It's just after 2 p.m. at Bryan's House, and most of the 2-year-olds have fallen asleep for their afternoon naps. They sleep in a semicircle, each boy or girl on his or her own miniature cot. Across the hall, the 3-year-olds are stirring. One girl with beaded hair is making a necklace. Another points at a finger painting she recently finished.
David Thomas, the director of Bryan's House, bends down to ask the girl how she's doing. She shyly tucks her head and smiles. "I don't get much time to talk to the children," Thomas says. "But it's the best part of my job."
Bryan's House is one of the only places in Dallas that provides day care specifically for poor children affected by HIV/AIDS. During the summer, the center serves 80 to 90 kids, from infants to 11-year-olds, while their parents work. Few of the children have HIV or AIDS. Most, if not all, are affected by AIDS through a family member who has the disease.
Bryan's House may be in trouble. In July, the center lost $70,000 in federal funding. Next year, it stands to lose even more. "We're the only place where poor people with HIV or AIDS can go to find day care for their children," Thomas says. "Without us, some of them wouldn't be able to work, and if they can't work, they can't afford the medications they need to keep them alive."
AIDS is no longer seen the same way it was 25 years ago, when the first case was reported. Today, it is a chronic, yet manageable, disease. Because of that, the federal government is changing the way it spends money to fight the epidemic among the poor. Over the last several years, it has mandated that more and more of the money that comes out of the Ryan White Act, which provides most of the federal funding for AIDS care and services for the poor, be spent on medical treatment instead of social services.
In the next year, Congress is expected to require local communities to spend 75 cents of every dollar that comes out of Ryan White funds on medical treatment. Thomas says this could force Bryan's House to cut back on some services such as day care. Other AIDS-specific organizations in Dallas are also losing money. AIDS Interfaith Network, which provides adult day care, lost $260,000 this year and was forced to cut back on some of its services.
Some AIDS organizations say the shift in funding is a good thing, however. Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles, says there are still thousands of people in the United States with AIDS who are not receiving treatment. The primary purpose of the Ryan White Act, he says, is to make sure people with HIV/AIDS get medical care. And while social services are an essential part of the equation, they are not as important to fund as clinics that provide medicine, especially now that there are drugs that can be used to effectively manage the disease.
"Ten years ago we had a revolution in treatment," Weinstein says, referring to these drugs. "And we have to catch up to that. I mean, this is a treatable disease, and we need to treat it like other illnesses. You can't have the tail wagging the dog." For too long, Weinstein says, most of the money the federal government spent on AIDS among the poor was going toward social services. That has to change, he says.
"Times have changed. You have this very large constellation of organizations nationwide that exist to deal with this issue but not as many are needed, or they need to change their focus to other areas like medical care or testing or other things that are needed now."
Parkland Hospital and other health care providers will benefit the most from the shift in funding. This year, for example, Parkland received $571,161 more than last year through the Ryan White Act. While Sylvia Moreno, the hospital's director of HIV services, agrees that treatment is the most important thing for those with HIV/AIDS, she says it would be a mistake to take money away from support services.
If her patients lose access to transportation, for example, they won't have a way to get their medication or make their doctor appointments. Besides that, social services that serve the poor are already struggling to meet demands.
"There's 15,000 people out there in the Dallas area who are HIV-positive today. The majority of these folks live at or below the poverty line, and as HIV services go away these folks are going to be forced into the general social service world more and more," says Raeline Nobles, executive director of AIDS Arms, which serves 3,000 clients in the Dallas area. "Already that social service world is so strapped for resources. How in the world do we expect them to absorb all these people overnight basically?"
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Without places such as AIDS Arms and Bryan's House, people like Gina Brown, who has HIV, say they wouldn't be able to manage the disease. Brown's 11-year-old daughter goes to Bryan's House during the summer while her mom works. Brown says she has also relied on transportation services in the past to get to work and make doctor's appointments.
"Without support services they won't remain consistent with their care," says Steven Pace, executive director of the AIDS Interfaith Network. "People will start showing up in crisis or in urgent need and that will be serving them through emergency rooms and urgent-need clinics, which is far more expensive than serving them through the regular HIV and AIDS clinics."
Back at Bryan's House, David Thomas walks outside to visit the playground. He points to a basketball court donated by Mark Cuban and former Mavericks player Shawn Bradley. In the future, he says, Bryan's House will have to rely more and more on private donations.
"Without us here, what's going to happen is those children are going to be in foster care in a system that's already overwhelmed and swamped. The mother is going to fall off the edge, and we're going to lose the members of that family to another generation of severe crisis and illness," he says. "We do everything we can to make sure that doesn't happen."