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Neumann's approach signifies the difference between MTAP education and that employed by mainstream health care. He witnessed the contrast firsthand once when MTAP subcontractors practiced testing scenarios alongside public health nurses.
"A couple of us who had been around a long time with this would often start bringing up scenarios that we knew darn well that these straight women had never thought of," Neumann says.
Specifically, gay and bisexual men aren't necessarily going to talk about sexual behavior with someone outside their community.
"These are the nurses, these are the ones that when they get a guy in their office, the guy is not going to tell this woman what they've been doing," Neumann says.
Now that MTAP's funding is gone, and Neumann's outreach work is over, he wonders whom those men will talk to now—or whether they'll talk at all.
Missoula AIDS Council Executive Director Christa Weathers, once charged with administering MTAP, doesn't skirt the issue: Losing the CDC grant cripples the nonprofit's statewide prevention efforts. What makes the situation even worse is the reason why the nonprofit lost the grant in the first place.
The AIDS Council's board of directors acknowledges an internal problem prompted CDC to deny the grant application. According to a statement from the board released Aug. 30: "It appears that there were some deficiencies in the MTAP grant application that resulted in denial of the Agency's request."
The board says it's taking measures to correct the problem and implementing a more stringent grant screening process to ensure a similar scenario doesn't play out again.
MAC can't apply for the CDC grant for another four years.
Meanwhile, Weathers is left to pick up the pieces. She assumed her position as executive director in February, long after the funding request was submitted. Sitting at her desk in MAC's underground Higgins Avenue office, she fidgets while explaining how the nonprofit will move forward. A thin strip of paper taped directly above her computer screen reads, "Stress is a Choice."
"It's a big deal for Montana," she says. "The impact is huge...But we have every hope possible of providing statewide outreach again."
Weathers says the lost grant exposed MAC's financial vulnerability. In other words, the nonprofit was relying too heavily on one funding source. It's clear now that diversifying revenue streams will be necessary to ensure the organization's survival. Weathers and the nonprofit's board of directors are strategizing ways to bring in additional resources, applying for grants and asking Montana's congressional delegation for help.
"You keep bugging them," Weathers says, "until someone pays attention to you."
Despite Eddie Rudd's comparably healthy lifestyle as of late, he has headaches just about every day, vomits frequently and is losing weight. An annoying "brain fog," not unusual for people with chronic HCV, makes even simple tasks difficult. For instance, he sometimes forgets how to get where he's going and is forced to call his wife for help. Before he got sick, Rudd was never one to sit around. Now when he exerts himself he gets nosebleeds and coughing attacks.
"It's no fun to be living with hep C," he says.
Once chronic HCV develops, as is the case with Rudd, treatment becomes even less of an option. Doctors tell him that he's not a viable candidate for HCV therapy. They also tell him that complications from the disease will significantly shorten his life. That prognosis leaves Rudd acutely aware of the urgency involved with his mission to prevent the spread of the disease.
MTAP paid the Rudds' nonprofit $17,000 last year to perform outreach work. Casey Rudd estimates 80 percent of the IV drug users they tested through the program turned up positive for hepatitis C.
With MTAP funding gone, even fewer resources are being devoted statewide for HCV prevention. According to the state Department of Health and Human Services (DPHHS), Montana's general fund contributes nothing toward outreach or testing. The federal government allocates roughly $56,000 annually—$34,000 of that pays for training and technical assistance and roughly $22,000 is used to purchase HCV tests. Those tests are distributed to public health departments.
"We've just recently acquired hepatitis C prevention money," says Judy Nielsen, DPHHS' HIV programs coordinator. "But it's very little. The feds don't invest much money in hepatitis C, which is going to bite us down the road, because there are many infected persons with hepatitis C who are going to end up needing liver transplants if we don't find them and get them treatment."
HCV treatment consists of immune system boosting drugs and antiviral therapy, usually interferon injections combined with ribavirin pills. The drugs fend off chronic liver inflammation in fewer than half of those treated, according to several studies, including a recent one by the Indiana University School of Medicine. Therapy must be administered for at least six months and costs upwards of $1,000 per month.
The Rudds hope they can continue their prevention work so the state's larger treatment expenses never become an issue. An HCV test costs just $40. Even inexpensive tools like those MTAP-furnished "vein care kits" help prevent blood-to-blood contact among users.
But Casey Rudd says she and her husband have now used up everything MTAP provided.