“While sequestration will have an impact on all ADAPs…it will have a significant impact on individuals living in the South. As of June 2012, southern states accounted for 33 percent of all ADAP clients served; through sequestration, up to half of the clients that will loss ADAP services reside in southern states.”

Budget sequestration is scheduled for today.  In other words, “a series of automatic, across-the-board cuts to government agencies, totaling $1.2 trillion over 10 years,” and split evenly between defense and domestic discretionary spending, will take effect. (Source)

Overall, budget sequestration will reduce funding for HIV/AIDS programs, “greatly compromise state health departments’ ability to implement programs,” and “erode the nation’s ability to meet the goals of the National HIV/AIDS Strategy (NHAS).”  (Source) Specifically, the National Alliance of State & Territorial AIDS Directors (NASTAD) estimates in The Impact of Budge Sequestration on Federal Funding for State HIV/AIDS and Viral Hepatitis Programs in FY2012 that, if sequestration occurs:

• ADAP will face an estimated $77 million in cuts, impacting 15,708 clients.
• Ryan White Part B to state health departments will face cuts of approximately $25 million.
• Funding for enhanced HIV testing will face approximately $5.4 million in cuts, which will lead to an estimated 412 HIV+ individuals not being identified each fiscal year.
• Health departments’ HIV surveillance efforts will face approximately $9.7 million in cuts.

Additionally, a new report, The Effect of Budget Sequestration on HIV/AIDS in the United States: Protecting the Human Impact in Fiscal Year 2013, by The Foundation for AIDS Research (amfAR) and the National Minority AIDS Council (NMAC), estimates that:

• Over 6,760 PLWHA of color will loss access to ADAP (of the approximately 10,130 PLWHA that amfAR and NMAC estimate will loss access to ADAP).
• Under the Housing Opportunities for Persons with AIDS Program (HOPWA), an estimated 1,360 fewer households will receive permanent housing and 1,780 fewer will receive short-term assistance.  Notably, “1,920 households that include at least one person of color [will] lose HOPWA housing services; 580 households that include at least one Hispanic person [will] lose housing services.”
• The National Institutes of Health (NIH) will face approximately $163 million in cuts to AIDS research funding. Specifically, “297 AIDS research grants [will] go unfunded, including 32 specifically funding AIDS vaccine research.”
• CDC-funded state and local prevention efforts will face more than $41.7 million in cuts.

Additionally, the impact of ADAP cuts will be disproportionately felt by the South. NASTAD recently released a one-page fact sheet entitled, The Devastating Impact of Sequestration on ADAP in the South: Sequestration Would Leave Thousands of People without Access to Life-saving Medications.  This fact sheet highlights that, of the approximately 15,000 clients losing access to ADAP, “[a]lmost half of the people that will be disenrolled live in the South, which as of 2010 accounted for 45 percent of all new AIDS diagnoses in the U.S.”  (Source)  Specifically:

• In Florida, it is anticipated that more than 1,000 clients will be impacted.
• In North Carolina and Texas, it is anticipated that 301-1,000 clients will be impacted.
• In Georgia, South Carolina, and Tennessee, it is anticipated that 201-300 clients will be impacted.
• In Alabama, Louisiana, Kentucky, Oklahoma, and Virginia, it is estimated that 101-200 clients will be impacted.
• In Arkansas, Mississippi, and West Virginia, it is estimated that less than 100 clients will be impacted.

Many southern states will also not be expanding Medicaid (Source), which would “provide coverage for the many people living with HIV in South who are currently uninsured.”  (Source)  ADAP underfunding will thus have far reaching consequences, including the exacerbation of existing structural barriers to health, as well as an increase in new infections, “particularly in the South and among people of color who are already disproportionately impacted by the HIV epidemic.”  (Source)