Bill Tracker

Minnesota's HIV Prevention Budget

Updated: June 27, 2005

MAP STATEMENT REGARDING
CLASSIFICATION OF CRITICAL SERVICES
IN THE EVENT OF A STATE GOVERNMENT SHUTDOWN

Lorraine Teel, MAP Executive Director
Monday, June 27, 2005

HIV is a communicable disease that results in a terminal diagnosis. All efforts need to be made to stop the transmission of virus to those who are not infected. These efforts are largely accomplished through two means:

1. Education messages and prevention programming. HIV education alone is generally passive in nature (e.g. “Learn about HIV”, “Use latex barriers”, “HIV is a dangerous disease”) and thus need to be complimented by prevention programming that includes active dialogue with those who are engaging in high-risk behaviors. As such the State of MN, through the MN Department of Health has established a network of prevention programming those at greatest risk of infection – gay and bisexual men of all races, high risk heterosexuals including efforts targeting African American women, African born Minnesotans and injecting drug users. The programs that are funded through the State (with a combination of state and federal funds) all have the following in common:

a. Community activities which are greatest during the summer months where access to those engaging in the highest risk behaviors are easiest to be found. This might include individual level interventions with those at public sex environments or community festivals and events.

b. Their materials and program plans, including curriculums, need to be set months in advance so that they might be reviewed by a community panel to insure that they are accurate and meet public health standards. As such, these materials and program activities been scheduled and advertised for some time – all targeting audiences that are difficult to access and gain trust with, thus canceling these events might very well result in these individuals not signing up again for similar events.

c. HIV testing is another activity that sees its greatest volume in the summer months. The federal government has just issued a number of alerts coinciding with National HIV Testing Day (June 27, 2005) and as such local HIV prevention providers have been promoting wide spread HIV testing. Signing up for an HIV test, and having one, is a big step for many people and again, not being able to follow through on this campaign would likely result in these individuals delaying another HIV test. Given that “knowing your (HIV) status” has been demonstrated directly to individuals reducing their risk-taking behavior, we’ve lost a great opportunity.

Finally – prevention works. In the past nine years the percentage of those living with HIV in MN has increased 54%. This translates to a 54% increase in the number of individuals able to transmit virus. Despite that the number of new infections annually has stabilized.

2. Case Management Services

a. Case management is the road to health care – prolonged lives, better quality of life, help to stabilize all core functions of life (food/shelter, emotional, interpersonal communication. The Administration has already identified the HIV insurance and drug assistance program and certain HIV housing assistance programs as critical services. However, case management is an essential part of providing these services as it ensures both access and effective use., ....

b. Case management supports medication adherence and medication adherence results in less drug resistant virus being produced

c. Case management is prevention – research shows that those connected to care engage in less high-risk behavior.

Letter requesting that HIV prevention services and social services, such as case management, continue operating in the event of a Government shutdown:

June 22, 2005

The Honorable Gregg E. Johnson
Chief Judge, Ramsey Count District Court
15 W. Kellogg Boulevard
St. Paul, MN 55102

Re: Petition in Support of Temporary Funding of
Core Functions of the Executive Branch of the State of Minnesota

Dear Judge Johnson:

Minnesota AIDS Project respectfully requests with this petition that the Ramsey County District Court grant the Motion of Relief filed by Petitioner Attorney General Mike Hatch for the temporary funding of core functions of the executive branch of government.

According to the Minnesota Constitution, our government is established “for the security, benefit and protection of the people.” MINN. CONST. article I, § I. In 2001, the Ramsey County District Court found that core functions of the government included matters relating to “life, health and safety of Minnesota citizens.” See In Re Temporary Funding of Core Functions of the Executive Branch of the State of Minnesota, No. C9-01-5725, Findings of Fact, Conclusions of Law, and Order Granting Motion for Temporary Funding (Ramsey Co. D.Ct., June 29, 2001). Cited, as examples of these core functions were “the funding of patient care and services in local government or private facilities or programs,” and “federal and/or State contracted or mandated programs and projects.” Id.

