At its March 8 meeting, the Hudson County Board of Freeholders struggled to find ways to cope with the significant lose of federal revenue to fight AIDS.
Under the new legislation signed into law by President George W. Bush earlier this year, Hudson County's status was downgraded because it did not meet new, more stringent AIDS figures imposed on communities around the nation.
Until March 1, 2007, Hudson County qualified as an Eligible Metropolitan Area (EMA), allowing it to compete with 21 other areas around the state for nearly $500 million in federal funding. But because Hudson County as well as numerous other areas failed to meet the new requirements, it must now compete with 33 other areas around the country for $145.7 million, resulting in a loss of more than $2 million in federal aid per year.
Congress enacted the Ryan White CARE Act in 1990 to help stem the spread of HIV/AIDS. As of last year, Ryan White funds helped provide services to more than 500,000 people nationwide per year, 59 percent of whom are people of color.
In Hudson County, 37 percent of those infected with HIV or AIDS are African American, 34 percent are Latino.
The program is broken up into four areas, offering funding to needy cities EMAs, states and regions, individual outpatient services, and family comprehensive care and special programs.
But under changes implemented by the Ryan White HIV/AIDS Treatment Modernization Act of 2006 passed last December, Hudson County failed to qualify for EMA status.
Under the new law, Hudson County must have 3,000 people living with AIDS and must have has 2,000 new AIDS cases reported within the last five years.
Although Hudson County has a reported AIDS population of 3,316, it has had, however only 1,062 AIDS cases reported from 2001 to 2005, shifting its designation to a Transitional Grant Area.
Of the 51 previously existing EMAs nationwide, 29 became TGAs under this new legislation.
Part of the reason for the apparently low number of AIDS cases reported has to do with another important change under the new law, in which HIV is no longer counted.
This means that 4,400 Hudson County residents infected with HIV are not considered relevant for the funding.
In implementing the new regulations, the U.S. Department of Health and Human Resources apparently reneged on a compromise New Jersey U.S. Senators Frank Lautenberg and Robert Menendez forged last November.
The existing EMA status and formula funding were supposed to take place for a three year period or, at the worst, for a one-year transition. But the changes took place on March 1, 2007 instead.
It was also promised that HIV counts, as well as AIDS, would be used to determine EMA status and formula. But only AIDS counts are being used.
"In other words, they are only counting full blown AIDS," said John Lorenzo, executive director of Faith Services, one of the groups providing healthcare to the AIDS and HIV population in Hudson County.
"By using new AIDS reports, not numbers living with AIDS or living with HIV, the county is being forced to cut medical services to people in need, an estimated 40 percent cut in medical resources," according to a report to the Hudson County Freeholder Board. "The new legislation, as interpreted by HRSA, has EMAs like Hudson County penalized for having quality medical care which has successfully kept people from progressing from HIV to AIDS, and kept people with AIDS living longer."
County officials said that without federal intervention to restore the original level of funding, Hudson County will be in a position to provide only core services and will have to eliminate programs such as mental health, substance abuse, home healthcare, home-delivered meals, emergency housing, food vouchers, Mobile Outreach, client advocacy, complementary therapies and buddy companion services.
Lorenzo said the drop in funding will cause a valuable safety net to deteriorate and will put additional burden on the already fragile hospital network in Hudson County.
Freeholder Bill O'Dea said that the new regulations will foster "an emergency room" culture on the AIDS community, and will increase the problems hospitals face with the increased level of charity care hospitals must provide.
Frank Solano, director of Jersey City Mental Health Programs, said the cuts would have a severe effect on services provided. Most of his clients have no insurance. The cuts will result in the loss of four staff members.
Tanya Williams, another AIDS worker in Hudson County, said the county needs to lobby federal legislators and that AIDS activists are already meeting with members of the Health and Human Services and the Energy Departments to see what can be done.
Donna Schiller told the Freeholders that the shift from counting HIV to only counting those with full-blown AIDS will have an extremely negative effort.
"We have to get back on track," she said.
Rev. Marvin Krieger, of the Hudson County HIV/AIDS Health Services Planning Council, said the changes will have an impact for the next three years, and affect not just the number of people who get services, but also increase wait for service. In urging the county to take action, Rev. Krieger said, "I do not want to stand here three years from now and tell you about the number of people who have died from AIDS."
"In the late 1980s before new drugs were developed to battle AIDS, a person had an 18 month life span," Rev. Krieger said. "We will see the same again."
Bayonne Freeholder Doreen DiDomenico said she was devastated to hear of the cuts and that the freeholders were committed to getting back some of the funding.
Freeholder Maurice Fitzgibbons said the county's department of Human Service needs to monitor the situation and the county needs to look into way of supplementing the loss.
"Hudson County has been impacted for many reasons," Fitzgibbons said. "But since we are one of the counties with a large number of HIV cases, this should be a priority for us. I would like to see us make up at least half the cuts. Maybe we have to cut back on building park or doing something in the Schools of Technology and the Community College. This issue can be devastating."
Freeholder Chairman Tom Liggio said he would talk with County Executive Tom DeGise about making some cuts in the upcoming county budget.