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Lost to Care 

Would you lend City Hall money? Would you advance city government hundreds of thousands of dollars? Suppose you did and, many months later, the city administration still hadn't paid you back — even though it had the money to do so and your bills were piling up? Strange as that may sound, that's exactly what has happened to local HIV/AIDS agencies.

Even though the federal government announced in early March that the city would receive more than $7 million to fund primary care and support services for the 4,144 people living with HIV/AIDS in the New Orleans area, the Nagin administration has yet to reimburse any of the agencies that have been providing the care and services that the federal grants were intended to underwrite. That is inexcusable — and the situation for several small agencies has become critical.

As we first reported in August, In this Together, a small organization that focuses on serving poor African Americans with HIV/AIDS, was forced to take out cash advances on a personal credit card to meet its payroll. The cash crunch became so severe that the agency eventually had to stop taking care of its 225 clients. Demitre Blutcher, director of N'R' Peace, a West Bank HIV/AIDS service provider, reports that she has applied for a line of credit — using her property as collateral — so she can pay her employees. She has no other choice, she says, because the alternative is unthinkable. "Half of our program would have to be halted," Blutcher explains. "That would affect over 200 clients."

Many of N'R' Peace's clients are part of a population that experts refer to as "lost to care" — severely poor, often recovering drug addicts and homeless. They are the invisible and disenfranchised, the very people government should be helping. Blutcher says her outreach workers go out in the community, locating and encouraging those in need to come in and get assistance. Like her clients, most of Blutcher's staffers are African American, so there is cultural sensitivity and a feeling of individualized service that isn't always present at some larger agencies and clinics. If N'R' Peace clients are transferred to other agencies, Blutcher fears that many of them won't make the transition; instead, they will become "lost" again, with dire consequences. "Our infection rate in the New Orleans [area] can go up," she says.

Worse yet, if local agencies had followed City Hall's advice, no one would have received federally reimbursable HIV/AIDS services since Feb. 29, the last day in the funding fiscal year. After the Mayor's Office of Health Policy and AIDS Funding (MOHP) sent out award letters on June 23 — more than three months into the new fiscal year — city CAO Brenda Hatfield sent out another letter that stated, "You should begin no work until all parties execute the contract." Late last week, the city reported it had executed eight of the 13 contracts, but no reimbursements have been made.

As often happens when the Nagin administration drops the ball, the City Council is trying to step in and patch things up. The council's Housing and Human Needs Committee will hold a hearing this month on the issue, and Fran Lawless, MOHP's director, will be expected to answer why delays continue to occur. Councilman James Carter says he and his colleagues will try to move the issue forward, but ultimately it is the mayor's responsibility. "We're going to try to come to some conclusion," Carter says, "but it lies in the executive branch of government. They're the ones who execute contracts." The administration also pays the bills, and that's scariest of all for HIV/AIDS agencies.

Time after time, members of the Nagin administration have appeared before the City Council and were unable to explain the federal funding process or their own inability to meet obligations. We are at a loss to explain why the city has no problem funding programs that don't provide promised services — like New Orleans Affordable Homeownership — but can't reimburse agencies for needed services already rendered.

What concerns us most is that some local HIV/AIDS agencies have been afraid to speak out for fear of retribution. Because they are providing services without city contracts, and because they have been advised not to do that, some fear the city will deny reimbursement claims. Moreover, funding decisions are made annually, and some agencies fear that if they complain, they'll get shut out the following year. District B Councilwoman Stacy Head, who co-chairs the council's Housing and Human Needs Committee, is well aware of that fear and promises that the council will 'take the pressure off" the agencies.

Blutcher and Michael Hickerson, In This Together's director, should be commended for shedding light on this problem. Without them, this dirty little secret of the Nagin administration would never have been uncovered. Instead of intimidating them, the administration should be facilitating contracts and getting these agencies paid for the vital community services they provide.

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