Minnesota AIDS Project provides confidential and non-discriminatory services to benefit the health and safety of individuals at risk of HIV infection and to approximately half of Minnesotans living with HIV. These services rely primarily on federal and state government contracts, administered by the Minnesota Department of Health and the Minnesota Department of Human Services. Termination of these services due to a shutdown of core executive branch services would have a devastating effect on Minnesota’s HIV population and on the public health of the state.

Therefore, Minnesota AIDS Project urges the Ramsey County District Court to grant the petition of Attorney General Mike Hatch and declare that the executive branch must continue those core functions required by Minnesota Constitution.

Sincerely,

Lorraine Teel
Executive Director
Minnesota AIDS Project

Updated: June 15, 2005

Read MAP’s Response to Attacks on Effective HIV Prevention at the Capitol

The Minnesota AIDS Project and others who support effective HIV prevention have been working very hard to defeat proposals to place unhelpful restrictions on the content of HIV prevention materials. On Thursday, June 2nd, Lorraine Teel, MAP Executive Director, respectfully but resolutely refuted the statements made by Rep. Tom Emmer (R-Delano) through the past weeks concerning MAP’s HIV prevention messages. Click here to read a transcript of Lorraine’s testimony (PDF).

Click here to listen to Lorraine's testimony (Click on June 2 Working Group Health and Human Services, House File 1422).

Click here to watch Rep. Tom Emmer's (R-Delano) testimony from Wednesday June 1st (it starts at minute 23, ending about 45 minutes later).

Updated: June 6, 2005

MAP Successfully Counters Continued House Attacks

At the Health Conference Committee hearing on Thursday, June 2nd, Lorraine Teel, MAP executive director, respectfully but resolutely refuted the erroneous allegations made by Rep. Tom Emmer (R-Delano) through the past weeks and from the previous day's committee hearing. MAP distributed materials from the Web site highlighting the appropriate warnings and sources of funding as well as an article from a local college student on his experience volunteering with PrideAlive.

Teel also reinforced the point that the materials to which some legislators were objecting were developed and distributed in such a way as to reach a specific segment of individuals engaged in very high risk, sexual behaviors. Teel made no apologies for the accuracy of the information, nor the appropriateness for providing information in a culturally relevant manner as part of a comprehensive HIV information program. She addressed charges by some legislators that MAP refused to talk with Rep. Emmer or others about their concerns, noting that the first MAP learned of these concerns was after amendments had been introduced and included in the House health bill, and that she has never received a direct invitation from Rep. Emmer to discuss his concerns. Click here to listen to the complete hearing (Click on June 2 Working Group Health and Human Services, House File 1422).

Under repeated questioning from Rep. Fran Bradley (R-Rochester) about the appropriateness of the materials, Sen. John Hottinger (DFL-St. Peter) read the opening paragraph aloud from one of the articles being challenged, observing that "It quite clearly discusses the risks of engaging in unprotected sex."

Rep. Duke Powell (R-Burnsville) asserted that given the increasing numbers of STIs and premature births, and HIV, that he didn't think the PrideAlive materials helped the overall situation. Ms. Teel responded that while she was not an expert in this entire list of things Rep. Powell mentioned, she could speak to HIV and noted that the "increases in HIV/AIDS cases were actually flat--in spite of the fact that there are more people living with HIV--and able to spread the disease--than ever before". Her point: prevention works.

Senate Health Committee Chair, Sen. Linda Berglin (DFL-Minneapolis) had compromise language passed out to the committee to amend the HIV content restriction language that was in the House bill. The Berglin compromise language says, in part, that "No state grant money awarded under this section shall be used for web sites, pamphlets, or other communications that contain sexually explicit language or images that are without value based upon scientific and public health research and education standards."

The issue did not come to a vote and will be laid over for future consideration.

Lorraine Teel, MAP Executive Director's, Testimony:

No state dollars were used for these materials. Contrary to what was presented to you earlier, the materials do clearly indicate that no state dollars were used in the production or distribution of this newsletter. And, I might add that the distribution of this material is targeted to PrideAlive participants – adult sexually active gay and bisexual men. Perhaps some of the confusion resulted in a misunderstanding that the Minnesota AIDS Project operates two prevention programs targeting gay and bisexual men – one program receives state dollars (MAP Gay / Bi Health Services) and the other (PrideAlive) does not. The materials in question came from PrideAlive. Our state-funded program, MAP Gay / Bi Health Services does not have a web site.

