AEGiS-BAYW: Local HIV/AIDS advocates support Senator Clinton's efforts to change Ryan White funding

Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.

Local HIV/AIDS advocates support Senator Clinton's efforts to change Ryan White funding

Bay Windows - August 31, 2006
Ethan Jacobs, ejacobs@baywindows.com

To read the Washington Post's Aug. 23 cover story on the Ryan White Care Act, the primary source of federal HIV/AIDS funding, one might think the debate over AIDS funding was now the latest front in the political schism between North and South, red states and blue states. The story details how New York Sen. Hillary Rodham Clinton has delayed movement on the Ryan White reauthorization bill currently before the Senate because the new funding allocation formula threatens funding for states with large urban areas like New York, California and Florida, and redistributes it to states that are primarily Southern, rural and Republican-leaning. Yet Rebecca Haag, executive director of the Washington, D.C.-based AIDS Action, the lead federal advocacy organization on HIV/AIDS issues, took the paper to task for attempting to paint the debates over Ryan White as a North-South conflict, writing a letter to the editor accusing the article of being "misleading and divisive." (The letter was not printed) Haag, who also serves as executive director of the Massachusetts-based AIDS Action Committee (AAC), told Bay Windows the HIV/AIDS service organizations represented by D.C.'s AIDS Action, which work in areas as diverse as New York, California, Texas and Tennessee as well as Massachusetts, believe the solution to questions over funding is not to pit one region against another.

"I think we would all acknowledge that there is a growing need for more services and care in rural areas of the country, particularly in the South, and I think all advocates would support additional funding to address that need," said Haag. Yet she said that funding should not come at the expense of depleting funds from areas currently receiving much of the funding under Ryan White.

"Pitting the North and South against each other is not the way we're going to find the right solution here," said Haag.

She said Clinton has been joined in her efforts to find an alternative to the present bill's funding formula by lawmakers in the House, and Haag said many lawmakers besides Clinton believe the reauthorization bill needs changes before it is ready to be passed. Haag said the disputes around the funding formula center on how to count the HIV and AIDS cases in each state and how to weigh them. Up until the current bill, funding under Ryan White was allocated based on the AIDS cases reported in each state, which benefits areas like Massachusetts, New York and California that have been hit hardest since the early days of the epidemic.

The reauthorization bill uses HIV cases to determine funding, a move that would likely see funding redistributed to more rural areas that have seen a rise in HIV infections but a comparatively low number of AIDS diagnoses.

Haag said one of the issues facing Congress is creating a funding formula that distributes funding equitably. While all states track AIDS cases using name-based reporting, some states track HIV cases using a code-based system. The Centers for Disease Control and Prevention (CDC) has pressured states to switch to a uniform name-based system to report HIV cases, and many states, including Massachusetts, have made the switch under federal pressure. But Haag said the lack of a uniform system makes it difficult for health officials to know the true prevalence of HIV/AIDS cases across the country.

AIDS Action is pushing Congress to devote increased resources to Ryan White rather than pull resources away from urban areas, and Fenway Community Health president Dr. Stephen Boswell echoed those sentiments. Fenway has also been involved in negotiations around Ryan White as part of the Care Coalition, a national group of HIV/AIDS service organizations and patients advocating around Ryan White.

Boswell said under the current proposed funding formula, Massachusetts is one of the states likely to take a hit in federal funding.

"For Title One funding in particular it would be likely in the new formulations that we would lose some funding," said Boswell. Title One funding under Ryan White is distributed to urban areas, although the Boston urban district under Ryan White extends north beyond the city to parts of southern New Hampshire. "Many of us would argue that the best way to handle the need for additional resources for new areas like the South is to allocate additional resources to them, not to take away resources from locations like New York and California which have done an outstanding job of responding to the AIDS epidemic," said Boswell.

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