Despite struggling with one of the nation's highest AIDS rates, Maryland is facing a 40 percent reduction this year in federal support to track infections - a cut that officials say could have a ripple effect on aid to treat the indigent.
The cut, from $1.8 million last year to about $1 million in calendar year 2008, eliminates funding for the state to perform tests that discern whether someone testing positive for HIV was infected recently or years ago, according to the Maryland AIDS Administration.
Also eliminated are state-ordered lab tests that indicate whether someone is carrying a strain that resists treatment by one or more medications. The state agency first learned of the funding cut in November but received paperwork indicating the grant amount last month.
News of the funding cuts has come in a series of communications from the U.S. Centers for Disease Control and Prevention.
"I think the main issue is that we are third in the country for AIDS case rates, so I find it alarming that the CDC would jeopardize our surveillance system at a time when we obviously have a significant burden of the epidemic," Heather Hauck, director of the state AIDS Administration, said this week.
Forced to scale down its surveillance activities, the state might have a harder time directing services to regions or groups where they are most needed, Hauck said. The state, as well as Baltimore, relies heavily on federal support for activities related to HIV/AIDS treatment and surveillance.
Hauck also warned that the state might find it harder to get as much funding for AIDS treatment under the federal Ryan White Care Act as it deserves. The amount depends in part on the number of new infections in a particular state - numbers that hinge on the state's success in counting them.
In 2005, the most recent year for which state-by-state comparisons are available, only Washington, D.C., and New York state had higher rates of new AIDS diagnoses. All told, more than 32,000 people in Maryland are living with HIV infection or full-blown AIDS.
While declining to explain why Maryland was denied funding for the two "surveillance" activities, a CDC spokeswoman said previous grants were "time-limited" and not meant to continue automatically.
States competing for renewed funding underwent an "objective review process," with Maryland apparently falling short.
"Unfortunately, in 2008, Maryland did not receive funding for some of these time-limited projects, resulting in a decrease in its total award," said Nikki Kay, the spokeswoman, in an e-mail.
The $1 million awarded to Maryland is designated for "core surveillance," the reporting of HIV diagnoses along with basic information about the patients.
The CDC denied funding for "incidence surveillance," which distinguishes newly acquired infections from long-standing ones; and "resistant strain surveillance," which identifies strains that resists certain medications.
Resistance testing, begun seven years ago under a federal grant, has shown that 10 percent of people testing positive were infected with strains that don't respond to one or more medications, according to the AIDS Administration.
"If we see a large amount of resistance to certain medications, we work with physicians to make them well aware of these resistant strains and urge them to use alternative medications," said Colin Flynn, epidemiologist with the state AIDS Administration.
Many doctors perform resistance testing on their own, but often not until a patient has lived with the virus for several years, Flynn said. By conducting such tests when patients are first diagnosed, the state can determine whether resistance patterns are changing.
In denying Maryland funding for incidence surveillance, the CDC indicated that it had also denied grants for several other states and cities that had applied, Hauck said. The cuts are apparently part of a broader cost-cutting trend across federal health care programs.
Locally, the surveillance cuts have become a matter of concern not only for the AIDS Administration but also the Baltimore City Commission on HIV/AIDS, which oversees the city's response to the epidemic.
Dr. William Blattner, the commission's co-chairman, said the city has made some progress in stemming the epidemic, "but the success is fragile."
"This particular cut is the unkindest of all because it undercuts the capacity of the city to understand the extent of the epidemic," he said. The impact "includes our ability to accurately reflect the needs for funding through Ryan White, so people's ability to get medical care is undercut."
The federal government sends about $65 million annually to Maryland through its Ryan White program, which is then distributed to local health departments as well as hospitals and clinics that treat patients in need.