It seems that at the crux of this matter is the use of sexually-explicit and frank language. While there has been an acknowledgement that such language is at times appropriate, I believe that where we may have differences is in understanding how far that language should go. I certainly understand and accept the fact that as public trustees of the taxpayers resources, you have valid concerns that we are careful stewards of those resources. It is for that very reason that we have developed our two programming strategies. We assure that all of our publicly funded program activities are carefully reviewed and meet federal material review standards as developed by the Centers for Disease Control. These materials routinely go through a local review panel established and run by the Minnesota Department of Health.

And while PrideAlive’s materials and web site do not have to meet these same review requirements (including a disclaimer about sexual content), we did choose to place that language on each page of our web site.

There have been statements made that MAP changed its web site.“overnight” in response to the criticisms leveled by members of this body. I welcome the opportunity to clarify that. We did listen carefully to the concerns raised and took that as an opportunity to clarify on the web site. which programs were publicly funded with State dollars and which were not. And, we have added a popup window for users to click on so that they understand that the material they will be viewing contains sexually explicit language. While this statement basically reiterates what I mentioned was already on each and every web page, we thought that this would help our users understand the content they would be viewing.

I would like to make the point regarding how important web-based outreach and the use of materials that are culturally relevant are. While I obviously don’t have first hand knowledge as I am not a gay man, the subject matter we included in our publications represent the kind of uncomfortable discussions gay men often have in their personal, sexual relationships. Our program functions in many ways to help gay men build the kinds of relationships where they can talk about the most challenging and intimidating aspects of their personal lives without feeling shamed, judged, belittled, or threatened.

Experts at the University of MN have for years researched the use of similar materials in adult education. Here is what they’ve said:

“The use of sexually explicit media (SEM) in sex education is somewhat controversial (p. 117). ... At least according to participants, not only is SEM not harmful, but it may aid resolution of people’s sexual issues and concerns, as well as clarify their emotional responses to aspects of human sexuality. ... It suggests most people find SEM helpful in becoming educated about sex, and comfortable with their sexuality, at least within the context of a structured experience like the SAR. This has important implications for other areas of education, such as HIV prevention, and would argue for employment of SEM as an aid to HIV prevention, rather than relying on non-explicit materials. (p. 126) What is clear from these data is that SEM are not judged harmful, and indeed may aid emotional awareness and aid people’s understanding of their sexual concerns. (p. 127)1

1 “Using Sexually Explicit Material in Adult Sex Education: An Eighteen Year Comparative Analysis”, B.R. Simon Rosser, Ph.D., S. Margretta Sweryer, M.A., Eli Coleman, Ph.D., Beatrice E. Robinson, Ph.D., and Walter O. Bockting, Drs. Journal of Sex Education and Therapy, Vol. 21, No. 2, 1995, pp. 117 – 12

HIV Prevention Attacks Heard in Committee

On Wednesday, June 1st Rep. Tom Emmer (R-Delano) testified on behalf of his amendment to prohibit the Minnesota Department of Health from awarding HIV Prevention Education grants to groups that used "sexually explicit" materials. After presenting and later withdrawing an amended amendment to change the wording to prevent grants to groups that used "web sites, pamphlets, or other communications that promote sexual promiscuity or unhealthy or unsafe sexual behavior", effectively extending government restrictions on the use of private funding, Rep. Emmer reasserted the original language prohibiting "sexually-explicit" materials.

Sen. John Hottinger [DFL-St. Peter] questioned the reasoning behind the amendment, "I don't understand why we as the legislature should set 'standards' that may inhibit the ability to educate people about the risks involved in sexual behavior. Frankly, sexual behavior sometimes need graphic or direct explanations." Rep. Duke Powell (R-Burnsville) said that while he didn't disagree with Sen. Hottinger's line of questioning, that he felt that it "didn't line up with the materials". Rep. Powell also said that sexually transmitted infections were serious and that one in four people had or would have one during their lifetimes, "even in this room". This prompted some some laughter from lobbyists in the back of the room

Sen. Becky Lourey (DFL-Kerrick) observed that the pictures that Rep. Emmer objected to "were not as bad as what came out of Abu Ghraib". Rep. Emmer said that his objections to the material were not about "my sensibilities" but "about money", reinforcing his erroneous assumption that the Pride Alive web site is financed with state taxpayer dollars. He also questioned the effectiveness of the materials since "AIDS cases are on the rise".

