The fight against HIV and AIDS has come a long way since the 1980s, but continuing federal budget cuts threaten to set back these gains, such as the drastically reduced rates of new cases in San Francisco.
Much of the HIV and AIDS care in The City is provided through nonprofit groups. But these small community-based groups have seen their federal funding decreased by about $20 million over the last three budget years.
As the cuts from the federal level continued -- such as a decrease in funding from the Centers for Disease Control and Prevention from $34 million in 2001 to $18 million today -- San Francisco's government has stepped in to fill in funding. Local government has provided $17.5 million in funding during the last three years.
In the upcoming fiscal year, which begins July 1, the hole in the budget for HIV and AIDS funding is $3.1 million. In the following year, there is a $3.9 million shortfall.
Providers in San Francisco have done a good job of reducing new infection rates. Two decades ago, there were about 2,400 new HIV/AIDS cases a year. In 2013, there were only about 200, according to the county Department of Public Health.
But that has hurt the funding that helped contribute to this improvement. Federal funding flows to areas in which there are higher infection rates. As recently pointed out by Supervisor Scott Wiener, an advocate of using local money to offset the federal cuts, The City is essentially being punished for its successes in reducing new infections.
We assume that Mayor Ed Lee and the Board of Supervisors, who have until the end of the month to finalize a budget, will find the needed funds for the local HIV/AIDS programs. But such local fixes are just a bandage for a much larger issue that state and federal officials need to address.
The fight against HIV and AIDS is not a one-time problem in which the infection can be reduced and then left alone. Continuous education and outreach through health programs is necessary to prevent new infections. One of the worst things that could happen would be for such programs to fold, leading to an increase in new infections and undoing decades of important work.
San Francisco has been able to reduce new infections with local funding. But small nonprofits say they are near the tipping point. Since they already operate with slim margins, more cuts could force them to close their doors. And The City cannot continue to funnel more and more funding toward the issue.
Federal and state lawmakers must eventually acknowledge that there is a minimum funding level required for HIV and AIDS programs to contain new infections. There is nothing wrong with steering funds toward areas where new infections are growing, but it should not be at the expense of other areas.
The nearly 35,000 people in San Francisco who are living with HIV or AIDS need the services The City currently offers them. And the untold numbers of people who may avoid infections through future funding also need the protection such money will provide.