Members of the LGBT community are questioning a recent decision by the Indiana Department of Health recently to remove white gay males from the priority list of HIV/AIDS funding.
On April 21st, Indiana's HIV-Prevention Community Planning Group held a meeting to discuss various issues facing people affected by, or in danger of contracting HIV/AIDS. Key to the discussion was the list of populations to be targeted by the Indiana State Department of Health (ISDH) as being of the utmost priority in administering funding to HIV-prevention programs.
The Planning Group decided to eliminate white MSM (men having sex with men) from their list of funding priorities, a conclusion reached after two votes, the first resulting in a deadlock of 8 for the changes and 8 against. It's a decision some in the LGBT (lesbian, gay, bisexual and transgender) community have reacted to with concern, with some fearing major repercussions in the white MSM population. The change has caused all parties of the debate to look at the role the Community Planning Group plays in HIV prevention.
Ultimately, it is the Indiana State Department of Health that allocates money to HIV-prevention groups, first by administering the Request for Proposals process and then finally by choosing the groups who will receive federal funding. The Community Planning Group's job is to set forth a series of recommendations for what are called the "priority populations," those considered most in need of funding. While the ISDH is not legally required to follow these recommendations, the Planning Group's priorities typically dictate the final outcome.
The Centers for Disease Control and Prevention (CDC) mandates that people currently living with HIV/AIDS are always to be the top priority. Previously, the second priority group included Men Having Sex with Men, subgrouped into White, African-American and Hispanic. With the ruling, only African-American and Hispanic MSM are included.
The important question being raised is whether this shows a disproportionate funding policy, or simply reflects the changing realities in the way HIV infections affect members of the community.
For many, the heart of the issue lies in the relation between two terms used to chart HIV/AIDS cases: Prevalence and Incidence. Prevalence, as defined by the CDC, refers to "the number of people living with HIV/AIDS in a specific area during a specific time period." Incidence measures the "number of people newly infected with HIV in a specific area during a specific time period."
When information from the State of Indiana's 2008 Epidemiology report is examined from each of these perspectives, very different implications emerge regarding how HIV/AIDS affects target populations. On a total number basis in Indiana, HIV/AIDS cases in the white MSM population are more than double the number of cases in the African-American and Hispanic MSM populations combined. Taken on its own, this information would seem to suggest that white MSM are a considerably more at-risk group.
However, according to the CDC, incidence rates show a much higher concentration of new HIV/AIDS cases per 100,000 in African-American and Hispanic MSM populations than among white MSM.
"The priority populations reflect populations that have shown a higher increase in infection rates and therefore the CPG feels that these demographics warrant a heightened focus," says ISDH Media Relations Coordinator Ken Severson. He reiterates that people currently living with HIV/AIDS, including all MSM, are always the CPG's top priority, but that prevention programs need to follow recent rates of infection.
While the alarmingly high rate of incidents of new HIV cases in minority communities seems to have motivated the new funding guidelines, some in the local LGBT community feel otherwise.
"The CDC guidelines, in several instances, fairly explicitly direct community planning groups to [include] both the incidence and prevalence of target populations in establishing the community's priorities," says Gary Essary, Board Spokesperson for the
Tri-State Alliance, a Midwestern LGBT organization. "The Community Planning Group] has chosen to go entirely with incidence in establishing priorities."
Essary contendss that such a policy change on the part of the Planning Group could cause serious problems for the white MSM population, including even a spike in HIV/AIDS cases.
Some policy experts, however, say that the CDC actually gives the Community Planning Group a good deal of discretion. Dr. Eric Wright, director of Indiana University's Center for Health Policy and an expert on HIV prevention, notes that the CDC "[doesn't] dictate the criteria on which decisions are to be made. They dictate more how the structure of the groups should be created to make divisions about that process."
Clearly, the subject of HIV/AIDS policy is a sensitive one and those who are involved with these issues have strong opinions. What on the surface may seem like a minor change in policy could potentially have sweeping ramifications in how the gay community approaches HIV prevention and treatment.
It remains to be seen what kind of influence such a change of policy would provoke, or even that the change will stay in place beyond next Tuesday, when the next Community Planning Group meeting will take place. It will be interesting to see both the content and tone of the meeting, which accepts public guests, as well as the conclusions that the Group members make on the subject. Whatever their decisions are, one can rest assured that conversation on the subject is far from dying down.
Community Planning Group
Tuesday, July 21, 10AM
Indiana State Department of Health
2 North Meridian Street
Sign in as a CPG Guest at the front desk and ask for the Community Planning Group meeting. Public Comment is a regular agenda item.