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SPONSOR: |
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DATE TYPED: |
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HB |
577 |
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SHORT TITLE: |
Native American HIV & AIDS Services |
SB |
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ANALYST: |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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$279.0 |
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Recurring |
GF |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Relates to: SB 49, HB 485, HB 144
Responses
Received From
Department
of Health (DOH)
Health
Policy Commission (HPC)
Office
of Indian Affairs (OIA)
SUMMARY
Synopsis
of Bill
House Bill 577 appropriates $279,000 from general fund to
the Department of Health for expenditure in FY 04 for services for Native
Americans living with HIV/AIDS.
Significant
Issues
The issue of
providing culturally appropriate and sensitive comprehensive medical services
to Native Americans with HIV/AIDS is being addressed by the Department of
Health through a system of Health Management Alliances (HMAs). The Department of Health has established
managed care contracts with four regional HIV/AIDS HMAs to provide HIV/AIDS
specialty case management, direct outpatient medical care services, HIV/AIDS
medications, practical and emotional support services, housing assistance,
mental health care, food bank support, and home health care. A Native American specific HMA located in
The
Department of Health, Office of Epidemiology, HIV Surveillance identifies 108
Native Americans (diagnosed and living) with HIV/AIDS in our state. Currently 87 are being served by the HMA
system described above; approximately ten percent (10%) of this number is
served by the Native American HMA in
FISCAL IMPLICATIONS
The appropriation of
$279.0 contained in this bill is a recurring expense to the general fund. Any
unexpended or unencumbered balance remaining at the end of FY 04 shall revert
to the general fund.
The General Appropriations Act provides $470.0 from the
tobacco settlement program fund for HIV/AIDS prevention services.
ADMINISTRATIVE IMPLICATIONS
The administrative impact to the Department of Health would
be minimal and could be handled with existing staff and the current HMA system.
RELATIONSHIP
Relates to:
The General Appropriations Act provides $470.0 from the
tobacco settlement program fund for HIV/AIDS prevention services.
Senate Bill 49 and House Bill 485, which proposes a $2
million appropriation to the Department of Health for HMA services and HIV
prevention.
House Bill 144 appropriates $470,000 to Department of Health
for HIV services and prevention from the Tobacco Settlement Fund. This would maintain the current level of
funding from that source.
HB608, appropriates $200,000 from the General
Fund to the Department of Health to fund prevention programs for Native
Americans with HIV and AIDS.
In the title of HB 577, “Making an Appropriation to the
Department of Health to Fund Services for Native American Victims of Human
Immunodeficiency Virus and Acquired Immune Deficiency Syndrome”, the word
“victims” could be replaced by the more common usage of “people living
with”. This also applies to the word
“victims” in the body of the bill.
Consideration should
be given to broadening the language in the HB 577 to allow some funding to be
used on prevention. Enhanced prevention services would serve to slow the
epidemic among this population.
OTHER SUBSTANTIVE ISSUES
Existing federal and state funding is significant, but not
adequate to provide care and services to all with HIV/AIDS, including Native
Americans. As the number of Native Americans with HIV/AIDS increases, the Native
American HMA is eligible to negotiate additional funding. The entire HMA system
needs additional funding for medications and services. This is due in part to
improved treatment technology and drugs.
Most individuals with HIV/AIDS are living longer and therefore require
ongoing, long-term care.
Increased targeted prevention efforts would lead to the
identification of increased numbers of Native American with HIV/AIDS. The appropriation contained in HB 577 could
expand the capacity HMAs to serve Native American clients with the full
spectrum of care services. The Centers for Disease Control and Prevention (CDC)
estimates as many as one third (1/3) of the population living with HIV/AIDS is
unaware of their condition. Given the
geographic and economic isolation of many Native Americans (a frontier
population), and the stigmatization of HIV/AIDS, the barriers to seeking HIV
testing are significant. As such, the
number of Native Americans living with HIV/AIDS could certainly be higher than
reported.
One of these HMAs is First Nations Community
Health Services, which provides culturally appropriate and sensitive medical
services to Native Americans. First
Nations has seen its budget reduced each year for the last 2 years – the
funding provided by HB577 would restore their budget and allow the agency to
continue serving Native Americans with HIV/AIDS.
The New Mexico Governor’s Task Force on HIV/AIDS
reported in January 2001 that HIV/AIDS is a serious problem among Native
Americans:
·
Between
1981 and 2000, a total of 132 Native American HIV/AIDS cases were reported in
·
More
Native Americans were infected via heterosexual transmission than any other ethnic
group in
·
A
higher percentage of Native American HIV/AIDS adult cases have been female –
18% - compared to other racial groups in
·
Many
Native Americans living with HIV suffer from poverty, isolation, drug or alcohol
addiction, as well as dual-diagnoses with other conditions such as diabetes and
hepatitis.
According to the Department of Health:
·
As of
·
Between 1981 and 2002, the cumulative total of
Native American HIV/AIDS cases is 157, representing 5% of the total for New
Mexican HIV/AIDS cases.
In
its
·
Native
Americans with HIV are vastly under reported.
·
Many
Native Americans living with HIV disease avoid the healthcare system altogether
for:
1) Lack of money.
2) No transportation.
3) Little or no
information.
4) Culturally inappropriate
and ineffective healing approaches.
5) Concerns of
confidentiality.
6) Concerns of
discrimination.
First
Nations, the Eight Northern Pueblos, and other organizations are working to
address these barriers. For example, the
Navajo Aids Network (NAN) promotes culturally relevant information in its
healthcare practice by providing counseling, confidentiality and traditional
beliefs and concepts.
(www.navajoaidsnetwork.org/pservices.htm.)
OAA notes that culturally appropriate and
culturally sensitive preventative programs that target not only Native American
males, but Native American females, and Native American youth would be of great
service in preventing at risk behavior and slowing the spread of HIV/Aids in
urban and rural Native American communities in
Drastic new cuts in the Indian Health Service
Budget being made as this analysis is written will not allow for HIV/AIDS preventative
programs, and much new screening or education is doubtful due to these drastic
cuts.
On Lines
12 and 19, replace “victims of” with “people living with”. On Line 20, after “syndrome” add “and
HIV/AIDS prevention services to Native American communities.”
BD/njw