AIDS Services
Organizations in
Crisis in U.S.
1S
S3
ctrm
By Bob Roehr
Contributing Writer
The Whitman-Walker Clinic, the major
AIDS services provider in the Washington, !
DC area and erne of the largest in the nation,
capped a month long financial crisis on June
1 by announcing massive reductions in per
sonnel and services.
The action reflects what has been occurring
at AIDS services organizations (ASOs) across
the country for several years, and what is
likely to continue unless both government
and private funding keeps pace with the
increasing demands for services.
The Clinic will close its satellite facilities in
the Maryland and Virginia suburbs, each of
which serves more than 300 clients; lay off 50
pf its 270 employees and not filI12exiating»f
vacancies; and cut its annual operating bud
get by $2.5 million. ' ■**'
interim execunve director Kooerta
Geidner-Antoniotti said that programs had
f .expanded to meet die need rather than the.5 ,
available funding.
The reorganization cuts "back to the cores -
. services that we know are the most sustain
able."
She said closing die suburban facilities
"will save the Clinic approximately $920,000
. annually." They will remain' open for a period ?
of months while attempts are made to find
other organizations to take on some or all of
. their responsibilities: .T •
Whitman-Walker will suspend its $60,000
, contribution to a needle exchange program
that if spun off as a separate agency several
years ago and perhaps lead to its demise,
; will dose two residential treatment and houa>.->?
ing programs for substance abusers, and it
wdl end prevention activities not directly ^
■}: ■ funded by grants or contracts. , 4
The food bank serving more than 300 .
clients will be closed, the research program .
will be scaled back, and case management
services and administrative overhead pared
back.
The Clinic had insufficient funds to meet its
mid-May payroll and employees were paid
„ only half their salaries. cv ' jHfSi
. That was blamed in part upon a cash flow
problem exacerbated by delays in pay
from the DC government, which has
been rectified.
However; the longer term financial pic
has been one where flat or declining govern4,;
ment funding, coupled with a downturn kli
private giving,; particularly after 9/11, has ,
lIMl . m
The Prognosis of Prevention
Despite Public and
Private Efforts, 40,000
new HIV Cases are
Diagnosed Annually in
the US
By Bob Roehr
Contributing Writer
"We've failed," said Howard
Grossman pointing to the estimated
40,000 new HIV infections a year in
the US, a number that has held
steady for more than a dozen years.
"Maybe it would have been much
worse without our intervention, but
culturally, something is wrong and
we are not getting the messages
across."
He spoke from his experience at
the epicenter of the American epi
demic, Manhattan, where for two
decades he treated primarily gay
men in his HTV practice, and now as
executive director of the American
Academy of HTV Medicine.
Grossman tied the successes in
Europe and Australia at controlling
infection rates to simple and explic
it messages about using a condom
every time. He also thought that the
American psyche of individualism,
versus a more societal perspective
elsewhere, played a role.
Steven Tierney, director of HTV
prevention for the San Francisco
Department of Public Health,
pushed for "targeted programs and
services for gay men," as well as
increased federal funding for those
activities.
runtung rur prevention pro
grams has remained flat for the last
five years, even while the agency
was directing money toward popu
lations where the epidemic
appeared to be growing most rapid
ly, among heterosexuals and people
of color. That has meant less money
for prevention programs targeting
gay men.
The result often has been a kind
of whack-a-mole where the ham
mer of prevention funding comes
down on one population and rates
of infection fall, only to pop back up
elsewhere.
The latest case numbers from
Florida, the state with die third
largest number of HIV infections in
file nation, are a good example.
From 1999 to 2004, the number of
new HIV cases among blacks
Ronald O. Valdiserri is the deputy director for the CDC’s National
Center for HIV, STDs and TB Prevention
declined by 30%. During that same
period they shot up by 23% among
whites and 29% among Hispanics.
"We need more resources tailored
to die black gay community" said
Gary English, with the People of
Color in Crisis in Brooklyn, an area
hard hit by HIV. "What works for
the white gay community is not
necessarily applicable for die black
gay community."
English urged the black gay com
munity "to take a page out of the
civil rights movement and bring
attention to the epidemic."
"Prevention is not a one shot
deal. Each generation must be
reached with HIV prevention as
they come of age. Both at risk and
infected populations need assis
tance maintaining safer behaviors
over the long term," said Ronald O.
Valdiserri, the CDC's deputy direc
tor of the National Center for HTV,
STD, and TB Prevention.
Prevention and Positives
A handful ofetudies from around
the country suggest that gay men,
both positive and negative, appear
to be serosorting—making calculat
ed decisions in choosing their sexu
al partners, engaging in certain acts,
and deciding whether to us or not
using condoms—based upon HIV
status and viral load.
A study from Denver found that
gay men seeking sex online were
more likely to discuss HIV status,
more likely to report having unpro
tected anal intercourse, and more
likely to be‘diagnosed with gonor
rhea. It concluded; this serosorting
may in part explain why an increase
in sexually transmitted diseases
(STDs) among gay men dos& not
. appear to have resulted in a parallel
increase in new HIV injections, pp
A study of 104 HIV-positive gay
men at Fenway Community Health
in Boston found that 64% believed
that viral load affects their likeli
hood of transmitting the virus. If
the person has an undetectable viral
load as measured in their blood,
then the risk of transmission is
thought to be low. And they use
that information in deciding
whether or not to use a condom.
The calculation is not without
risk, sometimes substantial risk.
The genital tract is a separate com
partment behind a blood barrier
that some anti-HIV drugs do not
penetrate very well. Also, a STD in
the genital tract can amplify HIV
viral load significantly and lead to
transmission, even though the per
son has an "undetectable" viral
load as measured in their blood.
Studies have shown that. any
where from 52% to 92% of gonococ
cal and chlamydial infections will
be asymptomatic at a typical physi
cians office. The exception is an STD
clinic, where most people visit
because their either have symptoms
or acknowledge having had a sexu
al contact that put them at risk for
acquiring an STD.
The frequent asymptomatic
nature of many STDs is why all sex
ually active patients should be
screened for those infections, not
merely for symptoms. A survey by
continued on page 13
For information on Crape Myrtle Festival XXV see www.crapemyrtlefest.org