members, the choice by some planning bodies to allocate funds in areas that are not consistent with assessed needs, institutional inertia in changing a planning body’s past allocation decisions, and perceived conflict of interest among planning council members whose agencies receive CARE Act funding.

Consistent with these challenges, the Committee notes that although the needs of people with HIV have changed dramatically, especially after the advent of HAART in 1996, the allocations by category of funds in the Title I program have largely remained the same. Health care services have not received a substantial increase in Title I funding, even though many people with HIV are not covered by Medicaid, Medicare, or private insurance and lack access to basic HIV primary care and medications. Title I funding for health care services actually decreased from 49 percent in 1996 to 44 percent in 2000, despite rapid advances in HIV care. The Title II ADAP has filled the need for prescription drugs, albeit with a thoroughness that varies among states. Antiretroviral therapy alone, however, is not helpful unless patients have access to experienced physicians who prescribe and manage the therapy. Illustrative comments on some of these challenges are included in the following testimony excerpts.

External Coordination

“Medicaid, the state substance abuse treatment agency, and the Title II consortia do not fully coordinate their programs or their funding as outlined in the EMA’s plan. So, here we are, writing plans that are, I hope, realistic most of the time and evidence based, as much as we can, and calling for other systems and other players and other parties to do things. They say they will. We know they have the plan. We train them on it. We shared it with them and maybe trained them on it and maybe helped with it, but then nothing happens with it on their side” (planning council representative).


“Issues related to HIV service delivery and financing are not commonly a major consideration in the planning, design, and implementation of broader public financing. Broad policy issues are also not within the authority of HIV planning bodies or CARE Act grantees” (researcher).

Internal Planning Body Collaboration and Functioning

“They [council members] come to the table with varying degrees of planning experience. Some are quite sophisticated and professional and they do it every day. A third are consumers, who are living with HIV and have varying degrees of experience and exposure to planning, to all



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