Fulton County’s inept handling of a $28 million federal grant hobbled efforts to expand HIV testing and prevention to thousands of people at high risk of contracting the disease.
The program was so poorly managed that the county was forced to return nearly $9 million because local officials failed to meet spending deadlines, according to interviews and records reviewed by the Atlanta Journal-Constitution.
From its start in 2012, the program has been plagued by poor leadership, staffing shortages and delays engaging the community it was supposed to serve, said Jeff Graham, head of the gay-rights group Georgia Equality and a member of an advisory panel over the program.
“The premise of this program was to make the system better,” Graham said. He added, “We have yet to make it better.”
It's not the first time Georgia's most populous county has been accused of bungling grants. The AJC recently reported on an audit that found the county failed to properly monitor more than $5 million in social services money for housing, employment and other services.
The HIV prevention program is funded by the Centers for Disease Control and Prevention. The grant was intended to expand HIV services in Fulton and DeKalb counties, home to one of the highest infection rates for the disease in the nation.
Scrambling to correct early missteps, the county has successfully requested some $3.4 million back from CDC, said Fulton spokeswoman Jessica Corbitt.
But a clearly upset John Eaves, head of the Fulton County Commission, railed against the bureaucratic fumbling and publicly grilled county health director Patrice Harris over the mistakes.
“This is just inexcusable,” said Eaves said during the June commission meeting. He was also angry that the commission was learning about the problems four years into a five-year project. “It’s beyond me why this board was never informed about this large amount of money not being used.”
Beyond that, Eaves worried that the county’s mismanagement could endanger future federal funding.
To Harris, he said pointedly, “Do you feel that this is a good reflection of this government?”
She responded, “It is not commissioner, certainly, nor me.”
The commission has ordered an audit of the HIV program and the entire health department. The first part of that audit, on the HIV program, is expected to be released within the next week.
Once a disease that largely affected gay white men, HIV has shifted so that nearly half of all new cases strike African Americans, according to the CDC. Prevention programs have contributed to significant reductions in new cases nationally, and rates of infection have largely stabilized. The South has the highest number of people living with HIV, according to the CDC.
The CDC’s five-year funding program was intended to provide a new way of reducing new cases, reaching deeper into high-risk populations and neighborhoods.
Instead of funneling the money through the states, the CDC began directly funding about 10 of the hardest hit municipalities in the country, including the Atlanta area. The great majority of new HIV cases in Georgia emerge in Fulton and DeKalb. Other recipients included Baltimore, Chicago, Los Angeles, New York City and Miami.
The program had three prongs, the first of which was to increase HIV testing in hospitals and other medical settings. The second was to fund community-based health organizations that would perform testing in non-traditional settings, such as health fairs and gay pride festivals. The plan was to target services to communities and populations at high risk of HIV. The third included increased educational efforts such as support groups and condom distribution.
Some of the grant money would be channeled through DeKalb.
But efforts sputtered from the start, at times for reasons that strained common sense. At one point, hiring ground to a halt because the program staffers thought they were constrained under a county government hiring freeze.
Eaves found that reason absurd, since the money was federal, not county funds.
The reviews of the HIV program uncovered systemic problems that could hamper other grants, officials said. For example, staffers found the county’s system of soliciting proposals from community groups to be time-consuming and cumbersome, requiring numerous internal reviews.
“It is clear there was obvious mismanagement,” said Craig Washington, AID Atlanta’s manager of HIV prevention programs. “We cannot afford the squandering of resources.”
Graham, the gay rights advocate, said those leading the Fulton HIV program lacked sufficient experience in running an HIV program and managing a major federal grant.
By 2014, the third year of the program, he said the HIV advisory group members realized there were major problems. But Graham said the health department provided them with little information, and later attempted to withhold all financial information.
He said the person leading the program departed in 2014.
Fulton’s program is not alone in fighting HIV in the Atlanta area. Nonprofits such as AID Atlanta often receive their own funding for testing and prevention.
County officials noted the program’s accomplishments over four years, such as performing over 100,000 HIV tests, distributing millions of condoms and hosting community forums on addressing HIV.
But if the Fulton program had been successful, thousands of additional people in the Atlanta area would have been tested for HIV, said Graham, who believes the problems reflect a broader lack of commitment on the part of the county health department to fight HIV.
Early this year, a new director, Leisha McKinley-Beach, took over the HIV program, and has been receiving praise for making improvements. The program is on track to spend all of this year’s CDC money. The county manager is revamping the management of grants.
Now, once a grant is obtained, Fulton officials hold “kick-off meetings” to address all financial transactions, such as contracts, procurement and the hiring of personnel.
HIV advocates say they see change.
“Out of the bad things happening with funding, there are some good things happening,” said Dr. Carlos del Rio, co-director of the Emory University Center for AIDS Research. “There is a willingness to change.”
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