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Taking risks with AIDS

EARLIER THIS month, Mayor Menino announced that Boston would be losing $1.1 million in federal AIDS funding, necessitating cuts in services for the estimated 4,500 people in the city living with HIV. Now the state is facing its own cuts in AIDS programs, including subsidies for life-saving drugs. Government cannot jeopardize support for AIDS funding and expect to continue the steady progress being made against the disease.

The cuts in the federal Ryan White Act are tied to a formula that actually penalizes Boston for reducing the number of AIDS diagnoses, which were down 14 percent in 2003 from the previous year. But advances in AIDS treatment have meant longer life spans for those who already have HIV infections. As people live longer, the demand for services such as transportation, nutrition, and respite care inevitably grows. It would be a cruel irony if the very fact that AIDS deaths are declining undermined improvements in care for patients who are living.

Delivered meals, emergency rental assistance, and home care contribute greatly to keeping HIV patients productive and in their homes, but health insurers will not cover these services. Because of budget cuts, such support services were denied to an estimated 3,500 individuals living with HIV over the two years ending last July, according to the state Department of Public Health.

Even more crucial to people infected with HIV is access to the promising combination drug therapies that cost, on average, more than $15,000 a year. The state's drug subsidy program for patients too rich for Medicaid but too poor to absorb the costs themselves is facing a $3 million shortfall for the fiscal year beginning July 1, largely due to a freeze in federal spending. Without full funding of the state's HIV Drug Assistance Program, waiting lists for new enrollees may have to be established. This is immoral on its face, but interrupting drug treatment regimens is also a danger for the whole society because it contributes to the development of new, drug-resistant strains of HIV. Last year the Legislature barely averted a similar shortfall.

As always, preventing AIDS infections in the first place is the most cost-effective use of government funds. But over the past two complete fiscal years, the state has reduced AIDS prevention budgets by 37 percent. DPH estimates that more than 25,000 HIV tests that might have been done were skipped in those two years, including tests for homeless individuals and intravenous drug users who are not aware they are at risk themselves or may be spreading infections.

AIDS continues to infect approximately 1,000 people a year in Massachusetts and kill 200. Backsliding is not an option.

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