Sen, Paul Koering (R-Fort Ripley) said he felt that the body was "vilifying MAP" who had been doing "one hell of a job" and that this initiative amounted to "gay-bashing" and that he was "quite offended" by it. Rep. Bradley (R-Rochester), who was chairing the hearing, said that that was not the intent of the amendment.

Rep. Emmer asserted that the amendment was addressing a "health" not a "lifestyle" matter and the Minnesota AIDS Project was "proposing activity to spread HIV/AIDS". He read from the letter he had sent to Lorraine Teel (please note she did not receive a copy of this letter until some time after it had been distributed publicly and only after contacting Rep. Emmer requesting a copy).

Sen. Hottinger objected to the use of the word "perverted" in the letter to characterize some activity and behaviors, and Rep. Emmer replied that even folks in the GLBT community disagree that "this is how the message should be delivered".

At the end, Community Affairs Manager Elizabeth Dickinson was called to testify. She reasserted that no state money was used for the web site and that although some people might be uncomfortable with the vernacular used, that it was targeted at a specific group of people at high risk of developing HIV/AIDS. Sen. Linda Berglin (DFL-Minneapolis) responded favorably to the suggestion that MAP Executive Director Lorraine Teel be invited to testify at a future Health Conference Committee.

Click here to watch the hearing, it starts at minute 23, ending about 45 minutes later.

Updated: May 31, 2005

Restrictions on HIV Prevention Providers, Specifically MAP, Remain a Threat at the Capitol

The Minnesota AIDS Project and others who support effective HIV prevention have been working very hard to defeat proposals to place unhelpful restrictions on the content of HIV prevention materials and to eliminate state HIV prevention funding for MAP. The matter has yet to be discussed publicly by the health and human services conference committee, though behind-the-scenes conversations seem to suggest that advocates for the restrictions want to make it look like they would compromise by dropping the direct attack on MAP in favor of tight content restrictions on all state-funded HIV prevention programs. This is not a good outcome for effective HIV prevention, so it’s hardly a compromise. HIV advocates are encouraged to encourage Senate conference committee members to simply reject all of the negative language in the House bill.

The House version of the Health Omnibus bill includes the following language, “the Minnesota AIDS Project is not eligible for any grants from the commissioner of health or the Department of Health.” The bill also includes a prohibition of state funding for “Web sites, pamphlets, or other communications that contain sexually explicit images or language.”

Updated: May 9, 2005

Health Omnibus Conference Committee Meets Tonight, MAP Funding at Stake

The Health Omnibus conference committee starts meeting Monday night, May 9 at 7pm in room 10 at the State Office Building. The conference committee will decide whether or not the “MAP Attack” language is passed along to the Governors desk. Senator Linda Berglin [DFL-Minneapolis] and Representative Fran Bradley [R-Rochester] will co-chair the committee.

The Minnesota House passed its version of a health omnibus bill, which included language that affects all Minnesota Department of Health (MDH) funded HIV prevention programs, by prohibiting funding for “Web sites, pamphlets, or other communications that contain sexually explicit images or language.” The bill declares, “the Minnesota AIDS Project is not eligible for any grants from the Commissioner of Health or the Department of Health;" effectively shutting down the MAP AIDSLine, and MAP testing, gay/bi health education, prevention for positives and street outreach services. The Senates Health Omnibus bill does not include that language. In conference committee members of the Senate and House must work together to approve a final version of the Health Omnibus bill to send to the Governors desk.

A group of Twin Cities-are foundations have come out in support of MAP’s prevention work, and expressing concern about efforts to restrict HIV prevention. Read their letter.

Click here to contact the committee members, as well as the Governor and the state Commissioner and tell them to reject restrictions on proven HIV prevention.

Updated: May 6, 2005

Letter of Support From Foundations

Click here to read a letter from the HRK Foundation, the Whitney Foundation, the Otto Bremer Foundation and the Bank Street foundation in support of the work of Minnesota AIDS Project.

