Federal funding cuts could hurt Iowa’s HIV fight

Iowa health officials fear reduced federal funding for prevention programs could reverse years of success in the state of holding down the spread of the human immunodeficiency virus that causes AIDS.

“HIV prevention in our state is going to look very, very different, I fear,” said Rhea Van Brocklin, executive director for the AIDS Project of Central Iowa, a Des Moines-based non-profit HIV prevention service.

At issue is the denial from the federal Centers for Disease Control and Prevention of $2 million in grant applications. That money would have cushioned the blow of the CDC's cuts to Iowa funding, from about $1.6 million to $750,000 over the next few years.

The denial and cuts are part of a new strategy by President Barack Obama's administration to funnel more money toward 12 cities that had the highest number of people living with HIV in 2008.

State officials say the new policy penalizes Iowa and other states that have been successful in containing the spread of HIV.

They say the key to preventing Iowa from becoming a high-prevalence state is by identifying people who have HIV but don't know it and engage in risky behavior. Iowa is one of 17 states that solely rely on the CDC for HIV prevention programs.

“Care is prevention and prevention is care,” said Holly Hanson, a manager at the Iowa Department of Public Health.

Randy Mayer, chief of the health department's Bureau of HIV, STD, and Hepatitis, expects the number of people with HIV and AIDS in Iowa to rise because of the cut to funding.

“I think (an increase) is going to be our best marker if we're seeing these kinds of consequences from funding changes,” Mayer said.

The CDC estimates that one out of every five people with HIV is unaware of it, which means they unknowingly could be exposing their sexual partners to the virus.

In Iowa, the state health department knows of 1,828 carriers of HIV/AIDS who had been diagnosed as of Dec. 31, 2010, with more than half living in Polk, Linn, Johnson, Black Hawk, Scott, Woodbury and Pottawattamie counties.

What worries health officials are the carriers they don't know about. Mayer's bureau estimates there are more than 500 people living with HIV/AIDS in Iowa who are undiagnosed and unreported.

The state had planned to use the federal grant money to test people and identify undiagnosed HIV carriers.

Mayer's bureau identifies an average of 114 new HIV infections annually. Without money to continue identifying and educating HIV carriers, the prevalence of the disease may rise again, making federal funding necessary again, Iowa officials argue.

The state then will be caught in what Mayer calls “funding cycles.”

“Tuberculosis is good example of this,” he said. “It was a disease that, at least on a national level, they put lot of money into fighting, and so the numbers (diagnoses) went down. Then they thought, we did a good job here so we can move the money around. But then TB started coming back.”

Last year, Iowa had 12 HIV health education and risk reduction projects. Now it has one.

“It has a huge impact,” said Van Brocklin, the director of the AIDS Project of Central Iowa, which is the last existing project. “Even the year prior, our prevention programs were able to reach to a lot more people. Everything is up in the air right now.

“We're not really sure what low-incidence states are supposed to do with this magnitude of cut,” she added.

CDC spokesman Scott Bryan said the agency realized prevention funding was no longer proportionate to the number of reported HIV and AIDS cases across the country.

He said the policy shift represents “a process of readjusting funding to eliminate resource inequities.”

Editor's note: The Iowa Center for Public Affairs Journalism - IowaWatch.org is a non-profit, online news website dedicated to collaborating with Iowa news organizations to produce explanatory and investigative work. Gazette Editor Lyle Muller, who will become executive director of the center next month, did not participate in the selection or editing of this story.