The Vermont Department of Health further weakened its commitment to serving gay and bisexual men this past November with announcement of HIV prevention grants to community organizations.
       On November 24, 2004, the Vermont Department of Health (VDH) announced HIV prevention grants awarded in the amount of $575,000 to nine Vermont non-profit organizations. The funding for the grants came from the federal Centers for Disease Control (CDC). The grant awards set the agenda for HIV prevention in the state for the next three years, when a new funding cycle will begin.
       Only two of the nine organizations will serve gay and bisexual men primarily. R.U.1.2? Community Center in Burlington will receive $63,980 to serve men in and around Burlington and online, and the AIDS Project of Southern Vermont will receive $75,674 to serve men in and around Brattleboro. These grants total 24 percent of the funds available. Outright Vermont will receive $38,160 to serve queer youth, but because of federal restrictions these funds will come from the allocation for heterosexual prevention services.

What the Programs Do

      R.U.1.2? Community Center plans to use the funding to hire a full-time Health and Wellness Coordinator who will oversee VTM4M.net, an existing online health and wellness outreach program, and a new program which will train and support gay, bisexual, and transgender men so they can help other men prevent the transmission of HIV. The project falls under the DEBI (Diffusion of Effective Behavioral Interventions) model approved by the CDC.
       The AIDS Project of Southern Vermont will implement a CDC-recommended program model used in urban areas called Mpowerment. The program is a combination of peer outreach and community engagement, which puts HIV prevention issues in a context that is relevant to gay and bisexual men. Like R.U.1.2?'s program, Mpowerment relies on men involved in the program sharing what they learned with their personal social networks.
       "These grants will allow gay and bisexual men to have an opportunity to access interventions that will strengthen their own community," said VDH's HIV/AIDS Section Chief Kurt Kleier. "In other words, provide self-strength, an opportunity to interact with other individuals, and strengthen prevention messages within those groups that they can then take out to the community and communicate this information to their peers." The funds will also increase the number of men who are tested for HIV.
       The funding allocation is not without its controversies, however. In September, Vermont CARES announced it would decline to seek funding because of increased and intrusive reporting requirements and the need to submit prevention materials for state approval (see "CARES Says No to VDH Funding" in OITM October 2004). Also, VDH declined to continue funding the Upper Valley Men's Project, a successful program of the AIDS Community Resource Network (ACoRN) that provided HIV prevention services to gay and bisexual men in Orange and Windsor Counties.
      As a result, access to HIV prevention information and education will be severely limited for gay and bisexual men in most of Vermont. This comes at a time when the rates of HIV and sexually transmitted disease are rising after a multi-year period of decline.
      "What it will mean is that for men who live in Vermont, we're not going to be able to do much at all for them," explains ACoRN Executive Director Thomas Mock. "We won't have the programs. We won’t have the funds to support the staff."

Are Gay and Bisexual Men Under-served?

     Historically, gay and bisexual men make up approximately two-thirds of the HIV/AIDS epidemic in Vermont. VDH officials dismiss the fact that gay and bisexual men carry the lion's share of HIV/AIDS cases.
       "One thing we have to take into consideration with the numbers is that they are cumulative numbers, and they represent individuals," said Kleier. "MSM were impacted disproportionately in the early part of the epidemic. I think you have to look at recent trends."
      In an article published in the December 3, 2004 issue of Morbidity and Mortality Weekly Report, the CDC reports an 11 percent increase in MSM AIDS cases from 2001 to 2003.
      According to the "Epidemiologic Profile for HIV/AIDS Prevention and Care Planning in Vermont" released by VDH in April 2004, two-thirds of new AIDS diagnoses (31 cases) between 2000 and 2002 were among men who have sex with men.
      "White men who reported having had sex with men continue to be the group most affected by the epidemic in Vermont," the report states.
     The report also states, "The proportion of cases attributed to injection drug use has declined." Only 6 percent of new AIDS diagnoses (fewer than three cases) between 2000 and 2002 were among injection drug users.
      In spite of these data, the percentage of funds directed towards programs serving gay and bisexual men fell from 37 percent in 1997 to 31 percent in 2004 while the percentage of funds for injection drug users rose from 22 percent in 1997 to 39 percent in 2004.
      VDH's preference for serving injection drug users coupled with a decrease in overall available funds has meant fewer and fewer dollars available for prevention services targeting gay and bisexual men.       The loss of HIV prevention funding to support the Upper Valley Men's Project also means a further erosion of infrastructure for delivering HIV prevention and other gay men’s health services to men in Vermont.
       "The hardest part about the way the funding was allocated is that there were so few MSM programs that were able to apply, so there are going to be gaps all over the state," said R.U.1.2? Executive Director Christopher Kauffman. "The organizational infrastructure isn't there."
     "But ACoRN did apply to serve two counties and they [VDH] knowingly zero-funded [us]," said ACoRN's Mock.
       Kleier countered that the real issue was that ACoRN's proposal to expand a program VDH was currently funding just wasn't good enough.
      "Some of the general concerns we had from the Health Department's perspective is that they had to successfully propose a model, tie it in together with the behavioral theory, and show how it would be put into practical application," said Kleier. ACoRN did not address these concerns to the satisfaction of VDH.
     But other organizations whose applications also had serious flaws did receive funding. For example, internal and external reviews of the Vermont Harm Reduction Coalition's application cited a range of problems with that organization's proposal: a lack of clarity on how many people the program would reach and how services would be evaluated, an incomplete timeline, no accounting for supervision of case managers, and a staffing plan that is not sustainable. One reviewer's note states that the director violates the confidentiality of their clients. Another note states that while the Harm Reduction Coalition clearly understands prevention case management, "It isn't clear that they really do it the way it should be done."
      The Vermont Harm Reduction Coalition applied for $65,000 to reach 36 individuals. VDH awarded them a grant of $69,000 to reach 25 individuals.
     "There was an element of clinical supervision involved in this work that needed to be strengthened," explained Kleier. "We felt like the four thousand dollars that we awarded extra would go very far in insuring a strong infrastructure for them over the next three years."
     The funding allocation process was "one of the more comprehensive processes that has ever been utilized for awarding any HIV grants here in the state of Vermont," said Kleier.
      New grants will not be available until 2008. Meanwhile, gay and bisexual men should not expect VDH to begin addressing their needs anytime soon. According to Klier, should new funds become available, they will be directed toward other communities.

Ric Kasini Kadour is a men's health activist who splits his time between Shoreham, Vermont and Montreal, Canada.