Updated: May 3, 2005

Sign-On Letter to Oppose Restrictions on HIV Prevention Grants

Do you work for an HIV service provider? If so, then think about having your organization add its name to a letter opposing restrictions on state HIV prevention funding. The letter will go to the Governor and the health omnibus bill conference committee urging them not to include restrictions on HIV prevention funding in the committee’s final bill. Read the letter. Then act now. We need your response by Friday, May 6 at 4 p.m. Join us in opposing prohibition of state funding for “Web sites, pamphlets, or other communications that contain sexually explicit images or language.” Email us at PublicPolicy@mnaidsproject.org to sign on to the letter, or call us at 612-341-2060 or 800-243-7321.
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Click here to read Op-Ed by Lorraine Teel, Executive Director of MAP, in the Star Tribune.

Click here to read a profile of PrideAlive that was published in the Star Tribune on Sunday May 1. 

Updated: April 25, 2005

TAKE ACTION!

Contact your state Senator NOW to save HIV Prevention in Minnesota!

Call or email your state Senator today to tell them to stop a homophobic, ill-advised amendment to the House health committee’s budget bill. The amendment includes the following language, “the Minnesota AIDS Project is not eligible for any grants from the commissioner of health or the Department of Health.” Contact your state Senator today and tell them to “add an amendment to the Health and Human services omnibus bill to delete the House’s earlier amendment.” The amendment added by the House to restrict MAP from receiving state health grants MUST be stopped! Don’t know who represents you? Click here to find out.
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MAP Holds a Press Conference on House Health Committee Attacks on HIV Prevention

Last Friday, April 22, the Minnesota AIDS Project (MAP) held a press conference to express concern and outrage at the House health committee attacks on HIV Prevention. Lorraine Teel, MAP Executive Director spoke, along with Dr. Alan Lifson and Dr. Simon Rosser of the University of Minnesota, Sarah Rybecki, Co-Director of the Midwest AIDS Training & Education Center, and Gretchen Musciant, the Minneapolis Health Commissioner. Lorraine summed up the ridiculousness of these attacks, saying that, “We have to talk about sex if we are going to help people understand how to eliminate or reduce infection. Isn’t it ironic that we can use sex to sell toothpaste, cars and frozen pizza but not to sell safer sex to adults.” Both the Pioneer Press and the Star Tribune covered the press conference in their Saturday editions.

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Read Lorraine Teel's, MAP Executive Director, Remarks from April 22 Press Conference

Read Sarah Rybecki's Remarks from April 22 Press Conference

Read Dr. Alan Lifson's Remarks from April 22 Press Conference

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Read a Summary of MAP's MN Department of Health Funding

Why We Need Good Web-Based Services to Stop HIV

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PRESS RELEASE:  PRESS CONFERENCE ON APRIL 22, 2005

FOR IMMEDIATE RELEASE

Proven HIV Prevention Strategies and Minnesota AIDS Project are Under Attack
New Rider Amendment Forbids the Department of Health from Funding Minnesota AIDS Project

The Minnesota House Health Committee has attacked HIV prevention by attaching a rider amendment to its budget bill [HF 1422] that includes the following language: “The Minnesota AIDS Project (MAP) is not eligible for any grants from the commissioner of health or the Department of Health.” The bill also includes a prohibition of state funding for “web sites, pamphlets, or other communications that contain sexually explicit images or language, ” that will affect all HIV prevention service providers. This would eliminate $401,000 in funding for MAP’s services targeting gay and bisexual (gay/bi) men, HIV-positive gay/bi men, African American men who are part of street substance using communities, and the MAP AIDSLine, a program connecting HIV-positive individuals to care.

“Public health research has shown that restrictions such as those proposed in HF 1422 only hamper our efforts to serve those at greatest risk in a culturally relevant way,” said Lorraine Teel, MAP executive director.

MAP has consistently been MDH’s largest vendor for HIV prevention services, and this year will deliver services for MDH totaling $401,000. All service contracts are awarded on a competitive basis, with the exception of an exclusive provider contract of $125K for help funding the MAP AIDSLine. MAP’s prevention programs are based on the Mpowerment Model, a CDC-approved, research-based HIV prevention initiative.

