Advocates disagree on HIV/AIDS lobby strategy

Following AIDS Action Committee's decision last month to withdraw from Project ABLE (AIDS Budget Legislative Effort), the statewide coalition that lobbies Beacon Hill on HIV/AIDS funding issues, more members of the coalition have begun speaking out about their dissatisfaction with Project ABLE's efforts to increase state funding for HIV/AIDS programs. The state's AIDS budget has yet to recover fully from the nearly $20 million dollars in cuts it sustained between fiscal years 2002 (FY02) and FY05. Some members of Project ABLE have complained that the coalition has not been aggressive enough in lobbying to reverse those cuts. Others argue that Project ABLE has done the best it can to make incremental gains during a series of tough budget cycles. Despite disagreeing over lobbying strategy, advocates agree on one point: the state still has a long way to go to provide funding that meets the needs of people living with HIV/AIDS and the agencies and programs working to stop the epidemic.

Rebecca Haag, executive director of AIDS Action, said her organization broke from Project ABLE because it has been unhappy with the coalition's performance over the last several years. She said AIDS Action has been pushing Project ABLE to build relationships with a broader coalition of advocates representing the communities hit hardest by HIV/AIDS, including LGBT groups, advocates in communities of color and substance abuse advocates.

In the current budget cycle Haag said AIDS Action will support Project ABLE's funding request, or "ask," for a $6 million increase for the state's HIV/AIDS line item, which in the current fiscal year, FY08, received $36.9 million. But Haag said that rather than rely on Project ABLE's lobbying efforts to secure that increase AIDS Action will mobilize the networks it has used in the past to lobby on HIV/AIDS related policy questions, networks that include organizations serving LGBT people, communities of color, and people affected by substance abuse. She said those networks were crucial in many of AIDS Action's public policy wins, including the 2006 passage of a bill to allow nonprescription over-the-counter sales of syringes. MassEquality, which Haag said provided key lobbying support during the pharmacy needle access bill campaign, is one of those coalition partners.

"We need that same focused effort around budget issues on behalf of people with HIV and AIDS, and we felt that the lobbying effort that Project ABLE was using was not adequate," said Haag.

Part of AIDS Action's effort will be to research the extent of the unmet need for services across the state. Haag said beginning last fall AIDS Action launched a survey to identify unmet needs, and in the coming months the agency will work to determine how much funding is required to meet that need. She said that research will enable AIDS Action to make a stronger case to the legislature for increased funding. Haag presented some of AIDS Action's findings to the Massachusetts Public Health Council Feb. 13 and called on the council to create a comprehensive state strategy to confront the epidemic. Among the findings were that people living with HIV/AIDS experience significant economic insecurity and rank housing as their greatest priority, along with a multitude of other needs.

Mary Ann Hart, Project ABLE's part-time lobbyist and the coalition's only paid staff member, declined to talk to Bay Windows for this story, but several Project ABLE steering committee members defended the coalition's efforts. Gary Daffin, executive director of the Multicultural AIDS Coalition and a member of Project ABLE's steering committee, said that since FY02, when a massive decrease in state revenue led to major cuts in state-funded programs across the board, the coalition has been effective at winning some increases. Before the cuts the AIDS line item had reached $51.1 million. It dropped to $32 million, its lowest point since the cuts, in FY04, but advocates have managed to bring it up to the current $36.9 million level.

"In any coalition there's always going to be disagreement on what to focus on and what might work, but in the end Project ABLE has been able to bring the line item back up. ... Maybe there are programs getting slightly larger increases, but overall I think everyone in human services are struggling to make due with what we see as inadequate funding from the state," said Daffin.

Speaking with a unified voice
Before the cuts, the HIV/AIDS line item peaked at more than $50 million. But back when Project ABLE formed in 1991, Massachusetts was spending less than $20 million on HIV/AIDS programs. Leslie Tarr Laurie, president and CEO of Tapestry Health, which provides HIV/AIDS and reproductive health services in Western Massachusetts, said that year the Department of Public Health called a meeting with HIV/AIDS advocates to discuss the department's efforts to increase funding for HIV/AIDS programs. In advance of that meeting Laurie said advocates met amongst themselves to discuss their priorities. That first meeting prompted a series of meetings among advocates that ultimately led to the formation of Project ABLE.

Laurie, who is also a member of the Project ABLE steering committee, said in those early meetings advocates from different parts of the state butted heads over where to allot state dollars. She said the agencies agreed to come together under the Project ABLE banner to push for increased funding across the state.

