Washington Blade - December 15, 2006
Lou Chibbaro Jr.

The revised legislation exempts the city from a policy set by the previous Ryan White law, which links federal AIDS funds to the number of people who test positive for HIV beginning next year. Washington's system for counting the number of HIV cases through a confidential names reporting system is considered incomplete by federal authorities.

A spokesperson for the city's Administration for HIV Policy & Programs said that without the exemption, federal AIDS funds would be linked only to the number of confirmed cases of full-blown AIDS, which are far fewer than the number of HIV cases.

"The benefit will be that we get a lot more money under this new legislation," said spokesperson Michael Kharfen. "We have gone to names reporting but it will take a few more years for the system to mature."

The $2.1 billion Ryan White CARE Act is the federal government's largest program for helping states and cities provide medical treatment and support services to uninsured and low-income people with HIV and AIDS. President Bush has said he would sign the revised Ryan White measure.

Congress first approved the Ryan White Act 1990. The most recent version expired in September 2005. Efforts to reauthorize the law stalled for more than two years due to disagreements over whether funding should be shifted from urban to rural parts of the country.

New York Senators Hillary Clinton and Charles Schumer, both Democrats, were among a small group of senators that placed a hold on the bill this year, saying the proposed funding shifts would result in their states losing millions of dollars a year in Ryan White funds.

Last week, Clinton and Schumer agreed to withdraw their hold on the bill after Senators Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyo.), the two lead sponsors of the Ryan White bill, agreed to revisions that would significantly reduce projected funding losses for New York, New Jersey and California. Kennedy and Enzi also agreed to extend the life of the new bill for three years rather than five years, with the aim of further adjusting funding formulas for different states at the time of the legislation expires.

Like states, D.C. relies on the Ryan White program to help pay for life-saving AIDS drugs for patients who could not otherwise afford the expensive medications.

With effective drug treatments resulting in far fewer cases of AIDS compared to HIV infections, the old version of the Ryan White law would have resulted in a funding reduction of millions of dollars for D.C. and states that have yet to complete their transfer from a code-based to a name-based HIV reporting system.

The U.S. Centers for Disease Control & Prevention has said the code-based system resulted in inaccurate counts of the actual number of people who test HIV positive, partially because of duplication of individuals who show up at different clinics or testing centers.

Beginning next October, the CDC said it would no longer accept code-based reporting.

The new version of the Ryan White law allows D.C. and states that used the code system to phase in, over a period of two or more years, the names-reporting system without being slapped with funding penalties.

Pat Hawkins, an official with D.C.'s Whitman-Walker Clinic, joined leaders of AIDS advocacy groups throughout the country in calling on Congress to increase the amount of funding for the Ryan White program.

Activists have said the fierce competition between urban and rural states for Ryan White funding, which resulted in Congress' delay in passing the reauthorized bill, could have been prevented if Congress appropriated more money to adequately cover all regions of the country.

While the number of HIV cases continues to grow, Congress has held the overall funding level for most Ryan White programs at the same figure for the past several years.

Hawkins said Whitman-Walker and other local AIDS groups would like the D.C. government to increase its own share of AIDS funds. Mayor-elect Adrian Fenty has said he would review AIDS funding levels when he prepares his first city budget next year.

The district's total AIDS budget for fiscal year 2007 comes to $82 million. Seventy million dollars comes from federal AIDS funds while $12 million comes from local, District of Columbia funds appropriated by the City Council.

Out of the $70 million allocation from the federal government, $45 million comes from the Ryan White CARE Act, $17 million comes from an AIDS housing program funded by the U.S. Department of Housing & Urban Development, and $8 million comes from the Centers for Disease Control & Prevention.

The act is named for the Indiana teen who died at 18 in 1990 of AIDS-related pneumonia.

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WB061203

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