December 22, 2005
NYCWatch: '05 PARTING SHOTS
Should auld prevention initiatives be forgot? We hope not. Back in the summer of 2001, alarmed by the high rates of HIV/AIDS in African-American and Latino neighborhoods, community advocates (including those at Housing Works) formed the New York City Communities of Color HIV/AIDS Coalition (NYCCOCHAC). Working closely with the City Council—particularly Margarita Lopez, who put up a personal $5,000 as seed money for the project—NYCCOCHAC wrangled $5 million from the city, even eliciting a promise from then-mayor Rudy Giuliani that the money would be "baselined" (guaranteed) over three to five years.
The idea behind it all? To supplement the city's top-down HIV/AIDS efforts by providing small, grassroots agencies in communities hard-hit by the epidemic with funding to create tailored ways of promoting HIV/AIDS prevention, services and advocacy right in their respective 'hoods. It was a beautiful idea. And at $5 million, the initiative cost chump change compared to the roughly $122 million of federal Ryan White CARE Act money the city receives for HIV/AIDS projects overseen directly by the Department of Health and Mental Hygiene (DOH).
THWARTED PLANS
Alas, due to budget crunches, bureaucratic bungling and political football matches, the reality of the NYCCOCHAC money has never lived up to the good idea behind it. First, due to the city's post-9/11 budget crunch, half of the hundreds of groups that vied for the NYCCOCHAC money that first year never got any—and Giuliani revoked the baseline guarantee. (It should be noted, though, that groups who did receive funds put them to impressive use, expanding condom distribution in their neighborhoods, holding community forums and increasing the overall capacity of their own offices.)
The following year, early into Bloomberg's tenure (and amidst a $6 billion city budget gap), NYCOCCHAC advocates asked for the $5 million (and the baseline) anew. They got it—sort of. The DOH, the money's disburser, gave half of it to community groups—and secretly used the other half to supplement federal CDC money that went primarily to large, established non-minority groups like the LGBT-serving Callen-Lorde clinic in Chelsea, and to the city's Health and Hospitals Corporation. That was not exactly the original intent for NYCCOCHAC's $5 million pot—but it happened the following year, too, when NYCCOCHAC advocates and the City Council finally learned where the DOH was diverting half the money.
Last year (FY05), a few million dollars more were lumped into NYCCOCHAC's pot, but things got even more complicated. With no proper competitive application process ever put in place, NYCCOCHAC advocates were left to draw up as fair and geographically balanced a list as possible of several groups that were to get $50,000 each. But once the DOH had the list, it held onto the money until this April, when AIDS Issues Update chided them for it in this story. The DOH then told the groups (most of them very small) they needed to spend all $50,000 by the end of June. For most, it was an impossible task. Some of the groups asked for half their share, others declined it outright rather than spend it all in a wasteful spree. Others never received their money in the first place.
A NEW CHANCE
This new year, though, could be a chance to get it all right. Even though only a bit more than half the original $5 million is pegged for NYCCOCHAC in the 2006 budget, the money will finally be handled not by the DOH but by a master contractor, Community Resource Exchange (CRE), which will work with NYCCOCHAC advocates to create a proper and speedy application process for groups who want a share of the funding. This way, applicants who win a share can get the money in their hands as soon as possible in 2006 so they have plenty of time to plan to spend it wisely.
It all comes down to the DOH's willingness to cooperate with the new process, starting with a meeting this Friday between the department and CRE to work out the intermediary group's contract.
Will the DOH cooperate? Advocates hope so. "This is one of the most historic pots of money in the city in a long time for HIV/AIDS," says Housing Works city advocacy director terri smith-caronia, a key NYCCOCHAC organizer. "It's also been very challenging getting the city to administer the money the way we intended it. But I'm hopeful that if disbursed in an expert and timely manner, it will create a synergy between communities and government in preventing HIV/AIDS in the city."
We'll keep you posted.
FIRST DIABETES...THEN HIV?
Last week, the New York Times and AP reported that the city's Board of Health had ordered laboratories to share with the Department of Health the individual blood-sugar test results of the city's roughly 500,000 diabetics. The DOH also said that, on occasion, it would contact individual doctors and patients to offer them assistance in managing the disease.
The news alarmed many health-care advocates, including doctors who fear that the information could raise people's insurance premiums or deny them eligibility for health or life insurance if it gets in the wrong hands. Health commissioner Dr. Tom Frieden has told press that patients could opt out of the reporting but didn't specify how that would happen.
At Housing Works, advocates wondered if the new diabetes policy was meant in part to "soften the ground" in order to do the same thing for HIV/AIDS. Currently, the DOH receives information on the treatment of the city's individual HIV/AIDS patients but can't legally intervene based on the information. Last week, asked twice in e-mails from AIDS Issues Update if the DOH was trying to remove that restriction, assistant commissioner for HIV/AIDS Dr. Scott Kellerman twice replied, "We are currently looking into this."
HW's city advocacy director terri smith-caronia says that the DOH is charting a "slippery slope" with the new diabetes policy—and that, in a sense, the department has "opened Pandora's Box" by being able to see individual HIV patients' treatment information without being able to act on it. "They can already look at trends in the aggregate to direct their broad guidance to doctors and patients," she says. "It seems like a pretty egregious line to cross to start stepping in on individual doctor-patient relationships, especially when there are often other factors in the mix like substance use, mental illness or homelessness that may account for less-than-desirable lab numbers. Sometimes imperfect HIV management is neither the doctor's nor the patient's fault."
It's hard to know what to do next, says smith-caronia, because Frieden and others at the DOH have not been forthcoming with their plans around HIV/AIDS. "We may partner with other disease communities around the idea that it's wrong for the DOH to be dipping into individual patient files," she notes.
The American Diabetes Association has not yet taken a stand on the new city policy.