of $282,855 in 01/02. (That figure includes Ryan White funds and Marin County General Funds.) In 02/03, their budget remained the same. In San Francisco and Los Angeles, employee cuts of up to 25% were made to save direct client services.
One Marin AIDS patient said that he rarely sees his case manager but has to talk around and around to two or three of them any time he needs something done. His feeling was that while case managers are important, their services are duplicated and could have been consolidated. "These cuts really hurt. I get medical herbs that work and go with the acupuncture. Now my treatment is half."
Howard Long is a member of the Marin AIDS Commission and fills one of the patient seats. He's also Marin's longest living AIDS patient. "Case management didn't take any cuts while I have to pay more for vitamins. Look what I take a month, just in vitamins." There are seven bottles on the table. "This is $100 worth. Paying an extra five dollars means I can't get that much at the grocery store. I used to get a big bag. Now it's half full. I can cope with two acupuncture sessions a month, I guess. What really worries me is having a setback. That's when I really need a session and now it won't be there. Acupuncture really does relieve a lot of the side effects from taking the primary medication. But it's still being treated like a fad. The AIDS community doesn't feel that way at all."
Commissioner David Martin of MAIN, which distributes the vouchers, affirmed this. "Last year 135 people accessed the acupuncture program. Acupuncture is even better if taken with herbs. It lessens side effects and helps patients tolerate their primary medication. It's important. Thirty-one low-income patients were able to get treatments. We have 13 people on the waiting list. If we serve new patients we could run out of funds long before the end of the year.
"Last year we spent $41,445 in Ryan White funds on vouchers. This year's voucher program is $26,160. In the nineties, we used to receive $50 per voucher for vitamins. Most of our patients are taking conventional things like multi-vitamins and anti-oxidants. Taking these vitamins helps them improve their energy and support their immune system. Vitamins are supplements and meant to compliment, not re-place, conventional medicine. Many physicians are now recommending these additional therapies."
Why then would computers take president over proven help for these medical pioneers?
Apparently a patient satisfaction survey was circulated to set priorities in the cuts. The Commissioners expected to discuss this survey with a view to cuts. However, in a rush of housing cuts, the Board of Supervisors meeting to approve the new Ryan White budget suddenly loomed. Karen Wuopio of the Marin Health and Human Services and liaison between the Board and the community worked with Commissioner Brian Slattery, (who fills a provider seat and runs the business end of the Marin Treatment Center) to come up with a budget. After reviewing the survey, they made their recommendations to the Supervisors. The Commissioners didn't see the purposed cuts until after the fact when they realized direct client services had been reduced. In addition no case management was cut and $19,000 was given to Slattery's department.
Howard Long complained. "We didn't know what hit us. The survey was very general. Before we figured out what was going on, the item was before the Board of Supervisors and cuts were made that we weren't aware of and wouldn't necessarily agree to."
Even this they might have accepted, somehow, except for Slattery's department receiving over $19,000 for computers and in-office upgrades. That's a lot of computers when lives are on the line. Commissioner Slattery didn't return our calls before deadline.
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