Just last week the Minnesota Department of Health (MDH) released epidemiological information showing that in Minnesota in 2004, 44 percent of new cases of HIV involved male-male sex as a risk factor. Seventy-two percent of new HIV cases among African-American men in 2004 involved male-male sex as a risk factor. Ninety-six percent of new cases of HIV among young men aged 13-24 have male-male sex as a risk factor.

HIV is primarily a sexually transmitted infection. “We have to talk about sex if we are going to help people understand how to eliminate or reduce infection,” said Teel. “Isn’t it ironic that we can use sex to sell toothpaste, cars and frozen pizza but not to sell safer sex to adults.”

“To stop the spread of HIV in Minnesota, MAP will continue providing vital, effective services for at-risk individuals in their communities, in bars, online and on their terms,” adds Teel.

Minnesota AIDS Project has been leading the fight against HIV in Minnesota since 1983 through prevention education, compassionate services and persistent advocacy. For more information visit www.mnaidsproject.org.
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Updated: April 20, 2005

Save HIV Prevention in Minnesota; Call Your State Rep Now!

If you haven’t made a phone call or sent an email to your State Representative yet this year, today is the day. Now is the time. And what do you need to say to them? “Stop attacking effective HIV prevention and remove the restrictions in the House health and human services budget bill that propose to eliminate HIV prevention funding for Minnesota AIDS Project (MAP) and to censor the content of all HIV prevention materials published – in print or through the Web—as part of state HIV prevention programs. Yes, you read that right. They want to eliminate state prevention funding specifically for MAP. Seriously, find out who your state rep is. Make sure they hear your voice. And, then, talk to your friends and ask them to do the same.

MN House Health Committee Attacks HIV Prevention

Leadership of the Minnesota House health committee is finishing the work on its budget bill [HF1422]. The bill includes a direct attack on all HIV prevention programs that receive funding from the Minnesota Department of Health. The bill includes a prohibition of state funding for “Web sites, pamphlets, or other communications that contain sexually explicit images or language.” It also states, “the Minnesota AIDS Project is not eligible for any grants from the commissioner of health or the Department of Health.” This would eliminate funding for MAP’s services targeting gay/bi men, HIV-positive gay/bi men, African American men who are part of street substance using communities, and the MAP AIDSLine. Rep. Tom Emmer [R – Delano] introduced the proposals with encouragement from the Minnesota Family Council. This year the group seems to object to the MAP PrideAlive Web site. Ironically, it is a service that is not funded with state MDH dollars. What’s at stake here is the ability of not just MAP, but of any organization to do good public health and try to prevent this sexually transmitted infection by using specific, culturally relevant

Updated: April 5, 2005

City of Minneapolis on Verge of Backing Away from HIV Prevention

On April 5, the Minneapolis City Council's Community Development Committee held a hearing to get public reactions to a plan for allocating CDBG [Community Development Block Grant] funds for community public health services. A city health department advisory group developed the plan. The advisory group rejected an outreach and testing project targeting GLBTQ youth, gay/bi men, and African American men who are part of substance using street communities. District 202, Access Works and MAP developed the proposed project targeting individuals at greatest risk of contracting HIV. If the advisory group's plan is approved by Minneapolis City Council committees and later in April by the full City Council, it will become the first time since 1991 that the City of Minneapolis will not make an investment in HIV prevention, a commitment continued in remembrance of Minneapolis City Council Member Brian Coyle who died of HIV.
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Letter to Mayor Rybak and Minneapolis City Council Members:

April 4, 2005

Mayor R. T. Rybak Minneapolis City Council Members
Minneapolis City Hall Minneapolis City Hall
Minneapolis, MN 55415 Minneapolis, MN 55415

Re: Community Development Block Grant Public Service Funds for Year 31

Dear Mayor and City Council Members:

Minnesota AIDS Project, Access Works and District 202 are, of course, disappointed with the Public Health Advisory Committee’s recommendations for allocating CDBG Public Service Funds in Year 31. We believe the project we proposed, which included outreach services and introducing the availability of field-based, HIV “quick test” services, offered the City of Minneapolis a unique and strategic opportunity to contribute to the overall effort to stop HIV. Our project would have directly served gay and bisexual men, GLBTQ youth, and substance using street communities of predominantly African American men. It would have indirectly established the capacity to provide field-based, HIV “quick test” services to other high-risk populations, including Africans. While we appreciate your reluctance to challenge these recommendations, we want to share with you our understanding of the consequences of approving these recommendations and our thoughts about how the process might be improved in the future.

