NH CARES Issues for HIV/AIDS Prevention and Treatment

Southern NH Aids Task Force - 3/23/09

Division of Public Health HB1 Budget Page: Page 1500, Class 568, “Ti Hiv Boston Ema”

Page	Class	FY10 Gov	FY 10 Maint	FY11 Gov	FY 11 Maint
1500	568	624,586	1,624,586	624,586	1,624,586

HIV/AIDS Services through Community AIDS Service Organizations (ASO)

Page 1500 provides funding to NH ASOs to provide disease education, case management including access to federally funded HIV drug assistance programs, access to consistent preventative medical care, and promotion of adherence to HIV medication regimens to people with HIV/AIDS. Providing these services is the ONLY proven public health focused cost effective way to treat HIV/AIDS. The cut of $1m per year from maintenance in the Governor’s budget will eliminate all state funding to NH AIDS Service Organizations and greatly reduce their ability to meet the need.

HIV/AIDS Care Funding is Critical Public Health Care

HIV is a communicable disease and with recent medical advancement the Centers for Disease Control has determined that care and treatment of the HIV infected individual is our most effective prevention strategy. Unlike other chronic illnesses HIV carries with it a stigma that causes those who are infected to fear disclosure and at times be resistant to treatment. Untreated HIV disease can exasperate an already overworked network of human service providers in the state, resulting in increased poverty, homelessness, sickness, and other social ills. Currently, the CDC prioritizes the HIV+ population as first in its prevention strategy. In this overall strategy, continued specialized care services and case management is critical.

HIV/AIDS Care Funding is Cost-Effective

Care support services means reduced transmission, healthier NH communities, and in the long run, less money required to keep New Hampshire healthy.

Effects of Cuts to HIV/AIDS Services

The negative effects are significant and include losing access to: (a) medicine, (b) case management services, (c) the NH AIDS Drug Assistance Program or ADAP, (d) specialized mental health services, (e) specialized substance abuse counseling services, and (f) child abuse prevention.

Requested Action

Add $1m per year to the Governor’s Budget on page 1500 Class 568 to restore it to the DPH Maintenance Request.

Contacts

Wendy Furnari wfurnari@aidstaskforcenh.org 603-595-8464, ext. 15 or other NH ASOs including AIDS Response Seacoast, Greater Manchester Aids Project, and ACORN.

Negative Results from Losing Core ASO Services

1. Losing case management services means an approximate 50-75% of HIV positive individuals won’t be able to access federal benefits (e.g. Section 8, Medicaid, Medicare, SSI, SSDI). AIDS Services agencies are the community access points for theses services providing the means test screening and follow up to ensure a continuum of care thereby reducing drug failure, co-occurring illnesses and expensive emergency medical interventions. Result: more burden on the welfare programs of local towns, emergency rooms, homeless shelters, soup kitchens etc.

2. Losing community access to the NH AIDS Drug Assistance Program (ADAP) means that clients will have to rely on the Department of Health and Human Services staff to locate, complete applications and monitor all HIV positive patients using the NH ADAP program for their medication assistance. The average cost of HIV drugs per is between $2,000 – 5,000 a month. A new drug recently released is $7,000 a month for that one medication. Result: Sick people will not be able to access their medications and prevent the progression of the HIV disease and subsequent infections and illness.

3. Losing specialized mental health services means an increase in patients at risk for suicide, not taking medications, relapse, and increased incidences of high-risk behavior for transmission. Result: Increased costs for in/outpatient treatment; increased criminal justice services.

4. Losing specialized substance abuse counseling services means an increase in relapse and increase in high risk HIV transmission.

5. Negative impact on children. Women comprise 40% of people living with HIV/AIDS many have small children in the home. Currently, 150 children in the state have an infected parent. Result: Increased abuse & neglect; ineffective parenting leading to lack of education & increased poverty, substance abuse & other behavior problems; children who become orphans when their parents die.

Studies on Cost Effectiveness of ASO Services

1. A Cornell/Johns Hopkins/Harvard/Boston University research team that analyzed the costs and benefits of modern HIV treatment found that people with HIV could get 24 extra years of life from modern treatments -- at a total cost of $618,900 in 2004 dollars.

2. The average monthly cost is about $2,100, but the cost of treatment started at a late stage of the disease averages $4,700 per month.

3. Nationally, the CDC reports that one in four people with HIV don't know they're infected. They find out only when their immune system collapses. In New Hampshire, the Department of Health and Human Services reported to the NH HIV Community Planning Group in 2006 that as many of 41% of individuals diagnosed with HIV are also given an AIDS diagnosis at the same time. Receiving both diagnosis at the same time CONFIRMS that people are not seeking medical attention early enough to successfully manage their HIV disease to increase long-term survival rates.