"The idea was, what commonality could there be in that vision so we could speak in one voice with competing needs for limited state resources?" said Laurie. "The idea was it didn't matter what your zip code was, you should be able to have the same access to services from prevention to care."

To maintain that unity Project ABLE concentrated its lobbying exclusively on funding and took no action on questions of policy that might divide the coalition.

Another goal of Project ABLE that has continued through the present has been to ensure that the state AIDS budget is free of earmarks designating portions of funding for specific agencies.

"What we would do is treat this as the public health emergency that it really was and allow the Department of Public Health to spend those dollars across the state, and that was the bottom line," said Laurie.

From the early years through the present the most visible components of Project ABLE's effort to increase state HIV/AIDS funding have been its annual winter lobby day on Beacon Hill, which took place this year on Jan. 30, and the work of the coalition's lobbyist, a role that Hart has filled for at least a decade, according to Laurie. A steering committee currently representing six of the coalition's more than 60 member organizations guides Project ABLE, and the coalition as a whole meets each October to plan its strategy for the coming budget cycle (see Project ABLE steering committee, p.15) Beyond its lobby day and Hart's work in the legislature Project ABLE has also conducted postcard campaigns to lawmakers, sent letters to lawmakers signed by member organizations, and arranged meetings between AIDS service providers and legislators to talk about the funding issues in their region, among other activities.

Since its inception Project ABLE has received its funding from Fenway Community Health. Henia Handler, director of government relations for Fenway and a member of the Project ABLE steering committee, said that originally Fenway funded the coalition through pledges from the Boston-to-New York AIDS bike rides. After the annual bike ride ended, Fenway continued to fund the coalition through its own budget.

Among the coalition's successes have been the expansion of state funding for HIV/AIDS programs to more than $50 million and the expansion of MassHealth, the state's Medicaid program, to cover HIV-positive people with incomes at or below 200 percent of the federal poverty level, which allows people to access life-saving HIV medications that they could not otherwise afford.

"I always felt extremely proud of a state where we always provided the drugs that could be available to someone who had means to everyone in the state who needed those drugs," said Laurie.

Advocates question lobbying tactics
While few question Project ABLE's effectiveness in its first decade, some members of the coalition have disagreed with its tactics in trying to win back funding after the massive cuts during the state budget crisis. With AIDS Action's departure from Project ABLE, the coalition's critics have taken their concerns public.

Joe Carleo, executive director of the AIDS Housing Corporation, a member of the coalition, said he believes Project ABLE has been too conservative in its "ask" each year during the budget cycle, making requests for funding that fall below the level needed to respond effectively to the epidemic. This year Project ABLE, joined by AIDS Action, has asked for $6 million, with the highest priority in that sum being $2 million to address disparities in HIV/AIDS services and treatment for communities of color. Gov. Deval Patrick's budget proposal, released last month, included only a small $225,000 increase. Carleo said Project ABLE's ask should be much higher, at least enough to bring the AIDS line item to its pre-cut level.

"I think in terms of money a lot of the wind got knocked out of people's sails in 2001, and people got very cautious about what they wanted to ask for. I heard one person say we needed to ask for an amount of money that would pass 'the laugh test.' ... If there's great unmet need we should ask for the amount of money that would fill that need and worry about the laugh test later," said Carleo.

He said he has met on at least one occasion with other members of the coalition to discuss their dissatisfaction with Project ABLE, but he declined to name any of the other participants in that discussion.

Jacob Smith Yang, executive director of Massachusetts Asian and Pacific Islanders (MAP) for Health and a member of the Project ABLE steering committee, also said he believes the size of the coalition's ask is too low.

"I think the ask does not reflect the need, and I think that's the problem I would have with it. We need more like $10 million. We're asking for $2 million," said Yang.

When asked to rate Project ABLE's lobbying efforts since the budget cuts Yang said he would like to see greater funding increases from the legislature. But he also acknowledged that Project ABLE has faced a steep uphill battle to restore funding in tight budget years.

"I would aspire to much more, and I do. And the question is how can you do that, and that's one of the questions that many of us are asking ourselves, and I think that's one of the reasons AIDS Action wants to pursue a different strategy. ... We continue to be in these budget years where resources are very tight, and to the extent I do hear from legislators I hear that across the board everything is really tight," said Yang.

He said MAP for Health will continue to work with Project ABLE, but it will also likely partner with AIDS Action in its lobbying efforts.

"I think [our approach is] probably working in multiple paths. This feels like an expansion to me, that there's more going on in documenting the need for services and prevention and tying it to an advocacy strategy," said Yang.

