DSHS LAR must include a request for increased funding for HIV medications. This is necessary to avert shortfalls in the next biennium. Without the funds, the program will be forced to end new enrollments and create waiting lists. People who must wait for their medications have less successful health outcomes, resulting in hospitalization and in some (documented) cases death.
The history of DSHS (formerly Texas Department of Health, TDH) has been that there is some reluctance to request additional funds for HIV/AIDS. The department is, first of all, subject to the instructions given by the state's leadership on what to ask for. Sometimes the instructions include a requirement to cut the budget by a particular percentage. In the last legislative session, there were instructions to cut budget requests by 5 percent. Always the instructions say that no new funds should be included in the basic budget request. However, state agencies are allowed to request "exceptional items," which include a request for new funds. These exceptional items are where the battles occur, since every penny has to be justified. Not all exceptional item requests are granted. New funds for HIV/AIDS would be an exceptional item request.
The department's reluctance to request HIV funds comes from several sources. One is that there are a lot of competing needs in public health, mental health, and substance abuse. It's easy enough to think that medications for people with HIV/AIDS could be more important than fish tissue testing until there's an outbreak of some nasty infection from Texas' oyster crop. The department has to balance all of these competing needs when making its requests to the legislature.
Another source of reluctance is the fact that there's just always such a need for HIV/AIDS funding. We needed $44 million in 2003. We got $26 million. We needed $15 million in 2005--and got it. The more we go back for funding, the more there is a perception that HIV is getting "too much."
And so on and on. It's not too far beyond speculation to think that reluctance is also bred by the attitudes of legislators toward people with HIV/AIDS. Knowing there's going to be a tough battle would make the strongest person think twice about picking a fight.
One of the goals to be achieved in Friday's hearing is to apply pressure to DSHS to include HIV among its exceptional item requests. The arguments in favor of that include:
- The Texas HIV Medication Program will face a shortfall before the end of this biennium. That means that clients who are currently eligible for the medications that are offered by the program will be turned away. That means that no new medications can be added to the program and some may be cut from the program.
- If clients are put on a waiting list, their disease will not wait. It will progress. If it progresses enough, the client will need medical care from some source. Usually that source will be a local charity hospital, funded by county property taxes, costing much more than the medications would have cost.
- HIV treatment is a key component of HIV prevention. The primary argument offered for getting tested for HIV and knowing one's status is to be able to enter treatment and take care of one's health. A key benefit of this process is the counseling that accompanies it. Being diagnosed with HIV, one is even more attentive to prevention messages and can become a partner in stopping the spread of the disease. Without testing, one can continue to spread the virus unknowingly. Without access to treatment, there is less incentive to be tested. Failing to maintain even the current level of service in the Texas HIV Medication Program will cripple the state's prevention efforts.
And the list could go on. Feel free to add to it in the comments.