Evaluating the Impact of State Budget Eliminations on STD Clinical Services in New Hampshire: Assessment and Development of a Statewide Response

Background: Prior to July 2011, New Hampshire funded Sexually Transmitted Disease (STD) clinical services at 13 agencies (19 sites) across the state. On July 1, 2011, state budget cuts reduced the number of publicly funded STD clinic sites in New Hampshire to zero.

Objectives: To describe the assessment of the impact of budget eliminations on STD clinical services in New Hampshire and the development of a response plan.

Methods: In September 2011, the STD/HIV/Hepatitis section conducted a telephone survey with formerly state-funded STD clinical sites to determine the effect that the loss of funding had on the provision of STD services. Information was gathered about STD/HIV/Hepatitis C testing and treatment services, cost to patient, billing practices, and referral protocols. 

Results: Initial survey results (89% response rate) indicate that the availability of separate STD clinic hours at previously funded sites has been reduced by 65%. Services that were previously no cost are now subject to fee-scale pricing that varies significantly by site. Additionally, STD services are more readily available in certain areas, leaving access poor in other geographic regions, particularly the rural northern tier of the state. 

Conclusions: The elimination of funding for STD clinics has significantly impacted the availability of services, reducing access to treatment and care for New Hampshire residents in need. At locations where services continue to be offered, cost fluctuates greatly and may present an additional barrier. The state of New Hampshire will use the information gathered in this survey to develop and implement an appropriate and feasible response plan.

Implications for Programs, Policy, and Research: Reduction of funding support for STD clinics can significantly impact the availability of accessible (low-cost, time-sensitive) services for a population with significant needs. Gathering key pieces of information from stakeholders can assist in the development of an appropriate and timely response.