Bay Area Reporter - October 12, 2000
Bob Roehr

"Most people do not consider it to be a perfect bill," said Bill Arnold, co-chair of the ADAP Working Group, "but everybody seems to consider it an acceptable bill."

Terje Anderson, executive director of the National Association of People With AIDS called it "the result of a lot of good bipartisan work, weighing a lot of diverse interests." He said one of the greatest challenges will be bringing in new people who should be in care.

One major change with the reauthorized CARE Act is the definition of what is measured as the basis for funding. AIDS, an advanced stage of disease, will give way to HIV infection as the yardstick of disease burden. The measure also will change from a cumulative count of all infections past and present, to simply the current caseload.

The AIDS standard was created when there was little that could be done to treat the disease. Protease inhibitors and combination therapy have radically changed that. Using the number of current HIV infections has become a better measure of the services needed for an area. Anderson credited Representative Tom Coburn (R-Oklahoma) for pushing this change.

The current definition created a bias in favor of "first wave" cities, those such as New York and San Francisco that first felt the brunt of the epidemic. That will be reduced with the new criteria. Funds will be more equitably distributed on the basis of current caseload, especially for smaller cities, rural areas, and minority communities.

San Francisco receives much more per patient than other jurisdictions under the present system. It would have been particularly hard hit by the formula revision passed in the House. But the compromise limited those reductions to no more than 15 percent over the next five years. And if total federal spending increases enough, it may see no reductions at all. Representative Nancy Pelosi (D-California) said she had done her best to limit harm to San Francisco and supported the compromise.

Money

Congress is just a few working days from adjourning but nobody is talking about what total AIDS funding will be for the fiscal year. "They are not talking details with anybody," said Anderson.

"The general feedback is that they will go above the high marks of the president, House, and Senate. The question is, how high?" Anderson called it "more of a black box than it has ever been."

"In this climate there is pork going on like you have never seen, and it is not just the Republicans," said Arnold. He is optimistic that AIDS will receive the funding increases that it needs, but that may depend in part upon total spending elsewhere.

ADAP, the AIDS Drug Assistance Program, needs more money for the current spending cycle that ends in March. Without an emergency appropriation, some states will begin to implement caps, waiting lists, and other impediments to patient access to life-saving medications.

Talk is increasing that Congress will take the unusual step of returning for business after the November election to finish up with the appropriations bills. If that happens, "God knows what the post-election dynamics will look like," said Anderson.

Testing rapists

The House also passed a measure that encourages states to pass laws that allow rape victims to demand an HIV test of their attacker. It stipulates that the test must be conducted within 48 hours of a formal indictment for rape.

The rationale for quick action is that early use of combination therapy, within 72 hours of exposure, seems to prevent most exposure to HIV from turning into an active infection. That data is based upon studies of health care workers exposed to HIV through needle sticks and were offered post-exposure therapy.

States that fail to pass such a law may see their federal crime fighting dollars shrink by up to 10 percent. The House vote was 380 to 19, however, the Senate is unlikely to act this session.

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