While pundits discuss a possible turnaround in the national economy, Darrel Cummings, the chief of staff at the Los Angeles Gay & Lesbian Center, says Californians haven't begun to feel the worst pain. Facing a $24.3 billion shortfall, the state's governor, Arnold Schwarzenegger, has proposed a new budget for the 2009–2010 fiscal year that drastically cuts or eliminates dozens of state programs.

Cummings says the cuts are brutal, especially for people living with, and at risk of, HIV infection. Schwarzenegger's budget calls for a 12 percent reduction in funding for the state's AIDS drug assistance program (ADAP), the complete elimination of state-funded prevention and education programs and a major draining of California's general AIDS fund—an $80 million slash in total.

HIV services aren't the only programs on the chopping block. The governor's proposal would also kick nearly a million underprivileged children off the state's health insurance program and eliminate state-funded home health care for severely ill people. He has also proposed massive cuts to the state Medicaid program. Cummings and other advocates are working with other disease group representatives wherever possible to oppose the massive cuts. But he warns that advocacy focusing on defending HIV programs also needs to take place.

The proposed cuts in AIDS services could yank California back to state funding levels not seen since the beginning of the epidemic, Cummings says. If the cuts go into effect, they would wipe out years of gains that have made California one of the best states for residents with HIV. He calls the consequences “unthinkable” and says they could literally result in life-threatening situations.

What the Cuts Could Mean

One proposal currently on the table—if ADAP loses 12 percent of its budget—would cut the maximum income limit from $50,000 per year to $30,000. This would mean turning away a significant number of the 34,000 people currently receiving ADAP assistance.

To illustrate the significant and drastic consequences of the proposed budget cuts, Cummings uses Los Angeles County as an example. Of the $8 million in HIV prevention and education grants that were recently awarded to LA-based organizations, $5 million would be eliminated if the state budget cuts go through. Experts say that there are already too few prevention programs for young gay men, so further cuts could be devastating to prevention efforts among this vulnerable population.

The proposed cuts also jeopardize California's claim to federal money supporting HIV prevention and treatment from the Ryan White CARE Act and the U.S. Centers for Disease Control and Prevention (CDC). Anne Donnelly, the director of health care policy for the San Francisco–based HIV information and advocacy group Project Inform, explains that cash from these programs comes with a “maintenance of effort” clause, which requires the states to match federal funds with some of their own money. If California falls below its maintenance of effort—and the proposed cuts would drop funding below the limit, Donnelly explains—the federal government could withhold its considerable share of dollars, further ravaging HIV programs in the state.

What's Being Done

While advocates are busy lobbying state lawmakers, California residents are also being urged to get involved. One initiative being developed is a rally scheduled for 1:30 P.M., Wednesday, June 10, on the steps at the state Capitol in Sacramento. People wishing to go can either visit the organizers' web site or call their local AIDS organizations to see about traveling with others.

State Assemblyman Tom Ammiano (D–San Francisco) advises people with HIV to reach out to other groups and fight for adequate health care for all—but they must make sure their voices are heard. In addition to writing and calling their state elected officials, he says, they should also reach out to their U.S. representatives and senators and plead for federal assistance. Civil disobedience and other forms of activism, Ammiano says, might be equally necessary. He says that the situation is dire and while it may not be possible to head off all budget cuts, there is hope of minimizing the cuts to vital HIV programs.

Fourteen other states are facing multibillion dollar deficits during the next couple of years, including: Arizona, Connecticut, Florida, Georgia, Illinois, Massachusetts, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, Texas, Washington and Wisconsin. Advocates argue that coming out in force in California to preserve state funding for HIV could bode well in these other states should they come up against the same budget challenges.