At the end of 2013, there were just over 76,600 Texans living with HIV, according to the Texas Department of State Health Services. That's a lot. A decade ago, the figure was about 50,000. Texas ranks fourth among states in total HIV cases and 11th in HIV cases per capita, according to data from the Kaiser Family Foundation. A disproportionate share of those cases are in urban areas like Dallas County, which has more AIDS patients per capita than anywhere else in the state.
On the bright side, new diagnoses are flat; the numerical increase in total HIV cases is due to more effective treatments that keep patients from dying. On the brighter side, programs aimed at preventing, detecting and treating HIV have had a major impact. Without them, state health officials estimate there would be 20,000 additional cases costing an extra $1.6 billion in treatment expenses.
See also: Sex Ed the Texas Way
If anything, the evidence suggests that the state should spend a lot more on HIV prevention than its $192 million outlay from 2013, says Dr. John Carlo, CEO of AIDS Arms. "You pay a dollar now, you save two dollars in the future," Carlo says.
But if the Texas Legislature based its decisions on evidence, then it wouldn't be the Texas Legislature. Rather than increase the $191.4 million in HIV/AIDS prevention proposed for each of the two years covered by the 2016-17 biennial budget, The Texas House actually voted to cut HIV prevention funding by $3 million in the preliminary, two-year budget it passed in the wee hours of Wednesday morning. The money will instead be used to fund abstinence education, which is lovely in theory but, as a mountain of evidence shows, has yet to convince teenagers to stop having sex.
How this came to pass becomes easier to comprehend when one reviews the transcript and learns that Representative Stuart Spitzer, the Kaufman County Republican who pushed the budget amendment, didn't get laid until he married his wife at the age of 29. "I've only had sex with one woman in my life, and that's my wife," Spitzer declared on the House floor while being grilled in highly entertaining fashion by Houston Democrat Harold Dutton Jr.
"I commend anyone who waited until they were almost 30 years of age to have their first sexual encounter," says Dallas County Health and Human Services Director Zachary Thompson. That said, he doesn't think Spitzer's sex life is a good model for crafting public policy. Despite an already heavy focus on abstinence education in schools, teen pregnancy rates in Texas are sky-high, and there's been an unsettling surge in HIV infections among teens and 20-somethings in Dallas County.
"Abstinence education is good for pre-K and early elementary-age school children, but what the data [are] showing is kids 18 to 24 years of age, they are already engaging in sexual activity," Thompson says. Lawmakers should be talking about handing out free condoms in schools, not pouring more money into telling kids not to have sex. "I was shocked that we're still having a conversation about abstinence education."
Shock was a common reaction among local agencies that work on HIV prevention. Rafael McDonnell, communications and advocacy manager for Dallas' Resource Center, says that when he read news about the House budget this morning, he wondered if he'd woken up in the 1990s. "It's not only bad medicine; it's bad public policy," McDonnell says of the budget cut. "And the fact that it was introduced by a doctor [Spitzer is a physician] just gobsmacks me."
McDonnell says its too early to say what impact the House's budget cut would have on the Resource Center, which receives some state funding but also gets significant chunks of its budget through federal Ryan White grants and community support. The cuts, which amount to slightly under 1 percent of the state budget's entire HIV prevention pie, are relatively small, but even a slight reduction endangers at-risk groups like African Americans and young people and sends a terrible message about Texas values.
Carlo, the AIDS Arms CEO, worries about the epidemiological impact that even a small cut to prevention funds will have. Texas has managed to keep the number of new cases in check, but the HIV virus is still prevalent. If lawmakers cripple the public health response to the epidemic, Carlo worries that there will be an explosion in the number of HIV cases. He thinks an HIV outbreak like the one currently taking place in rural Indiana could very easily strike Texas, particularly if prevention funding is cut.
Carlo also worries that a small budget cut could have a cascading effect if it triggers the federal government to exclude Texas from its federal HIV grant programs. The agreements governing federal HIV programs require "maintenance of effort" (i.e. a steady funding stream) from the state in order for it to be eligible for most federal HIV money. Since federal dollars make up about two-thirds of the state's $192 million 2013 budget, that would be catastrophic.
The budget debate yesterday caught Carlo and the rest of the public health community off guard. "Honestly, to bring in something that is such a potentially charged debate around abstinence and the religious aspect of prevention, and to throw that into a budget line item, I think it's frankly unacceptable." But now Carlo's and the rest are on their toes. The Senate still has to pass its budget and the two have to be reconciled, so there's till time to restore HIV prevention funding and with it, perhaps, a dose of sanity.
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