From the Office of Congresswoman Nancy Pelosi
 

Pelosi Seeks Explanation from CDC Director for Cuts in San Francisco AIDS Prevention Funding

August 6, 2004

San Francisco, CA -- House Democratic Leader Nancy Pelosi sent the following letter today to Dr. Julie Gerberding, Director of the U.S. Centers for Disease Control, in response to recent cuts in funding for HIV prevention services in San Francisco:

August 6, 2004

The Honorable Julie L. Gerberding, MD, MPH
Director
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333

Re: Prevention

Dear Dr. Gerberding:

Thank you for your work to strengthen our nation’s public health system. HIV prevention is a critical component of that system, and I am writing to express my strong concern about the recent cut in funding for HIV prevention services in my district. This reduction will have a devastating impact on access to these vital services in the Bay Area.

Despite San Francisco having the third largest number of people diagnosed with AIDS in the country, only three community-based organizations (CBOs) in San Francisco were recommended for funding as part of the Centers for Disease Control and Prevention’s (CDC) recent release of $49 million in HIV prevention grants to CBOs. The three funded agencies are excellent organizations that provide culturally-competent HIV prevention services to their respective target populations: African-Americans, Asian-Pacific Islanders, and American Indian/Alaskan Natives. However, the decision not to fund two additional San Francisco applicants who were seeking renewal of their grants, the Aguilas and Stop AIDS Project, leaves a significant gap in services to two other high-risk populations: Latino men and gay and bisexual white men.

San Francisco is well known for its diverse and multicultural population. Though over half of the city’s residents are people of color, San Francisco’s epidemic, compared with national trends, affects a greater proportion of gay and bisexual white men. White residents account for 43.6 percent of the San Francisco population but comprise 67.2 percent of persons living with AIDS. Latinos account for a disproportionate number of cases nationwide, representing 13% of the population, but 19% of new AIDS cases reported. Without CDC funding for HIV prevention services targeted to these populations, I am concerned that the progress we have made in addressing prevention in these populations will rapidly erode.

As you are aware, San Francisco was one of the first epicenters of the AIDS epidemic and continues to be one of the hardest hit areas in the country. Today, there are an estimated 23,000 people living with HIV/AIDS in the San Francisco metropolitan area, one of the highest per capita rates of total AIDS cases in the country. San Francisco also has the tenth highest rate of new AIDS cases in the nation, and an increasing rate and prevalence of HIV infection. It is estimated that 1 in 40 San Franciscans is infected with HIV.

After reviewing the CDC’s Strengths and Weaknesses statements on the grant applications for the Stop AIDS Project and Aguilas, I am concerned that the evaluation contains several inaccuracies and clear contradictions. The following are two examples of the misinformation contained in CDC’s statements for Stop AIDS Project:

  • Under Section C, one weakness reads, “The overall confidentiality plan for program is not clearly defined.” Yet, two strengths read, “QA plan is extensive and detailed” (Section C) and “Applicant has a clearly articulated plan for confidentiality” (Section E). In addition, in Section E with the same confidentiality plan in place, a strength includes, “Applicant has a clearly articulated plan for confidentiality.”

  • Under Section C, another weakness reads, “Applicant should identify strategy or plan to identify and address additional barriers as they emerge.” The application extensively noted strategies and plans to address barriers in the areas of accessing, recruiting, retaining, and involving the target population (pg 11- 17). In fact, a strength in this section reads, “The applicant has demonstrated strategy used to provide involvement of the targeted population in the planning and implementation of this program.”
    The following are examples of inaccuracies of the Strengths and Weaknesses statements for Aguilas:

  • In Section B, one weakness reads: “Concern over whether staff credentials (i.e. Ph.D.) are truly indicative of its cultural competency and sensitivity to the target population.” However, a strength in Section B states, “Demonstrates a history of culturally and linguistically appropriate prevention services.” Dr. Eduardo Morales is a nationally recognized researcher and has written extensively on HIV, particularly involving Latino gay/bisexual men. The remaining staff is comprised of bilingual Latino gay men who reflect the diversity of the population served and demonstrate a high level of cultural competence.

  • In Section E, a weakness reads: “Regarding quality assurance, the applicant emphasized staff performance rather than program effectiveness.” While the application extensively cites staff qualifications, training, supervision and evaluation, it also notes program effectiveness and quality assurance throughout the document. Page 9 of the application describes quality assurance strategies, including: surveys of participant satisfaction, program effectiveness and topics of interest; data collection on client satisfaction based on type of group, facilitator and topics covered; ongoing training and supervision of staff and facilitators providing prevention services; and staff evaluations and professional development plans.

I respectfully request a detailed explanation of the process by which allocations were made. The CDC reports that after reviewing independent scores, they made adjustments to ensure representative funding. Please explain that procedure, provide a response to the concerns raised herein, and provide documentation that allocations were made in an equitable and accountable way. In addition, I hope that we will be able to work together to identify other funds within the CDC to help offset these cuts and prevent reductions in critical prevention services for San Franciscans at risk for HIV infection.

Thank you for your immediate attention to this matter. I look forward to working with you to ensure that people at risk for HIV infection in San Francisco and across the country have access to the HIV prevention services they need to stay healthy.

Sincerely,

NANCY PELOSI
Democratic Leader


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