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Even as Atlanta struggles with one of the nation’s highest HIV infection rates, the agency tasked with curtailing the epidemic here is failing to spend millions of dollars set aside for HIV prevention.
In some years, the Fulton County Health Department has given back to the federal government as much — or more — than it spent.
Change in national HIV policy
The HIV/AIDS rates in certain areas of the U.S. are so bad, the Centers for Disease Control and Prevention in 2012 decided to change the way it tackled the epidemic.
In the past, the CDC handed state health departments yearly grants, and prevention was largely handled at the state level.
But most new infections happen in a handful of the nation’s biggest cities, so the CDC shifted hundreds of millions of dollars in prevention funds away from states and reallocated the money to the local level.
Because of Atlanta’s high prevalence of HIV, the Fulton County Health Department suddenly found itself with millions of new dollars and a mountain of new responsibility. It not only had to spend a huge influx of new money, but it had to put into action a federal plan that represented a major shift in HIV policy.
A shifted focus on HIV prevention
One goal of the CDC’s HIV new prevention strategy is to get more people tested and to do it outside of a clinic or doctor’s office. Places like Atlanta’s University Barbershop, which sits next to Morehouse College.
Last summer, the business offered $10 haircuts and a free HIV test to customers.
“We got involved with the project to help the community,” said barbershop manager Terrance Barron. “This is a way to give back to the community, to know your status.”
The event caught the attention of Morehouse student Frederick Miller, who passed by the barbershop on his way to class.
Statistically speaking, the 26-year-old black man is at a higher risk for HIV. Miller said he’d had a HIV test before, but figured it was a good time to have another.
“A lot of time when you’re a student, there are so many distractions,” Miller said. “And you don’t think about this kind of stuff until it hits you for real.”
Miller said he planned to tell his friends about the testing outreach and encourage them to drop in and get a test.
The Fulton County Health Department, along with several Atlanta barbershops, sponsored the event. And this type of partnership is exactly what the CDC had in mind when crafting local HIV prevention grants.
Fulton County isn’t doing enough, at least when it comes to spending its grant money.
Money on the table
Documents obtained by WABE show that since 2012, the CDC has awarded Fulton County grants totaling nearly $20 million to fund its HIV-prevention efforts.
In the first two years of the program, Fulton County spent about half of the money. Last year, the county health department did a little better, spending more than half.
But what it didn’t spend, it had to give back — some $8.7 million.
“The fact that we have millions of dollars of funds to address this problem that have gone unspent is something that should be a concern for a lot of folks,” Jeff Graham, executive director of Georgia Equality, said.
Graham, who is also a member of Fulton County’s newly-formed Taskforce on HIV/AIDS, has pressed the health department’s director about the county’s lack of prevention spending.
Dr. Patrice Harris, director of health services for Fulton County, said the spending problems “absolutely concern” her. As the grant’s principal investigator, Harris is responsible for executing Fulton County’s HIV prevention strategy.
So why hasn’t the money been spent?
Harris said there many reasons, including the grant’s funding cycle, the amount of time needed to hire and train personnel, turnover and county bureaucracy. Plus, because the CDC requires Fulton County to contract with various community-based non-profits, ensuring their compliance can slow things down, she said.
“It’s certainly money that’s not spent going to work toward HIV prevention, and we need every dollar we can get,” said Harris. She noted the county is eligible to apply to get some of the unspent money back, a process called “carry-over.”
But that amount doesn’t begin to cover the county’s loss, and some close to the process said on background the money only replaces new funds the CDC would otherwise grant.
Dr. Harris, meanwhile, remained firm that her department is committed to fixing its spending issues. In April, she convened what she called a “turn-around” meeting, where various stakeholders offered their ideas on how to mend the problem.
She also said she’s certain the county will spend all of its grant money this year, barring what she called “unforeseen personnel problems.”
Spending issues not unique to Fulton County
As it turns out, the spending problem isn’t isolated to Fulton County.
Other health departments across the country also have struggled, according to Natalie Cramer of the National Alliance of State and Territorial AIDS Directors.
“A redirect of funding is not flipping a light switch,” Cramer said. “It takes a significant amount of time.”
NASTAD commissioned a study that found many state and local health departments faced challenges one year into the CDC’s shift in HIV prevention strategy. Because some health departments saw reductions in their funds, they had to scale back or eliminate programs already in place.
Others, like Fulton County, quickly had to ramp up brand new programs.
“Fulton County had both this brand new resources with new reporting requirements, brand new scopes of activities, and not the historical infrastructure for HIV prevention,” Cramer said.
Given the demands of starting the program from scratch, it makes sense there would be growing pains. But Fulton County is heading into year four of the five-year grant, and the health department continues to struggle in some ways like it was day one. It still gives back to the CDC millions of dollars it hasn’t been able to spend.
A promise to fix the situation
Like all county agencies, the health department falls under the oversight of the Fulton County Board of Commissioners. The Board’s chair, John Eaves, said he only learned of the spending problems a few days ago.
“This is one area that we were not aware of, in terms of the challenges,” Eaves said. “It really is disappointing and to a certain degree inexcusable.”
But unspent HIV prevention funds are just one problem the Fulton County Health Department has faced. Compliance documents obtained by WABE show the health department also failed to meet several key benchmarks tied to the grant money.
For example, it didn’t link enough newly-diagnosed HIV patients to medical care. It also failed to identify enough new HIV-positive people in non-health care settings. Recording and reporting data also posed a challenge, according to CDC records.
Fulton Commission Chair John Eaves said he was not aware of the compliance issues, but said he would direct the county manager to investigate “to make sure someone is held accountable and that going forward, this type of thing never happen[s] again.”
Fulton County is about to enter the final year of the CDC grant. Soon, the health department will apply for the next round of HIV prevention money.
Despite multiple requests, the CDC did not make anyone available to comment for this report, so it’s unclear what effect years of under spending and compliance problems could have on Fulton County’s future funding.