1. Health Department Funding Allocations
Under Program Announcement 04012
for CDC-Supported HIV Prevention Activities,
2008-2009
Argelia Figueroa M.S., Choi Wan Ph.D.,
and Mesfin Mulatu Ph.D., M.P.H.
Division of HIV/AIDS Prevention
2011 National HIV Prevention Conference
August 15, 2011
The findings and conclusions in this presentation are those of the authors and do not
necessarily represent the official position of the Centers for Disease Control and
Prevention/the Agency for Toxic Substances and Disease Registry
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention

2. Background
 CDC’s Division of HIV/AIDS Prevention (DHAP)
funds about $650 million per year to address the
domestic HIV/AIDS epidemic
 About $300 million through Program
Announcement (PA) 04012 for HIV prevention
 Funding for HIV prevention projects is
supplemented by other program awards focused
specifically on communities of color and men who
have sex with men (MSM)

3. Issue
 Describe how health departments allocate
CDC PA 04012 funds
 HIV prevention program activities
 Prevention interventions designed for persons living
with HIV
 Compare distribution of allocations with
patterns of the HIV epidemic by race/ethnicity
and by risk categories

4. Setting
 59 Health Departments
 50 states  6 cities
 District of Columbia  Chicago
 Houston
 Puerto Rico
 Los Angeles
 U.S. Virgin Islands
 New York City
 Philadelphia
 San Francisco

5. Methods

6. Methods
 Collaboration among CDC, the National
Alliance of State and Territorial AIDS Directors
(NASTAD), and the Urban Coalition on
HIV/AIDS Prevention Services (UCHAPS)
 Data collection template provided by CDC to
report PA 04012 2008 and 2009 allocation
information
 Template provided in April 2010
 Information received between April and June 2010

7. Methods
 Allocations under PA 04012 were requested for:
 HIV prevention program activities
• Community planning (CP)
• Evaluation
• Health education and risk reduction (HE/RR)
o by race/ethnicity and by risk (reported)
• Counseling, testing, referral, and partner services (CTR+PS)
o by race/ethnicity and by risk (estimated for CTR)
• Other
 Prevention interventions designed for persons living with HIV

8. Methods
 Race/Ethnicity  HIV risk
 American Indian/Alaska  MSM
Native (AI/AN)  Injection drug use (IDU)
 Asian  MSM/IDU
 Black (non-Hispanic)  High-risk heterosexual
 Hispanic contact
 Native Hawaiian/Pacific  Other
Islander (NH/PI)
 White (non-Hispanic)
 Other

9. Methods
 Quality assurance during and after reporting
 Checks for any incomplete or inconsistent
information
 Requesting additional information when necessary
 Provide feedback on submitted data

10. Results

11. Proportion of Allocated PA 04012 Funding for
Prevention Interventions Designed for
Persons Living with HIV, 2005-2009
15% 14%
Proportion of Allocated Funding
13%
12%
12% 11%
9%
9%
6%
3%
0%
2005 2006 2007 2008 2009
Year
N= 59 state and local health departments

12. Proportion of Allocated PA 04012 Funding for
HIV Prevention Activities, by Year, 2005-2009
45% 2005
41%
40%
40% 39%39% 2006
38%
Proportion of Allocated Funding
36%
35%35% 35% 2007
35%
31%
2008
30%
2009
25%
20% 18%
17%17% 17%17%
15%
10%
6%
5% 5% 5%
5% 4% 4% 4% 4% 4% 4%
0%
CP Evaluation HE/RR CTR+PS Other
Prevention Activities
N= 59 state and local health departments

13. Proportion of Allocated PA 04012 Funding for HE/RR,
by Race/Ethnicity, 2009
White (non- Other
Hispanic) 21%
17% American Indian
or Alaska Native
1%
Native Hawaiian
or Pacific
Islander
<1% Asian
1%
Hispanic
22% Black (non-
Hispanic)
38%
N= 59 state and local health departments

14. Proportion of Allocated PA 04012 Funding for HE/RR,
by Risk Group, 2009
Other
20%
High-risk
heterosexual
contact
38% MSM
27%
MSM/IDU IDU
2% 14%
N= 59 state and local health departments

15. Proportion of Allocated PA 04012 Funding for CTR,
by Race/Ethnicity, 2009
White (non-
Hispanic) Other
31% 7%
American Indian
Native Hawaiian or Alaska Native
or Pacific <1%
Islander
<1%
Asian
<1%
Hispanic
18%
Black (non-
Hispanic)
37%
N= 49 state and local health departments

16. Proportion of Allocated PA 04012 Funding for CTR,
by Risk Group, 2009
High-risk
MSM/IDU heterosexual
1% contact
45%
IDU
4%
MSM
10%
Other
40%
N= 49 state and local health departments

17. Estimated HIV Diagnoses in 2009
(N = 40 states with confidential name-based HIV infection reporting)
Race/Ethnicity HIV risk group
High-
Other risk Other
3% hetero- 3%
White sexual
28% 32%
Hispanic Black IDU MSM
17% 52% 9% 56%
Source: CDC HIV Surveillance Report, 2009

18. Comparison of Allocations from PA 04012
with the National HIV Epidemic, 2009
HIV/AIDS Diagnoses
80% HE/RR Allocations
CTR Estimated
Allocations
60% 56%
52%
40% 38% 37%
27%
20%
10%
0%
Black MSM

19. Summary
 Largest budget allocations for HE/RR and
CTR+PS
 From 2005 to 2009, budget allocations
 Increased slightly for prevention interventions designed for
persons living with HIV (9% to 11%)
 Increased for CTR+PS (31% to 39%)
 Decreased for HE/RR (41% to 35%)
 Differences between national HIV epidemic and
national level allocations of HIV prevention funds
distributed under PA 04012

20. Lessons Learned
Limitations and Discussion

21. Lessons Learned/Limitations
 Funding allocations provide proxy measure of
populations served and services provided
 PA 04012 represents over one half of total CDC
HIV prevention funding and does not include:
 CDC funding for specific initiatives (e.g., 07-768)
 CDC direct funding for specific grantees (e.g., CBOs, Pacific
Island Jurisdictions)
 Funding from other federal agencies, state or local
governments, or private sources
 Change in budget allocation reporting
requirements to allow for a relatively
comprehensive analysis

22. Lessons Learned/Limitations
 Information was collected retrospectively
 Level of detail of data collected
 Overall CTR allocation was a true allocation;
however, CTR allocations by race/ethnicity and
by risk were estimates
 High percentages of estimated CTR allocations
by risk categorized as “other”

23. Discussion
 Understanding funding allocations helps CDC
and stakeholders make policy decisions and
improve prevention programs and resource
targeting
 Documenting actual expenditures should be
considered
 Determining whether and to what degree
programs are underfunded for black and MSM
populations is warranted

24. Acknowledgments
 Health Department Grantees  DHAP, Office of the Director
 Jonathan Mermin
 NASTAD
 Rich Wolitski
 Julie Scofield
 Janet Cleveland
 Natalie Cramer
 Chris Cagle
 Prevention Advisory Committee
 June Mayfield
Members
 DHAP, Prevention Program Branch
 UCHAPS
 Wendy Lyon
 Anna Ford
 Project Officers
 Coalition Representatives
 DHAP, Program Evaluation Branch
 Dale Stratford
 Janet Heitgerd
 John Beltrami

25. Thank you!
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention