The goal of the High Impact HIV Prevention Services funding allocations was to dramatically increase HIV testing in high-incidence, geographically targeted areas in order to increase the number of people who know their HIV status and are linked to medical care, partner services and prevention programs. People who are unaware of their status drive the epidemic. Research shows that once individuals learn they are HIV-positive, they take steps to protect their own health and prevent HIV transmission to others. Reaching HIV-positive individuals is the core of the President’s National HIV/AIDS Strategy, the CDC’s new HIV-prevention priorities and the Philadelphia Health Department’s strategic direction to reduce HIV infection.
Because of the disproportionately high rate of HIV/AIDS in minority communities, reaching HIV-positive African Americans and Latinos, particularly men who have sex with men, through an effective, strategic testing program was the critical factor in making these High Impact Prevention Services awards. An agency’s track record in reaching HIV-infected individuals through its testing program was an important factor in selecting agencies that were funded.
The allocation process began with a Request for Proposals for funding issued by the AIDS Activities Coordinating Office based on the CDC funding requirements and the Philadelphia Comprehensive HIV Prevention Plan, which is produced annually by the HIV Community Planning Group housed in the City’s Office of HIV Planning. Since the mid-1990s, the HIV Resource Allocations Advisory Committee (RAAC) evaluates all proposals and makes specific funding recommendations to the health commissioner, who makes the final allocation decisions. The RAAC was created to assure objective review of all eligible proposals. Along with making recommendations to the commissioner, they identify strengths and weaknesses in proposals that are provided to the applicant upon request. One half of the membership of the RAAC consists of persons living with HIV/AIDS from the community, and all members must be free of potential conflicts of interest in the outcomes of their recommendations at all times (not just at the time of appointment). The committee is representative of the community and of the epidemic in Philadelphia and the eight surrounding counties. Committee members are continuously trained on the shifting dynamics of the epidemic and the federal, state and city’s response. Since its creation in the mid-1990s, the membership of the RAAC has been confidential to ensure no one is subject to undue influence or pressure by grant applicants.
The Department of Public Health/AACO understands that it is imperative to work in partnership with community-based agencies that have specialized in helping people of color, not only with this High Impact HIV Prevention Services CDC funding but with other city, state and federal prevention funding. It means that while some agencies received funding from High Impact HIV Prevention Services dollars, other agencies continue to receive other AACO dollars. For instance, The Attic received level funding from HIV Impact HIV Prevention Services RFP, and in addition receives $165,274 in other AACO funds. The Safeguards Project of the Family Planning Council of SEPA received an increase in funding through this RFP and, in addition, receives $179,474 in other AACO prevention and testing funds.
The complex nature of AACO funding sources and the variety of RFPs that AACO puts out each year make it at times confusing about whether a given funding decision disadvantages or changes an organization’s funding from AACO. This is relevant to other agencies cited with concern by community members when AACO announced the funding levels coming from this RFP. YO-ACAP, BEBASHI and GALAEI had not received CDC prevention funding in the past so did not experience a decrease in funding. They continue to receive other prevention funds from AACO (BEBASHI: $468,294; YO-ACAP: $346,406; and GALAEI: $319,687). After a meeting between AACO and the COLOURS board of directors, called because of the unexpected death of its executive director, the COLOURS Organization received $135,000 in CDC funds, which is a cut of $55,000 in CDC funds, and also continues to receive $15,000 in other AACO prevention funds.
Tough funding decisions will become increasingly common as federal and state dollars shrink. Consistent with the president and CDC’s HIV prevention plans, we must intensify proven prevention interventions where HIV is most heavily concentrated and increase the percentage of HIV-diagnosed men who have sex with men, African Americans and Latinos who are linked to care. We believe these most recent funding allocations are consistent with this goal.