By way of background, it is important to note that just over half of all new HIV cases reported in Minnesota each year are among Minneapolis residents. When looking at the trends over the past three years, gay and bisexual men of all races and all ages continue to comprise the largest proportion of the new cases reported each year at 57 percent, and 64 percent of those living with HIV. Thirty-three percent of these men were African American. African high-risk heterosexuals accounted for 19 percent of the newly reported cases, and 9 percent of those living with HIV. The third highest risk population according to Minnesota Department of Health statistics are those whose only reported risk for HIV was injecting drugs. These individuals comprised 10 percent of new infections and 16 percent of those living with HIV.

Loss of Flexibility to Provide Primary Prevention Services

Since 1991, the City of Minneapolis has supported primary HIV prevention services with CDBG funding. This practices was initiated as a “living memorial” to former Minneapolis City Council Member Brian Coyle, who died of AIDS. Initially, the annual appropriation was $50,000. This gradually declined to $23,000 in CDBG Year 31. The funds were used for HIV prevention services targeting gay and bisexual men.

While the City’s support has always been important, since 2003 it has provided an essential degree of flexibility. In Minnesota, almost all of the resources available for HIV prevention are distributed by the Minnesota Department of Health, which has a combination of resources from the State of Minnesota and federal funds from the CDC [Centers for Disease Control and Prevention]. A few agencies in Minnesota received funding directly from the CDC.

Increasingly, CDC funding comes with conditional requirements intended to advance a political rather than a public health agenda, making it particularly difficult to implement research-proven public health behavior change strategies appropriate for populations such as sexually active gay or bisexual men or active injection drug users. Corporate and private sponsorship or contributions to support HIV prevention activities targeting high-risk populations and behaviors are extremely limited. The City of Minneapolis provided some of the only funding for primary HIV prevention that did not also come with onerous restrictions. When used as a supplement to CDC-dollars, it provided the flexibility to do what worked and needed to be done.

Elimination of City support for HIV primary prevention removes the capacity to provide effective services to communities in need. For this reason, it is our hope you will give serious consideration to other opportunities to reengage the City as a partners in HIV primary prevention.

Missed Opportunity to Add Value to Minnesota’s HIV Prevention Services System

Encouraging individuals to know their HIV status has always been an important part of the overall strategy for stopping HIV. Increasingly, HIV screening and testing has become a part of the national plan for stopping HIV, and using new testing technologies that provide results in 20 minutes is strongly encouraged.1 Currently, OraQuick rapid testing is available on a very limited basis through the Hennepin County Red Door Clinic, temporary research-based services offered through North Memorial Hospital, and for a fee in some private physicians’ clinic. A significant barrier to expanding availability of rapid testing is that the Minnesota Department of Health does not have funding available to make rapid testing kits available to organizations that provide field-based HIV testing services.

MAP is unique in its capacity to provide field-based testing because it is the only HIV service provider capable of offering mobile outreach services. The proposal we put before the Public Health Advisory Committee would have made it possible for MAP to to its outreach van with Access Works and District 202, and to introduce field-based rapid testing to the HIV prevention service system. We think, the committee missed a unique opportunity to add value to our overall HIV prevention efforts by making something that is needed, possible.

Opportunities to Improve the Process for Deciding Public Health Services Appropriations

We fully appreciate this is the first year the Public Health Advisory Committee has been responsible for developing recommendations for appropriating CDBG funds for public health services. We offer our thoughts in the interest of helping you make decisions about how this process should work.

Promoting collaborations. MAP participated in the Public Health Advisory Committee’s community input process, and was encouraged by what seemed to be intent to emphasize collaborative partnerships between larger and smaller service providers. However, we were disappointed to see that the final guidelines and review process did not seem to embrace this recommendations that we felt was strongly supported by those asked to provide input into the shaping the process. We hope the City will revisit the objective of promoting collaborative partnerships. Were it not for the added capacity of a larger partner such as MAP, smaller providers such as Access Works and District 202, who do very effective work, would find it difficult to participate as a service vendor for the City.

