Los Angeles Times - May 29, 2006
Rong-Gong Lin II, Times Staff Writer

A Senate health committee, by a 19-1 vote earlier this month, approved the proposal, which would renew and revise the Ryan White Comprehensive AIDS Resources Emergency Act.

The measure, which would appropriate about $2 billion annually to HIV and AIDS programs nationwide, is expected to have bipartisan support as it to goes to the full Senate and House.

California lawmakers and activists are particularly worried that the proposed geographic shift in money could come without a substantial increase in overall funding.

"If you're not expanding the pool of money, big cities like us are going to lose," said Rep. Hilda Solis (D-El Monte).

However, lawmakers from rural and Southern states said they believe federal HIV funds have disproportionately benefited urban areas at the expense of their constituencies. "Since we're in a limited budget, the intent is to distribute the money fairly, not disproportionately and unfairly," said Sen. Tom Coburn (R-Okla.). Southern and rural states, he said, are "where the epidemic is going."

California counties that have recorded declining new AIDS cases are most at risk of losing funding, local officials said.

Orange County stands to lose so much that its current annual $4.8 million in direct federal funding could drop below $1 million within five years, said Donna Fleming, an Orange County disease control manager. And the Sacramento region could eventually lose all of its eligibility for direct federal funding, with $3 million at risk, said Adrienne Rogers, coordinator of Ryan White programs in that area.

"We will not even be able to cover our basic medical care needs. That's how devastating it is," Fleming said.

Fleming and others said the funds are critically needed to provide medicine and care for HIV-positive patients to prevent them from falling ill with AIDS.

San Francisco could also lose one-fourth of the $28 million it now receives each year. That is because the new legislation proposes phasing out limits on how much a region could lose in funds every year. "Drastic reductions in funding destabilize existing systems of care," said Scott Boule, an assistant policy director for the San Francisco Department of Public Health. "It's irresponsible."

Although critics complain that San Francisco gets more than its fair share of funds, Boule said San Francisco's federal money for AIDS programs has declined every year since 1996.

Craig Vincent-Jones, executive director of the Los Angeles County Commission on HIV, said it was likely local programs would lose money, but could not say how much the county might lose.

Sonoma and Santa Clara counties are also at risk for losing direct funding, said Michael Montgomery, chief of California's Office of AIDS. California officials also raised concerns that the new legislation would tighten the criteria on what federal money can be spent on. Under the legislation, 75% of federal funding would have to be spent on "core medical services."

That may mean that federal funding may be reduced for related services, such as food, temporary housing for the homeless, transportation, child care services and case managers, who help clients organize their medical and social services.

Some counties spend up to half of the federal funding on non-medical support services, which some advocates say are necessary to keep the indigent on drugs that prevent HIV-infected patients from falling ill. Some of the drugs require refrigeration or need to be taken with meals, for example, which necessitates additional support.

Some lawmakers from rural and Southern states argue that it is inappropriate to spend federal dollars on nonmedical services when residents in their states are on waiting lists for AIDS drugs.

Despite the drawbacks, some HIV advocates in California praised the bill as a bipartisan compromise that avoided proposals to divert more money from urban states.

Montgomery said the state's losses could be partly offset because the bill removes a formula that undercounted California AIDS cases by predicting deaths earlier than they occurred.

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