When Curtis Greenhaw tested positive for the HIV virus in 1982, he—like many others living in San Francisco at the time—considered his diagnosis a death sentence.
Today, at 49, Greenhaw expects to live a long, normal life, working as a volunteer and test counselor at Pacific Pride Foundation, a resource center for HIV-positive clients in Santa Maria.
“I’m healthy,” he said. “I’m taking my pills. I’ve never been sick. I’ve never had any infections or anything like that. I’ve been very lucky.”
Greenhaw is concerned, however; not for himself, but for the welfare of the 190 clients Pacific Pride serves in the county. That’s because the organization and clinics in the Santa Barbara County public health system no longer have the resources to perform HIV-related outreach and education as they once did, due to an $85 million budget cut to the state’s Office of AIDS in 2009.
According to Greenhaw, the situation is dire for HIV-positive patients needing mental health counseling, help navigating through the maze of Medicare and Medicaid, or just someone to talk to.
“They just seem to be tying our hands tighter and tighter,” Greenhaw said. “The client is suffering. Maybe not medically, but they’re not getting their questions answered.”
Greenhaw said it’s fortunate for the local HIV community they’ve even been able to stay open.
“We’re really hurting with donations and staffing, but we’re hanging on,” Greenhaw said. “It’s sad because I think a lot of times our clients in the area feel very left out.”
The story is a similar one at the county’s public health clinics, which serve about 250 HIV-positive clients. Clinics have been forced to scale back services to meet the needs of only the most high-risk of the population, according to Scott McCann, director of health education for the county’s Public Health Department.
“We’re really looking at people’s history of exposure,” McCann said. “Testing is still available, it’s just limited. The concern, of course, are the people who don’t come in and aren’t likely to come in and get tested.”
Most alarmingly, McCann is concerned about the future impact of the cuts on new incidences of HIV infection.
“Our fear is that with all the moderate-risk people now not getting the outreach and education, in five or 10 years we’re going to see a surge of new cases because it will all start happening again the way it used to,” he said.
‘It’s still happening’
According to the Center for AIDS Research, California has the second highest HIV and AIDS incidence rates in the United States, after New York. The California Office of AIDS estimated there were 190,000 people living with HIV in the state in 2009, with up to 7,000 new infections occurring every year.
Greenhaw is one of about 500 Santa Barbara County residents known to be HIV-positive, though the actual number of infected people might be double or triple that number, according to the Public Health Department. Despite decades of education, he said, the numbers keep rising.
“It’s still happening,” Greenhaw said. “We’re still seeing people turn up positive.”
Nationwide, according to the National Centers for Disease Control, more than a million people were living with HIV at the end of 2006. However, Nikki Kay, a CDC spokeswoman, said a recent trend analysis showed a leveling out in new cases.
“We’ve actually seen stability,” Kay said. “But of course, the epidemic remains at an unacceptably high level because it is preventable.”
Unfortunately, Kay said, HIV and AIDS are disproportionately affecting Latinos beyond the rest of the population. In fact, new AIDS diagnoses among Hispanic and Latino men are three times greater than white men, and rates among Hispanic or Latina women are five times greater than white women.
According to the Public Health Department’s McCann, there’s been a general increase of HIV among the local Latino population, especially among pregnant women and migrant farm workers. At Pacific Pride, where about 90 percent of clients are heterosexual, counselors are seeing a significant number of Latino farm workers and their families.
“The men are gone for long periods of time while they follow the fields and pick up and down the valley. A lot of times there’s also prostitutes that follow these groups around,” Pacific Pride’s Greenhaw said. “It’s a stigma in a lot of the cultures. They don’t talk about it. They don’t talk about sex.”
For the recently diagnosed, the county provides a bridge program to help get patients familiar with treatment options available within the public health system. One female bridge program worker, who preferred anonymity, said Oaxacans and Mixtecas in the Santa Maria area are increasingly becoming infected with HIV.
One reason, she said, is that the population tends to be isolated or monolingual, making it difficult to convey information on HIV prevention
or STDs.
“Men who come here and leave their families behind find themselves turning to drugs and alcohol,” she said. “They tend to have risky sexual behaviors and they find themselves infected. It’s culture. It’s socioeconomics. It’s lack of education. They don’t have the resources for the information.”
Before the cuts, bridge program counselors would travel to high-risk places like housing projects and fields to talk about HIV prevention and safer sex practices. However, due to layoffs and reassignments, only two counselors remain, meaning community outreach isn’t being done.
“We don’t have the money to do that sort of prevention,” the source said. “People aren’t getting that information anymore, and so now we’re going to probably be dealing with an increase in infection. It’s kind of a sad thing.”
HIV is especially devastating to the county’s heterosexual Latina women—many find out they’ve contracted the virus only after they’ve become pregnant.
“They’re low risk on paper if you look at them, but then they turn out positive,” she said. “There’s a whole population we’re missing that’s probably infected, but we’re not testing them because we’re not providing those resources.
“I’m afraid to even know what the consequences will be,” she added.
For heterosexual women, according to Christine Lyon, vice president of external affairs for Planned Parenthood, learning methods of prevention is especially critical.
“Worrying about pregnancy is not sufficient, especially for the women. They might have a form of hormonal birth control but that is not going to prevent being infected with an STD or HIV,” Lyon said. “The risks are high. They need education and access.”
