The Bay Area Reporter - June 29, 2000
Terry Beswick

Here in California in the 21st century, of course, when we have disputes between our modern cities we would never resort to such means.

Yet a simmering battle between San Francisco and Los Angeles - with millions of dollars in federal AIDS funding at stake - has recently bubbled over into some volleys that are nearly as unpleasant.

"Folks are looking at this in a simplistic way to make a grab for resources," charged Pat Christen, executive director of the San Francisco AIDS Foundation. "It really isn't necessary to be destructive to care for people with AIDS in San Francisco in order to try to boost care in other areas."

"We can't understand the principle that says a person living with AIDS in one jurisdiction should receive X, while a person living with AIDS in another should receive Y," countered Charles Henry, director of the Office of AIDS Programs and Policy for the Los Angeles County Department of Health Services.

But the ugliest barbs came in a recent e-mail from Ernest Hopkins, SFAF's director of federal affairs, to one of Henry's staffers. "When I am finished Chuck [Henry] will [be] discredited as the liar that he is," wrote Hopkins. "Bottom line: he is nothing but a pimp."

The stakes are high, as the future of the Ryan White CARE Act, which currently distributes about $1.6 billion to fight AIDS nationally, is being debated in the halls of Congress.

The Ryan White Comprehensive AIDS Resources Emergency Act, originally passed by a Democratic Congress in 1990 and named after the Indiana teenager with hemophilia who died of AIDS that year, was designed to target badly needed funding to those areas of the country hardest hit by AIDS.

The CARE Act must be reauthorized by Congress every five years if it is to stay in effect and this year, the CARE Act will be authorized for the second time by a Republican-controlled Congress - provided that the internecine squabbling over the bill's text does not bog the entire process down.

The debate between Los Angeles officials and virtually the rest of the country is over the formula that will be used to determine a large portion of how much each eligible city gets to provide care for its people with AIDS.

The current conflict centers on whether CARE Act funding to cities should gradually be changed so that is distributed on a per-case basis, like an entitlement program with an annual cap, or whether funds should be distributed in part to sustain health care delivery systems that the CARE Act has already put in place.

"The CARE Act fund[s] systems of care NOT people," Hopkins wrote in his May 9 e-mail. "It is not an entitlement but a discretionary program therefore it is designed to fund systems of care that are providing services to individuals where they are living with HIV/AIDS."

Much to the dismay of SFAF and other local AIDS advocates, Los Angeles officials want to make changes to the bill that could cut an estimated $8.2 million from San Francisco's AIDS service organizations over five years.

Currently, San Francisco receives about $35 million annually from the CARE Act's Title 1, the part designated for cities or eligible metropolitan areas.

"Washington, D.C. and Houston have almost as many people living with AIDS as they do in San Francisco, and yet they get half as much money," Henry told the Bay Area Reporter.

"San Francisco has a very small tax base of just 750,000," Christen responded. "We carry this enormous burden of health care costs."

"The CARE Act must allocate funds in ways consistent with the distribution of AIDS cases, without penalizing jurisdictions that have been successful in promoting the health of people with HIV and delaying progression to AIDS," reads a position paper circulated to Congress by the Los Angeles DHS.

Although a version of the bill favorable to San Francisco was recently passed unanimously by the U.S. Senate, the House has not yet put forward its own version, and Representative Tom Coburn (R-Oklahoma) has taken a leadership role in shaping a bill that would likely reduce San Francisco's share of funding.

Christen, however, told the B.A.R. that Los Angeles will accomplish little by targeting San Francisco, pointing out that whatever cuts they are able to make to programs here would have to be spread out over 51 other cities included in the Title 1 program.

"We have always taken an approach that all ships should rise together," Christen said, adding that SFAF has been working hard to broker a compromise on the issue that would be acceptable to Los Angeles and all other parties. "Otherwise you end up robbing Peter to pay Paul."

Hopkins, a former lobbyist in D.C., took strong exception to the L.A. health department's aggressive stances in his widely circulated e-mail. Apparently written in some haste, Hopkins's note attempts to counter some of the positions previously espoused by Henry, but quickly resorts to personal attacks and regrettable epithets.

"If you are planning to change formulas to address equity it makes a BIG difference and is only one of the fundamental flaws in the simplistic analyses that continue to be promoted by that fucking destructive asshole Chuck [Henry]," wrote Hopkins.

Hopkins's missive provoked a letter to Christen from John F. Schunhoff, Henry's supervisor in Los Angeles, "I acknowledge that Los Angeles County and the San Francisco AIDS Foundation have significant policy disagreements with respect to the formula used to distribute resources of Title l of the Ryan White CARE Act. But, it is important that disagreements are respectful and not permitted to become personal attacks, threats, and misrepresentations."

"I think we owe them an apology. I think that comments that Ernest made in the e-mail were inappropriate and unprofessional," said Christen, adding that Hopkins had presumed his e-mail would be kept private by its recipient. "It was a mistake."

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