America Living With AIDS

crises may also make it all but impossible for these localities to comply with
or fulfill the intent of federal programs
when maintenance of level-of-effort or
matching funds are required.
LOCAL GOVERNMENT
(COUNTY AND MUNICIPAL)
A number of examples of extraordinary leadership on the local level have
emerged in recent years. Many county
and municipal governments have
established comprehensive planning
processes that involve not only health
care providers and public health leaders, but also a much broader base of
citizens, HIV-infected individuals, and
representatives of impacted communities. Also, many counties and
municipalities have worked successfully with employers to sponsor policies against discrimination and
to educate employers, health care
providers, community and religious
organizations, and other public sector
agencies including police, emergency
services, and schools.
The capacities of some county and
municipal governments are strained,
however, by jurisdictions too small to
support adequate county and municipal health departments. These small
counties and cities operate without the
public health programs and competence necessary to organize effective
HIV-related (or other) public health
and medical programs.

County and municipal governments are increasingly overwhelmed
by the demands of providing access to
medical care services (HIV-related and
non-HIV-related). Although local
government is the provider of last
resort for a growing population of
medically indigent people, tax revenues are diminishing in proportion
to the programs now delegated to
local government, and access to care
must compete with many other
important social programs including
education, public safety, and general
assistance.
Lack of information and technical
assistance is as critical a problem at
the local level as it is for state agencies.
State and federal agencies provide no
systematic information or technical
assistance regarding HIV program
design, management, and effectiveness.
All levels of government must
exhibit strong leadership and improve
their response to the HIV epidemic.
The following recommendations
should be adopted immediately.

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