Be explicit about the commitment to GLBT communities. The GLBT community is not visible in the Community Health Access priorities established by the Public Health Advisory Committee. This is a systemic problem. Most public health research and policy systems do not collect data or commonly include GLBT communities within their work. When this does happen, the focus tends to emphasize HIV, in part because this is one condition for which relevant information is collected in such a way as to highlight the health risk. We strongly encourage the City to take note of this omission, both in terms of how Community Health Access priorities are defined in the future for the purpose of CDBG funding recommendations, but also in its overall approach to understanding the health needs of the City’s citizens and the health disparities experienced within GLBT communities. The GLBT compendium to the federal governments Healthy People’s 2010 Report [available only through the Gay and Lesbian Medical Association, because the current federal administration refuses to provide the money to print this public document], is a good place to start to better understand how to serve Minneapolis’ GLBT citizens. More inclusive research and data collection should also be considered. We encourage the City to take a much closer look at how it attempts to understand and respond to the public health interests of its GLBT citizens. It is not apparent from information readily available to the public that GLBT public health needs are being addressed as a priority concern through any of the services recommended for CDBG funding.

Review process limitations. We looked at the scoring information on our proposal that was available. One person gave the proposal a near perfect rating, we suspect the individual on the committee who has the most experience with HIV primary prevention. Another ranked it extremely low. One scorer noted the objectives and timeline as proposed merited a perfect rating of five points. Another score rate the same qualities as zero. The ratings on this proposal were all
over the place, which does not surprise us given the relative lack of community knowledge about the HIV service system and needs. However, the advisory committee’s review process did not seem to have a mechanism for addressing this apparent deficiency. It is our understanding that no HIV-related service secured a high enough ranking to even make the advisory committee’s list of proposal meriting a committee discussion. It was only after the committee noted that no HIV-related services were receiving funded that the group decided to allocate funding for whatever HIV-related proposal received the highest ranking. This process should provide a
point-of-reference for rethinking how the advisory group is going to do its work in the future and do it in such a way as to ensure that limited dollars are used strategically.

Use the opportunity to support your nonprofit community providers. Funding provided to nonprofit organizations through this CDBG public health initiative not only enables the delivery of a service, supports the ability of these agencies to survive and servethe community. This is especially true for smaller organizations. We do not challenge the value of services provided through public agencies. However, in the context of making choices about what to do with limited public dollars, we think there may be some value to emphasizing partnerships with nonprofit, community-based providers. For example, the cost of delivering service will more likely be less with a nonprofit, community based provider than with a government agency. In other words, you can get more “bang for your buck.” We also want to underscore the fact that a decision not to partner with a nonprofit, community-based organization can have negative consequences for the community. It not only limits an organization’s ability to deliver a particular service, but it also threatens its ability to survive. This is especially true for smaller organization; those that have a unique capacity to reach individuals who are disproportionately underserved by public programs. Conversely, a government agency is not going to go away because funding for a particular service is not in place. We hope as you look ahead that you will consider reasons why it might be advantageous to emphasis partnerships with nonprofit, community-based partners as you work to improve access to public health services.

Again, we offer these observations and recommendations from the perspective of the interest that we share with the City of Minneapolis; to ensure that the limited public dollars available to improve the public’s health be invested as strategically as possible.

Sincerely,

Lorraine Teel, Executive Director, Minnesota AIDS Project
Rae Eden Frank, Executive Director, Access Works
Laura Ayers, Executive Director, District 202

cc:

Gretchen Musicant, Minneapolis Department of Health and Family Support

1 The OraQuickÓ is an oral test that does not require a blood draw. It provides reliable results indicating either a negative reaction for HIV antibodies or an indeterminate response, which requires additional testing and laboratory evaluation to determine a positive reaction for HIV antibodies. In short, OraQuick can give a “no or maybe” result in 20 minutes. A maybe response requires additional testing.

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Last Updated: Friday, March 30, 2007
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