Increase Funding for AIDS/HIV Services

The Legislature should increase general revenue funding for AIDS/HIV services to make a more tangible contribution to dealing with this important health care problem.


Background
The first reported case of Acquired Immune Deficiency Syndrome (AIDS) appeared in Texas in 1980. Since 1980, 17,334 cases of AIDS have been reported in Texas. This number does not include reported Human Immuno-Deficiency Virus (HIV) positive cases. Of thes e cases, 174 were children under 12. 1

Texas currently ranks fourth in the nation in the number of reported AIDS cases. By the end of 1994, Texas is expected to have 27,000 residents diagnosed with AIDS. As of January 1993, the definition of individuals with AIDS was changed by the National Cen ter for Disease Control to include reported HIV positive cases. Approximately 100,000 Texans are currently infected with HIV, most of which will develop AIDS. 2

AIDS has taken a huge toll in human tragedy and poses a growing health problem for all Texans. In Texas, 11,547 people have died of AIDS. 3 AIDS was Texas 10th leading killer in 1990. The Houston metropolitan area reports more AIDS cases than 45 states, and Dallas reports more cases than 40 states. The trend is that more Texans are diagnosed each year than the previous year, and there is no indication of the rate slowing down. Women are the fastest growing segment of the AIDS population in Texas. According to a recent study, the number of children in the United States left motherless by the AIDS epidemic could result in a social catastrophe, with 18,500 children already left orphaned. 4

The Bureau of HIV and Sexually Transmitted Diseases (STD) Control in the Texas Department of Health (TDH) administers programs related to AIDS and HIV. The HIV Division has the following programs: the HIV Prevention Program, which provides information thro ugh Public Health Regions and local and community-based organizations; the HIV Services Program, which provides health and social services to persons with HIV infection; and the HIV Surveillance Program, which measures the extent of HIV infection in Texas. The Pharmacy Division operates the HIV Medication Program, which distributes approved HIV medications to public health clinics. The STD Cont rol Division provides programs specifically designed for the prevention of sexually transmitted diseases and their complications. The STD Control Division works closely with the HIV Division to provide HIV counseling and testing. 5

The demands for services from the HIV Division are continually increasing. The HIV Services Program experienced a 34-percent increase in demand for basic social and health-related services from 1990 to 1991. The HIV Medication Program increased from 3,675 clients in fiscal 1991 t o 6,250 clients in fiscal 1992. Likewise, the HIV Counseling and Testing Program provided 100,000 tests in 1991 and is projected to provide 130,000 in 1992.

The Texas Department of Health was budgeted $31.8 million ($14.9 million state and $16.9 federal funds) for the HIV/AIDS Disease Prevention Program. 6 Federal funding is based on the number of HIV and AIDS cases reported, and some federal funding requires state matching or maintenance of prior-year state funding levels. TDH intends to strengthen reporting efforts to ensure that Texas continues to receiv e its fair share of federal dollars. 7 Federal funding for prevention programs have been reduced for 1993. Continual reduction in federal funding would require additional funding by the state to maintain th e current level of prevention programs.

Recommendation
The Legislature should increase the general revenue appropriation to the Department of Health for AIDS/HIV services and related educational programs by $7.5 million in fiscal 1994 and $7.5 million in fiscal 1995.

A portion of these funds should be used for hospice and other community-based services.


Implications
Additional funding would enable the state to increase its efforts to seek cost-effective early treatment and medical evaluations to delay the onset of AIDS. Early intervention should decrease the use of more costly inpatient care by increasing the use of less costly outpatient care. Such intervention could keep HIV-infected persons functioning and productive longer, thus reducing the costs borne by taxpayers.

Prevention occurs through education, counseling, testing, referrals and care systems. Additional funding would also increase the number of clients reached by prevention programs, which should decrease the number of individuals contra cting HIV, resulting in long-term savings.

Most importantly, these services could help prevent and ease the suffering of thousands of Texans who are HIV-infected, have contracted AIDS or who are at risk of this disease.


Fiscal Impact
This recommendation would cost $7.5 million in general revenue funding for each fiscal year. This investment would be expected to produce significant long-term savings to individuals and the state in dealing with the AIDS problem. However, there is insuffi cient data to estimate these effects.

Fiscal Cost to the
Year General Revenue Change in
Fund 001 FTEs

1994 $7,500,000 0
1995 7,500,000 0
1996 7,500,000 0
1997 7,500,000 0
1998 7,500,000 0



Endnotes
1 Associated Press, State says federal AIDS fund cuts will harm prevention effort, Dallas Morning News (December 31, 1992).
2 Texas Department of Health, Bureau of HIV & STD Control, Program Summary for Budget Review (Austin, Texas, 1992), p. 1.
3 Associated Press, State says federal AIDS fund cuts will harm prevention effort.
4 Marlene Cimons, Number of AIDS orphans to sore in 1990s, report says, Houston Chronicle (December 23, 1992).
5 Ibid, p. 2.
6 Texas Department of Health, Bureau of HIV & STD Control, HIV Funding - FY 93 (Austin, Texas, January 14, 1993). (Printout).
7 Texas Department of Health, Bureau of HIV & STD Control, HIV Division, HIV Services Program: Maximizing Federal Dollars, Annual Report (Austin, Texas, January 1992), pp. 9-10.