Unfortunately, Santa Maria’s Planned Parenthood recently had 60 percent of its funding cut for Confianza, an HIV/AIDS education and prevention outreach program for high-risk Latina women in the North County.
“You’ve got a situation there where you’ve got high teen pregnancy rates, high [STD] rates, it’s a high-risk community,” Lyon said. “Our concern is that we won’t be able to reach as many people in an area we believe requires more resources, not fewer.”
Lyon said though state money is no longer coming in to Planned Parenthood or Pacific Pride, the Santa Barbara County Board of Supervisors have agreed to keep $50,000 in the budget for the county’s subcontracted HIV programs.
“The supervisors have always been incredibly supportive of the prevention and testing programs,” she said. “But everyone’s hurting right now.”
The state of HIV prevention
According to the CDC’s Kay, since some of the nation’s most vulnerable populations bear the greatest burden of HIV, states play a vital role in providing HIV prevention and treatment services.
Kay said the CDC hasn’t studied the possible impact of individual state budget cuts to HIV-related health, but will continue to work with states to optimize existing tools and achieve the best possible public health outcomes.
“We do know that many areas across the country are facing significant challenges and funding shortages,” Kay said. “We’re going to have to increasingly make difficult decisions to ensure that the available funds and resources have the greatest impact.”
In times of funding shortages, Kay said local communities must focus on what works most effectively to stop the spread of HIV: condoms and HIV testing. Unfortunately, because of the cuts, the county is largely unable to provide either on a walk-in basis for free.
Pacific Pride is currently only funded to run HIV testing in halfway houses and Alcoholics Anonymous meetings, and has only a limited number of rapid tests available to the general population. Rapid tests are done with cheek swabs, and take 20 minutes to get results, compared with blood tests offered by Planned Parenthood and most private physicians, which often take two weeks to get results.
Both Pacific Pride and county clinics have had to turn away people who don’t fit certain high-risk criteria for tests, and cuts have forced the county to forgo free anonymous HIV testing on college campuses.
According to McCann, the lack of available testing options could have lasting repercussions on certain segments of the community.
“The outreach testing is really important because it makes it easier and more convenient for people to get tested who otherwise might not do it at all,” McCann said. “If people aren’t getting tested, then we don’t know. If they don’t know their own risk, then they’re not going to get tested, especially older people who don’t perceive themselves at risk.”
Nationwide, the average age of new HIV-positive victims is between 15 and 24. Because of the lingering stigma of HIV, many young people are too embarrassed to ask their physicians for a test, and most will never get one, according to Pacific Pride’s Greenhaw.
“The worrisome thing is that the numbers are going back up, especially in the younger community,” Greenhaw said. “They’re the ones that we need to target, and we’re not being able to do that.”
Young adults who used to visit Pacific Pride for free condoms—either because they couldn’t afford them or were too hesitant to purchase them—are also being left out. The organization can’t supply condoms to schools and no longer gets condoms from the state to provide to the local community; instead they write to condom manufacturers for donations.
In California prisons, where HIV infection rates are eight to 10 times higher than in the general population, state law forbids condoms. While the prison system has its own medical services to treat its HIV-infected population, inmates are shuffled back and forth from jails to the county clinics for medical care.
Through Santa Barbara Neighborhood Clinics, the county used to offer rapid HIV testing in jails, but can now only perform them when they’re court-ordered, usually in cases of sex-related crimes, according to McCann.
The state is responsible for assigning parolees with HIV to caseworkers in their area. Because of the cuts, there are only a few transitional case managers for recently released HIV-positive inmates statewide.
Fears of more cuts
With no indications of when county and community clinics might receive funding from the state’s Office of AIDS to provide the anti-HIV programs they used to, the Public Health Department’s McCann said the HIV community’s highest priority is to maintain medication and treatment programs for uninsured or underinsured sufferers.
Currently, the state’s AIDS Drug Assistance Program provides anti-HIV medications to more than 35,000 uninsured and underinsured Californians who can’t otherwise afford them.
In his 2010 budget proposal, Gov. Arnold Schwarzenegger included $87.5 million for the ADAP program, though a $9.5 million cut to the program means medications won’t be supplied for HIV-positive inmates incarcerated in county jails.
Schwarzenegger has pledged to make no further cuts to ADAP, and McCann said he believes the governor is aware of the importance of the program. Still, he worries.
“The fear is with the ones we serve, almost all of them are low income,” McCann said. “Without the ADAP program, they would be in big trouble because the medications are so expensive to buy privately.”
Diagnosed with AIDS in 2006, Greenhaw said drug advances allowing patients to live longer, combined with the lack of outreach and education now faced by the community, is causing complacency about HIV in a society removed from the AIDS scares of a generation ago.
While he used to ingest as many as 20 pills a day, now he takes just one, a drug called Atripla. It keeps his HIV at undetectable levels, but causes severe side effects, including extreme night sweats and lack of appetite. The prescription also costs more than $900 each month, which, as a Social Security recipient, he’d be unable to afford if ADAP is cut.
“If we lose that, there’s going to be a lot of people hurting out there, including myself,” he said.
Staff Writer Jeremy Thomas can be contacted at jthomas@santamariasun.com.
This article appears in May 5-12, 2010.