AIDS WARRIORS HOPE SLASHED BUDGET IS RESTORED

State May Have Squandered Successful Lead In Fight Against Disease

In the public mind, AIDS might be a disease of yesterday -- something
the government has under control at home and is a danger only in the
Third World.

The people on the front lines in the fight against HIV disease know
differently. They say they are growing frustrated and believe that
Massachusetts squandered a once-promising opportunity to dramatically
limit the spread of HIV and AIDS. Now they are looking to the new
Patrick administration to try to make up for lost time. The
importance of the state's commitment has grown because the Bush
administration continues to level-fund the Ryan White CARE Act, which
supplements AIDS treatment for the underinsured.

The state's AIDS budget, at $36.7 million, remains more than $14
million less than its level in fiscal 2001, when Massachusetts was
considered a national leader in combating AIDS. New infections in the
state have leveled off in recent years at about 1,000 annually. It is
that number, which some blame on a misinformed complacency, that most
discourages those who work in the world of HIV and AIDS.

Rebecca Haag, executive director of the Boston-based AIDS Action
Committee, notes that the AIDS line item is only part of the story
when it comes to preventing and treating AIDS.

What has hurt over the years, she said, "is this idea that government
doesn't play a role, when we know there is a huge percentage of
people who are dependent on the government to help them maintain some
sort of stability."

Many people with HIV and AIDS rely on Medicaid funding or fall into
the crack of not having health insurance and not qualifying for
Medicaid with its 200 percent of poverty threshold, "which is very
low," Ms. Haag said.

Meanwhile, community health care programs are getting cut and the
average annual family income of a person with HIV or AIDS in
Massachusetts is $7,500 a year. Then there are the housing, domestic
violence and substance abuse issues faced by many who are infected.

"These are people who are dependent on a wide variety of state
services," Ms. Haag said. "Unless you maintain these folks, there are
costs to the state. It throws them into crisis."

One possible development, viewed by advocates as critical in
advancing the fight against AIDS, is the naming of a new head of the
state Department of Public Health. One candidate for the job, John
Auerbach, previously ran the agency's AIDS bureau. Naming him to the
top DPH position would be seen as an indication that the Patrick
administration is committed to fight the battle against AIDS anew.

Project ABLE (AIDS Budget Legislative Effort), a statewide coalition
of AIDS organizations and advocates, is asking for a $5 million
increase in the state's AIDS line item. The request is not out of
line with some of its proposed budgets from recent years with one
notable exception: Project ABLE leaders actually believe they have a
chance of getting the money this year, despite the specter of a
looming $1 billion state budget deficit.

State lawmakers slashed the AIDS budget radically five years ago
during a round of deep budget cuts overseen by former Govs. Jane M.
Swift and Mitt Romney.

State funding, which was at $51.1 million in fiscal 2001, dropped to
a low of $32 million in fiscal 2004 and restoration has been slow and
incremental. The $36.7 million now budgeted includes a $300,000
funding infusion from a supplemental budget.

Project ABLE noted that as of Jan. 1 there were 16,426 people
diagnosed with HIV or AIDS in Massachusetts, with an estimated
several thousand more people unaware they are infected and possibly
putting others at risk. The rate among blacks is 11 times that of
whites, and the rate among Hispanics is nine times that of whites.
AIDS Project Worcester interim director Joseph D. McKee said those
figures play out in Worcester and Central Massachusetts, particularly
among women.

"In Worcester, we need to do a lot more work with women who are at
risk for this disease. In particular women in various communities of
color, not exclusively, but those communities are disproportionately
represented in terms of new cases of AIDS out of proportion to the
general population," he said.

Project ABLE's Mary Ann Hart said three-fifths of the proposed
increase anticipates federal cuts in AIDS money to the state.

"We will know in March or April," she said. "That is the best
estimate we have."

"If we were to really ask for what would be ideal, we would be
talking millions and millions of dollars," she said. "It is possible
the state budget will be cut in several places in fiscal 2008."

Despite the fact that the picture of AIDS in the United States is far
rosier than in many countries, Mr. McKee said a large majority of the
infections would not have happened had government done a better job.

"We're talking about 1.3 million people living with this disease," he
said. "That's 1 in 298 people, incredible for a country that is 26
years into the disease with billions in spending."

Mr. McKee, said 40,000 to 65,000 people in the United States will be
infected this year.

"We shouldn't be seeing numbers like this," he said. "We should be at
5,000 to 7,000, and with a yearly diminishment."

An outspoken advocate for clean needle exchange programs, Mr. McKee
insists Worcester would have fewer new infections if a program was
enacted here, as it has been in Boston and Cambridge, which have the
lowest rates of AIDS among IV drug users of any Massachusetts cities.

Most communities that enact needle exchange, wherever they are in the
world, experience a drop in infections of 13 percent to 33 percent
within 18 months to two years, he said.

"We really politicized a lot of our public health practices," he
said. "That does not serve our communities, our people, or our nation, well."

Ms. Haag is holding out hope that with last year's enactment of a law
that allows people to buy syringes over the counter, much of the fear
that surrounds needle exchange will fade away.

"I couldn't more encourage places like Worcester and Fall River,
Lawrence other places that have higher rates of infection through the
use of needles than the state norm to consider needle exchange
programs," she said.

Mr. McKee of AIDS Project Worcester, the largest AIDS service
provider in Central Massachusetts, said the need for testing in all
walks of life is greater now than it has ever been.

"Everybody who is not monogamous in their sexual life needs to be
tested for HIV disease, and I can't emphasize that enough. They need
to be tested, regardless of age," he said.

Mr. McKee said anyone who has used intravenous drugs or has a sexual
history with partners who were IV drug users also needs to be tested.
A particularly disturbing component to the 1,000 new Massachusetts
infections a year, he said, is that about one-third of them already
have progressed to full-blown AIDS. Mr. McKee said many people do not
seem to be aware that a person can live with HIV for years without
experiencing any visible symptoms.

Ms. Haag said the urgency for testing is a product of "virtually no
money anymore for comprehensive prevention programs aimed at youth
for sexually transmitted diseases, pregnancy as well as HIV."