VOICES FROM THE MOUNTAINS:
AIDS and the Illusion of Fiscal Responsibility

Bennett Law

BETHEL -- In mid-October the AIDS Program of
the Department of Health at long last was allowed
to recruit applicants for three federally funded
positions established to implement HIV prevention
programs in the state of Vermont. A hiring freeze on
state employees instituted by the Dean
Administration was inexplicably extended, denying
the filling of positions funded entirely by federal
monies. The Dean AdminislIation’s effort to
convince Vermonters that it is serious about limiting
the size of government only hamstiung efforts to
improve the effectiveness of Vermont’s AIDS
service community. This ill—conceived political
strategy, which similarly negatively impacted
federally funded positions devoted to cancer,
amounted to nothing less than an abdication of its
responsibility‘ to protect the public health.
Introduction of much needed services in the
continuing struggle to halt the spread of HIV
infection was unnecessarily delayed.

The Vermont HIV Prevention .Community
Planning Group (CPG), established and
supported entirely with funds provided by the
national Center for Disease Control (CDC)
operating out of Atlanta, was created to ensure
that HIV prevention strategies implemented by
the state Department of Health reflect explicit,
community-identified needs enunciated by a
body “which reflects in its composition the
characteristics of the current and projected
epidemic” in Vermont. Members are selected to
represent the communities at highest risk for
HIV infection, including men who have sex with
men, injection drug users, women at risk (both as
injection drug users and as sexual partners of
I-IIV—infected men), youth at risk, persons of
color, people with hemophilia and their sexual
partners, and the HIV-infected and ‘their sexual
partners. In addition, CDC specified that “the

recruitment process for membership (be)
proactive to ensure that socioeconomically
marginalized groups, and groups that are
underserved by existing HIV prevention

programs, are represented.”

CPG, which has been in operation for nearly two
full years, unites people from all over the state
living and working at the heart of the battle
against new HIV infections. Medical
practitioners, mental health professionals, people
working in street outreach and corrections
programs, clergy, students, teachers, youth
counselors, people working with the Red Cross,
the Department of Education, Vermont’s AIDS
service organizations and the AIDS Council, of
assorted ages, races, religions, genders, sexual
orientations, HIV-positive and the non-infected
—- all come together as members of CPG to lend
their talents to the battle against new HIV
infections in Vermont.

In the September report made to the Community
Planning Group of implementation progress of
directives emanating from its 1994 plan, an
abbreviated list of the projects, recommendations
and activities identified as being at least partially
“delayed pending hiring of additional staff’
included the following:

* the provision of technical assistance to
providers and potential providers to increase
expertise and organizational capacity

* establishment of links between primary and
secondary prevention service providers

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* evaluation of Department of Health
counseling and testing and public information
programs

* expansion of hotline hours

* development of materials describing testing
options and efforts to raise awareness of
testing among targeted communities

* outreach to domestic violence and abuse
victims

* increased linkages between programs of the
Department of Health and the Office of
Alcohol and Drug Abuse

* approaches to business leaders/employers in
support of HIV prevention including
workplace education and employment
policies

* engagement of clergy and religious
communities in support of education and
prevention

In its 1995 report to the Centers for Disease
Control, the Community Planning Group stated
that “the greatest obstacles in integrating the
CPG—developed priorities into ongoing program
activities and funding have related to the
challenge of getting the programs  up and
running.” The report went on to state that “state
budget shortfalls (that) resulted in severe
restrictions on state hiring and contracts created
special implementation problems. For example,
while the Department of Health was able to issue
a vastly increased amount in grants to community
organizations for prevention activities, the ability
to hire new employees to support these grants
through coordination of training and technical
assistance activities means that there has been
delay in implementing the capacity building and
prevention support programs envisioned by the
planning group.”

Unable to overcome the political hurdles and‘ ‘

lines drawn in the sand by an administration
struggling to establish itself as responsible, and.
faced with the possible forfeiture of federal
funding, the AIDS Program of the Department of
Health negotiated an agreement to secure new
staff to perform the CPG’s mandates by issuing
grants to community—based organizations to hire
them. This ultimately allows, after considerable
delay, for the implementation of essential grantee
support activities, training, and technical
assistance, and early intervention activities
determined by the CPG to be vital in halting the
spread of HIV.

The Dean Administration traded the
straightforward and responsible performance of
its public health charge for the illusion of fiscal
responsibility. The new staff needed to support
the IHV prevention efforts recommended by the
Community Planning Group are entirely funded
by federal monies: not a single penny of state
revenue was requested. While the Dean
Administration measures its effectiveness in
dollars, those of'us committed to fighting the
spread of HIV in Vermont are measuring the
battle in new infections.

____...___._____._..._..___..________________'

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12/95

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December “1995‘

In the fight against HIV, time counts. With each passing month
additional young people become sexually active for the first time,
individuals turn to (or return to) injection drugs, and a host of
Vermonters wittingly or unwittingly place themselves at risk for
HIV infection. All Vermonters deserve more respectful
consideration from our state officials. The Governor and his staff
need to realign their priorities to ensure that their nonsensical
political maneuverings don’t cost Vermonters their futures.

Bennett Law is a member of the Vermont HIV Prevention
Community Planning Group. '

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