Georgia’s HIV Unit continues to struggle with internal turmoil and lack of leadership, and is constantly mired in bureaucracy directly impacting care for people with HIV and AIDS, activists say.
In late June, the state’s HIV prevention program manager, Leisha McKinley-Beach, resigned the post after only 16 months on the job. Before she took the job, the position was vacant for two years.
“The state has not provided any leadership toward public health in general and HIV in specific for several years,” said Jeff Graham, executive director of Georgia Equality and a veteran HIV/AIDS activist.
In 2009, Georgia Equality formed the Georgia HIV Advocacy Network after it determined there was a void in the community to lead HIV advocacy efforts.
The loss of McKinley-Beach is just one symptom of the troubles of the state’s HIV Unit, Graham said.
“She cared, she was compassionate and she was passionate. And most importantly, she was very smart,” he said. “We lost a great person.”
The HIV Unit originally was part of the state Department of Human Resources and was then rolled into the Department of Community Health. On July 1, the HIV Unit became part of the new standalone Georgia Department of Public Health.
“Now there is a third standalone department, and I’m willing to give them a chance to do their job,” Graham said.“There are good people in the unit, but they’ve been shackled, they’ve had to answer to so many people. There’s the standard problem with bureaucracy. The staff doesn’t have leadership or support. And you have had this constant turmoil for past the three years.”
The HIV Unit, now that it’s part of the Department of Public Health, must tackle within the next two months the AIDS Drug Assistance Program crisis in the state, Graham said.
More than 1,600 people remain on the state’s waiting list for ADAP, a program that provides life-saving drugs for people who have no insurance or who are underinsured.
“We have people who have been on the list for a year. They’ve got to start cycling people through,” Graham said.
Prevention money going to waste?
Mark Douglas, a co-founder and the executive director of My Brothaz Home in Savannah, is also co-chair of the Georgia HIV Prevention Planning Group. The planning group is a collaborative body of representatives of state, local or territorial health departments “charged with planning strategies to prevent the spread of HIV in Georgia’s urban and rural areas.”
This can be hard to do when the state itself has no strong leadership, Douglas said.
“We need continuity, stability,” he said of the HIV Unit. “Now that it’s in a separate department, I hope it will be different.”
The constant turnover in the HIV Unit — there have been nine different directors over the past seven years — makes it difficult to keep a stable approach when it comes to HIV prevention in Georgia.
“We are always losing people, losing experience and losing a connection to the community,” Douglas said.
Red tape at the HIV Unit also makes it difficult for agencies to receive federal funding for prevention programs from the federal Centers for Disease Control & Prevention. Georgia ranks sixth highest in the nation for its cumulative reported AIDS cases, based on the most recent data released in 2009, according to state records. And in 2009, there were 2,250 newly diagnosed HIV/AIDS cases in the state — 61 percent were HIV (that had not progressed to full-blown AIDS) and 39 percent were AIDS.
Bringing down these numbers is crucial to stemming the epidemic in the state. It is the HIV Unit that is responsible for distributing CDC funds to state health departments and HIV/AIDS agencies for prevention efforts, such as outreach, support groups and free HIV testing.
“The bureaucracy just takes forever. There are delays [in getting grants]. Sometimes it takes six months or more. That’s my biggest complaint,” Douglas said. “And that makes it hard on us to deliver contracts.”
My Brothaz Home was to receive funding in September 2010 as part of the CDC initiative to test more people and link them to care. But the agency did not receive the funding from the state HIV unit until January 2011. That means the agency lost three months of providing services.
“We got a one year grant that we now had to conduct in nine months,” Douglas said. “The paperwork just goes through so many people. It impacts my work locally, changes my timeline, I have to adjust my budget, change personnel. We’ve had to lay off — it just messes everything up,” he said. “And it shouldn’t be that way.”
And when an agency cannot spend all of its money, the money goes back to the state, which in turn must return it to the CDC.
“From fiscal year 2007 through fiscal year 2009, the Georgia Department of Public Health averaged an annual award of approximately $7.93 million and requested to carryover funds an average of 8 percent [or about $634,000] per year,” said CDC spokesperson Scott Bryan.
“Essentially, if a health department has unspent funds at the end of the year, that money is returned to CDC. The state health department can request those unspent funds be carried over and added to the following year’s budget (funds),” he added.
Simply put, Douglas said, that is “government waste.”
“We don’t need to give any money back. This money needs to hit the streets,” he said. “It should be going to local on-the-ground community based organizations.”
Instead, the money may go to health departments across the state. But even then the money is not being used wisely, Douglas argued.
“Health districts don’t have the history or experience reaching black gay men, transgender, high risk populations. The state needs a lot of improvement,” he said.
HIV Unit: ‘Committed to improving’
Dr. Brenda Fitzgerald, who has been on the job approximately four months as Commissioner of the Georgia Department of Public Health, said that rolling into a new standalone Department of Public Health has caused some hiccups in service. But Fitzgerald said she and her staff understand there has been a history of staff turnover and plenty of red tape.
However, the staff is committed to making changes as it begins a new chapter.
“I’ve been the commissioner here for about four months, and the head of HIV [in the Department of Public Health], Dr. Anil Mangla, has been here for about a year,” Fitzgerald said.
“We are committed in this new department to improving,” she added.
Fitzgerald said they are in talks with funding agencies, such as the CDC, on how to spend efficiently.
And while there are 1,600 people on the ADAP waiting list, approximately 99 percent are receiving their needed medications through pharmaceutical companies, Fitzgerald explained, so that no one is going without treatment.
Making sure agencies receive money in a timely manner is also a definite area the HIV Unit wants to work on, Fitzgerald said.
“Because it is unacceptable. We will put a new plan in place to get time tracks moving. That will not be tolerated,” she said of agencies receiving funding late.
In 2009 (the most recent figures available), the number of people living with HIV/AIDS in Georgia was 40,328 — 43 percent had HIV (not AIDS) and 57 percent had progressed to AIDS. In 2009, 67 percent of Georgians living with HIV/AIDS resided in the Atlanta metro area.
Men who have sex with men accounted for 49.1 percent of HIV cases while 46.6 percent of AIDS cases were among gay and bisexual men.
“We want to make an impact. We want to increase awareness, education, and make sure that’s happening,” Fitzgerald said.
“We are looking at that whole area of these non-treatment funds very carefully and at that entire process, to make sure every single dollar is used in the best way possible,” she said.