"Unfortunately, in 2008, Maryland did not receive funding for some of these time-limited projects, resulting in a decrease in its total award," said Nikki Kay, the spokeswoman, in an e-mail.
The $1 million awarded to Maryland is designated for "core surveillance," the reporting of HIV diagnoses along with basic information about the patients.
The CDC denied funding for "incidence surveillance," which distinguishes newly acquired infections from long-standing ones; and "resistant strain surveillance," which identifies strains that resists certain medications.
Resistance testing, begun seven years ago under a federal grant, has shown that 10 percent of people testing positive were infected with strains that don't respond to one or more medications, according to the AIDS Administration.
"If we see a large amount of resistance to certain medications, we work with physicians to make them well aware of these resistant strains and urge them to use alternative medications," said Colin Flynn, epidemiologist with the state AIDS Administration.
Many doctors perform resistance testing on their own, but often not until a patient has lived with the virus for several years, Flynn said. By conducting such tests when patients are first diagnosed, the state can determine whether resistance patterns are changing.
In denying Maryland funding for incidence surveillance, the CDC indicated that it had also denied grants for several other states and cities that had applied, Hauck said. The cuts are apparently part of a broader cost-cutting trend across federal health care programs.
Locally, the surveillance cuts have become a matter of concern not only for the AIDS Administration but also the Baltimore City Commission on HIV/AIDS, which oversees the city's response to the epidemic.
Dr. William Blattner, the commission's co-chairman, said the city has made some progress in stemming the epidemic, "but the success is fragile."
"This particular cut is the unkindest of all because it undercuts the capacity of the city to understand the extent of the epidemic," he said. The impact "includes our ability to accurately reflect the needs for funding through Ryan White, so people's ability to get medical care is undercut."
The federal government sends about $65 million annually to Maryland through its Ryan White program, which is then distributed to local health departments as well as hospitals and clinics that treat patients in need.
jonathan.bor@baltsun.com
