Economic downturn leads to a contraction of HIV evidence-based behavioral intervention implementation

Background: The recent economic downturn has affected funding sources for HIV behavioral prevention in the US. We examine how funding reductions impact the ability of public health departments (HD) and community-based organizations (CBO) to translate evidence-based interventions, particularly HIV behavioral prevention programs.

Methods: Two approaches were employed. Using a database of agencies in the western region trained on a CDC DEBI (RESPECT) (n=80), we screened agencies for eligibility. Screening data were used to examine changes in agency intent to deliver RESPECT. Then, using a national database of trained agencies, we enrolled 30 urban and rural CBOs and HDs implementing RESPECT. We report on interviews with executive directors addressing fiscal changes and their impact.

Results: The screening study revealed a loss of agencies and of agency capacity. Fifty percent of agencies committed to participate in the study in 2008, did not enroll in 2009/10 because they no longer existed or were not delivering RESPECT. Analyses revealed that the majority of agencies in our study experienced fiscal loss (Reduced overall funding -64%; reduced prevention funding- 54%, reduced behavioral HIV/STI prevention funding -64%). Funding reductions were more pronounced in rural HDs and among CBOs. Overall, CBOs experienced greater losses than HDs. Agencies experienced staffing reductions, reductions in scope or elimination of prevention programs.

Conclusions This qualitative study supports anecdotal reports that the prevention safety net is unraveling, particularly in rural areas and in CBOs, and suggests the need for a larger nationally representative study to provide comprehensive data on HIV prevention.