InsideOut at City Hall

Houston and HIV
The city lags behind nationally in spending on the epidemic
by Annise D. Park

Houston Heealth Department HIV workers participate and vote at UCHAPS (Urban Coalition of HIV/AIDS Prevention Services) meetings. Three-year old UCHAPS lobbies on behalf of the six large cities Congress designated to receive HIV/AIDS funds directly from the Centers for Disease Control. The lobby effort continues despite the fact that only five cities have paid the $10,000 annual dues for the past several years. Houston is the poor relation.

Houston has a similar relationship with the other five cities in terms of local spending for prevention. Chicago, for instance, which received $7.7 million in CDC grants in 2001, contributed $3.6 million from the city’s general fund. Philadelphia, which is about the same size as Houston, got $6.5 million from the CDC and contributed $4.1 million (for prevention, care, and surveillance).

That same year, Houston received $5.4 million from the CDC and contributed $207,300 from the general fund. Things haven’t changed much in two years.

Beginning July 1, Houston will spend just $259,300 in general funds as part of the city’s $6 million HIV/AIDS prevention program.

Halfway through the city’s five-year HIV/AIDS State of Emergency plan for the African-American community, about 40 percent of the original $1,964,300 budget has been spent or budgeted. About $100,000 will be earmarked for the plan this year.

Criticism that the State of Emergency effort exists in name only is the latest rift in a 20-year-old frustrating relationship between the city health department and the GLBT community and, more recently, a wide range of HIV/AIDS and Hepatitis C service providers. Mention former department directors James Haughton and John Arrandondo or the city’s mobile van program and watch longtime activists bristle. It would be too cruel to bring up HOPWA (Housing Opportunities for People With AIDS) and the city’s housing department.

Before the State of Emergency was declared on World AIDS Day, December 1, 1999, I joined with other officials to urge the mayor to declare it. After its mostly unfunded budget was announced, I tried unsuccessfully to get more funding.

While the city administration understands the seriousness of the HIV/AIDS crisis, many conservative city and county leaders remain unwilling to commit sufficient local dollars for prevention—and not just for HIV/AIDS. Immunizations, Hep C, and timely prenatal visits at city health clinics also fall through this crack.

To make matters worse, the city tried to launch its underfunded Emergency program just as Hep C grabbed the spotlight. We were already way behind the curve, and there was the perception that the two diseases were pitted against each other for funding. AIDS/HIV organizations wanted to work with Hep C groups to piggyback outreach efforts. Some Hep C activists, however, did not want to be associated with HIV. "Hep C is not a sexually transmitted disease," one Hep C activist protested at a meeting in the Medical Center.

As Houston’s first openly lesbian City Council member and an at-large member, one of my top priorities upon taking office on January 2, 1998, was improving the Health Department's HIV/AIDS services. I convened a meeting of service providers and listened to an hour of blistering complaints:

• Late, inaccurate contracts

• Late, inconsistent reimbursements

• City outreach workers showing up to test clients 10 minutes before community providers appear at the same location

• City workers telling clients tested at remote locations they had to go to clinics for test results

• Inefficient and punitive behavior by the city (“It can’t keep a bargain.”)

Providers said they had tried to work out problems with the city to no avail.

Health Department director Dr. Mary desVignes-Kendrick soon received a lengthy memo about the complaints and answered in great detail. Thus began our relationship of memos, meetings, phone calls, and discussions at Neighborhood Protection Committee meetings. Kendrick is compassionate and dedicated, as are many of her employees. Her greatest challenges are money and management.

I have tried to push the department to become a conduit for grants and to be an evaluation and support resource for community programs, not a provider. We were competing too much with community service providers. (City and community outreach workers have stopped colliding at test sites.) The city has also improved its efficiency and financial relationship with service providers, who have begun meeting informally for lunch to discuss problems.

New Council Member Ada Edwards brings renewed energy and her many years of advocacy to the task of directing the City/County HIV/AIDS Task Force established in the State of Emergency plan. Her first task force meeting attracted 125 people. At press time, a second meeting had been scheduled for July 17.

Several commitments were made during a recent meeting between task force leaders and Mayor Lee P. Brown and Dr. Kendrick:

• The mayor and Dr. Kendrick will speak loudly, clearly, and consistently about the epidemic to the African-American community and will convene and participate in meetings with service providers and concerned citizens.

• The mayor will be a strong advocate for additional funds and services and will make this a priority for the city’s state legislative lobby effort.

• The mayor and health director will work with service providers to reevaluate the training and testing of city and community-based organization staff.

In response to the task force’s request for a project manager, health department clinical education coordinator Courtney Rogers will coordinate the department’s task force effort. He has been involved in the task force for three years.

City Council member Edwards is determined to take the task force to the next level through such efforts as block walking in hot spots. “We need aggressive outreach outside of 9-5 M-F. A majority of individuals expressed a willingness to work outside the box, volunteering their time to take this project on, taking common sense, not clinical information, to the laundromats, homes, and beauty shops,” she commented at the April task force meeting.

Another hopeful sign is the arrival of Rick Mendiola in the health department. Mendiola served as AVES (Amigos Volunteers in Education and Services) director of education before joining the city in April 2000. A year later, he became the HIV Prevention Program manager.

Mendiola believes he has improved the program: “HIV prevention efforts/resources are prioritized before being contracted out for service. I feel I can help make decisions regarding specific populations and interventions as well as find ways to fill gaps.

“The bureau needed to be more administrative than providing direct services. I helped build a section within the bureau for capacity building/technical assistance and quality assurance. We are looking at new and innovative interventions for Houston.”

Mendiola gets high marks for his compassion and dedication from one HIV/AIDS service provider, who still fault some department employees for not caring about their work. “The department’s problems are systemic,” the service provider said.

Years of underfunding and budget cuts have skeletonized many services and surely affected morale. The department’s broad mission—air quality monitoring, restaurant inspections, Bureau of Animal Regulations (BARC), bioterrorism, health clinics, infectious diseases––also spreads limited resource thin and makes filling specialized medical and technical positions difficult in a highly competitive job market.

When the budget passed in June, I asked the administration to conduct a long-overdue performance review of the health department so Dr. Kendrick can concentrate on long-range planning. We need a Health Department to Standard program, much like Neighborhoods to Standard and Parks to Standard, to provide adequate services to a growing population in the midst of an emergency care crisis. After two years of excruciatingly painful health department budget hearings, I think City Council is primed to bring the department up to a standard we can be proud of. At some point, we may even use proven but controversial approaches to HIV/AIDS, such as needle exchange.

A Houston City Council member who happens to be a lesbian, Annise Parker is serving her third term in At-large Position 1. To receive her monthly newsletter, contact her office, 713/247-2014 or annise.parker@cityofhouston.net. Her website is www.ci.houston.tx.us/citygovt/council/1/.