The Year in Review: A Reflection on the Challenges Health Department HIV and Hepatitis Programs Faced over the Last Year

By Randy Mayer, Chief, Bureau of HIV, STD, and Hepatitis, Iowa Department of Public Health and NASTAD Chair (Outgoing)

Randy Mayer, Chief, Bureau of HIV, STD, and Hepatitis, Iowa Department of Public Health

Randy Mayer, Chief, Bureau of HIV, STD, and Hepatitis, Iowa Department of Public Health

As I began my tenure as NASTAD’s Chair in May 2012, state health department HIV and viral hepatitis programs were trying to understand and react to the impact of the funding redistributions brought about by the Centers for Disease Control and Preventions’ (CDC) HIV prevention funding opportunity announcement 12-1201. At the same time, we were just learning about the possibility of fiscal sequestration, set to begin in early 2013. NASTAD’s analysis pointed to the potential for an overall 8.2 percent cut to HIV/AIDS and viral hepatitis programs that would severely impact ADAP enrollment and critical prevention, surveillance and viral hepatitis programming. The cuts would be especially devastating at a time when ending HIV/AIDS and viral hepatitis is within our reach. The National HIV/AIDS Strategy (NHAS) and the Department of Health and Human Services’ Viral Hepatitis Action Plan provide roadmaps for reducing new infections and increasing access to care, but these cuts mean we may never be able to realize these goals.

Like many health departments, Iowa has already faced steep reductions in funding, particularly to our HIV prevention program. Sequestration will mean further reductions in core activities like condom distribution, partner services, and disease surveillance. There is no way to maintain current levels of health department infrastructure with these cuts.
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In addition, the implementation of health reform confronts us with daunting challenges and uncertainties. Perhaps at no time since the first AIDS program directors banded together to create NASTAD have we faced such adversity.

Despite the very difficult times in which we find ourselves, I am proud to have served NASTAD as we advanced critically important policy and program initiatives. Efforts to address stigma, particularly to decriminalize HIV and address states’ harsh and unnecessary criminal statutes pertaining to HIV transmission, will be one of the keys to achieving an AIDS-free generation. Only by reducing the fear and stigma surrounding HIV/AIDS and viral hepatitis will we be able to achieve that goal.

Moreover, addressing the social determinants of health is essential for tackling the hugely disproportionate impact of HIV on gay men of all races and ethnicities, particularly young Black gay men, as well as people who use injection drugs. NASTAD’s work to develop state health department capacity to address the HIV and viral hepatitis epidemics among these populations and to provide best practices for other states to emulate is imperative.

As we forge ahead to achieve an AIDS- and hepatitis-free generation, NASTAD will continue to play a critical role in facilitating peer-to-peer exchange of information, strategies, best practices, and capacity building through its multi-faceted technical assistance program across prevention, viral hepatitis prevention and health care access programs in the U.S. and internationally.

We want to hear from you! What changes have your health department programs experienced over the last year? Tell us by leaving a comment below.
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