Seeks Explanation from CDC Director for Cuts in San Francisco AIDS
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
Julie L. Gerberding, MD, MPH
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Dear Dr. Gerberding:
Thank you for
your work to strengthen our nations 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
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 Preventions (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.
is well known for its diverse and multicultural population. Though
over half of the citys residents are people of color, San
Franciscos 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.
the CDCs 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
CDCs 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.
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.