Gov. David Ige’s latest proposed health budget for the state of Hawaii contains a massive 64% cut to HIV-related services that will impact thousands of Hawaii residents. If this proposed cut becomes law, the state will experience a significant reduction in access to and availability of HIV treatment and prevention services, threatening the public health and safety of Hawaii’s most vulnerable communities.
It is critical, particularly during this time of pandemic, to speak up on behalf of those who will be disproportionately impacted by this cut and demand that state lawmakers restore critical funding for HIV treatment and prevention services in Hawaii.
When I learned about the proposed cut, I was at a loss for words.
As executive director of Hawaii Island HIV/AIDS Foundation, or HIHAF, I am seriously concerned not only about the depth of the cut and how disproportionate it is when compared to the proposed statewide health budget overall (down 4%), but also about what these cuts could mean for our organization.
For 36 years, HIHAF has provided HIV case management, HIV and STD medical care and treatment, patient navigation, transgender health services and sterile syringe exchange — services of immense value not only to the Hawaii residents who rely on them, but to broader public health on the Big Island and throughout the state.
The COVID-19 pandemic has only brought into starker relief the systemic health disparities facing historically marginalized groups already facing long-term chronic health issues at a disproportionate rate.
In Hawaii, 2,751 people are living with HIV, many of whom belong to minority communities. It is imperative, therefore, that we bolster — not decimate — state investments to protect access to HIV therapies and other critical health services throughout Hawaii.
The 64% proposed cut would actually affect five different statewide organizations, including HIHAF. If the new budget were to become law, a HIHAF office would have to be eliminated — likely our Kailua-Kona office on the Big Island — which would do unimaginable damage to our community.
The Kona office offers very quick turnaround appointments for HIV medical care, PrEP services, STD treatment, hepatitis C treatment and trans health services. Should this facility be forced to shutter, the patients who have come to rely on it — many of whom often require immediate attention — would be forced to visit a federally qualified health center, which often requires up to a two-month waiting period.
For some of our community members, significantly reduced access to treatment, prevention and other care services can literally mean the difference between life and death. As it is, the HIHAF Kona office serves some of the most remote residents. If Kona were to close, it would become enormously complicated for many rural and remote Hawaii residents to access lifesaving services.
A budget is an illustration of a government’s values and priorities. By moving forward with this unprecedented 64% cut for HIV services, Gov. Ige and Hawaii’s state legislature would effectively dismiss out of hand the importance of programs that, for example, safely discard more than 1 million syringes (preventing new HIV infections), as well as programs that offer housing, case management and medical care for vulnerable Hawaii residents.
If the proposed budget is approved as written, Gov. Ige and state lawmakers will be sending a clear message to Hawaii residents that preserving access to health services — especially for historically underrepresented communities — isn’t a priority. And eliminating options Hawaii residents have to access critical services safely and confidently will only serve to further stoke a culture of stigma and shame around HIV and STDs.
HIHAF fully understands the havoc that the COVID-19 pandemic has wreaked on state budgets. But it is unacceptable to cut funding for one public health concern to pay for another. In fact, the need to preserve the state’s budget is felt across party lines — in conversations with lawmakers and other state-based advocates, I have yet to come across anyone, regardless of party affiliation or political leaning, who has not been surprised by the proposed cut and afraid of the long-lasting consequences for the communities it will impact.
To enact this 64% cut would be a decision that Hawaii residents would not soon forget. It would not only destroy the trust between public officials and the communities in need whom they serve, but it would also dismantle the 36 years of work and hard-earned trust HIHAF has built within our Big Island community and throughout the state.
Gov. Ige, working together with state lawmakers on behalf of vulnerable Hawaii residents, can take the first steps in maintaining a culture of compassion and trust by restoring funding and protecting access to HIV treatment and prevention therapies and other public health services throughout Hawaii.
Peter Tui Silva is executive director of Hawaii Island HIV/AIDS Foundation, which provides islandwide coordination of services to all people affected by HIV/AIDS. HIHAF is dedicated to assisting those affected by HIV/AIDS to maximize their quality of life and to ending the spread of HIV.