Jonathan Scott, executive director of Victory Programs, another member of Project ABLE, echoed Haag in arguing that the coalition needs to broaden its scope and adopt a more aggressive lobbying policy. Scott, who helped found a similar coalition for substance abuse advocacy organizations, the Mental Health and Substance Abuse Corporations of Massachusetts, said that while Project ABLE did not noticeably alter its lobbying operations in response to the deep cuts of the last few years, substance abuse advocates made radical changes to the way they did business on Beacon Hill. A major component of that effort was reframing the issue to show the state the long-term costs of cutting funding and showing how those cuts impacted a wide array of state, local, public and private agencies.

"We knew we had to make a major case for a change, and the case was that, yes, you've achieved immediate cost savings, however the cost of substance abuse in the Commonwealth hasn't decreased. It's just migrated to more expensive parts of the healthcare and criminal justice system," said Scott.

He said substance abuse advocates lobbied successfully for the creation of a Joint Committee on Mental Health and Substance Abuse in the legislature, ensuring that lawmakers would take ownership of the issue, and they convinced former Gov. Mitt Romney to create an Interagency Council on Substance Abuse, giving the governor's office a stake in the issue. They also pushed for the creation and implementation of a state strategic plan to confront substance abuse issues. Since FY 03 the substance abuse budget has increased by more than $50 million.

Scott said when he learned that Patrick's budget contained such a small increase for the AIDS line item he saw that as a sign that HIV/AIDS lobbying had gone off course.

"I just took a look at his budget and thought, this is the problem. It isn't hitting his radar in a substantial way like equal marriage did, for instance, or even what some of the smaller LGBT groups are doing around lobbying on youth issues. ... I thought, well this is a terrible way to start," said Scott.

Yet supporters of Project ABLE argue that given the state budget crisis, the coalition has been effective at winning back some substantial increases, gaining nearly $5 million from the low point in FY 04 to the current fiscal year.

"When there is absolutely no money but you have allies willing to work with you and perhaps carry some of the water and be incremental in the approach, I think that is a strategy that history has told us tends to work in tight times," said Handler.

She said that despite the priority the organization has placed on the $2 million to deal with disparities in communities of color, Project ABLE is committed to lobbying for the full $6 million ask, and given the tense budget climate that ask is an aggressive one.

"The $6 million is, even though it may sound modest, it is pushing the envelope," said Handler.

Beyond its lobby day, which Handler said brought more than 200 people to the State House, Project ABLE is ramping up a postcard campaign urging lawmakers to push for the $6 million increase, and the coalition has set up meetings between key lawmakers and people in their districts. In the current climate she said she is unsure whether the House, which will soon begin debating the budget, will approve the increase, but she said if Project ABLE is unsuccessful in the budget process by this summer they will continue to press for more funding through supplemental budget requests.

"I think even with allies, and we have many in the House ... I think there's a chance that this could be reduced to $1 million," said Handler. "Depending on the other demands on our champions, we may walk out with a million out of that vetting process. We could walk out with zero. ... But you could come back with an amendment."

Rep. Alice Wolf (D-Cambridge), one of Project ABLE's allies in the legislature, also emphasized that this year's budget will be tight.

"In fact there are many, many different programs that are not back to their 01 or 02 or 03 levels. This is not unique. It's not like everything else is being funded better and HIV is left on the table," said Wolf.

She said lawmakers are concerned about HIV/AIDS funding, and Project ABLE has maintained a presence on Beacon Hill through its lobby day and through meetings with lawmakers.

"They're a pretty regular presence. Let me put it that way," said Wolf.

She said during difficult budget years advocates should be careful to set priorities in their ask and approach the process with realistic expectations. Wolf said while she would like to see major increases in funding in a variety of areas, including HIV/AIDS programs, she herself has had to pick and choose among her goals. Among her top priorities in this budget cycle Wolf said she will be advocating for the $2 million in additional HIV/AIDS funding to deal with disparities in communities of color.

"It's also important to set priorities. I would not recommend that people come with many large asks, even if they have some data to support it, because it's just not realistic," said Wolf. "You have to be wise. It's a question of priority setting and good data. ... And also not to be enormously disappointed when after all that you still don't get what you want. We're all disappointed."

Daffin said he has reached out to AIDS Action and hopes they will rejoin the coalition. He said he supports their efforts to push for Project ABLE's ask of $6 million, but down the road if AIDS Action does not coordinate its lobbying efforts with the Project ABLE coalition he said that could threaten their lobbying efforts.

"If there are two messages and they are not compatible I think legislators would be somewhat confused, and particularly in this tough budget environment I think they would be concerned and frankly less likely to be supportive if they weren't clear that the community was unified about what the need was," said Daffin.