Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
San Francisco Chronicle - May 23, 2007
Sabin Russell, Chronicle Medical Writer
Health officials said Tuesday they were stunned by the allocation of money for the next fiscal year under the Ryan White Treatment Modernization Act. The changes will result in sharp cuts in support services to AIDS patients and people with HIV, particularly in San Francisco.
Pelosi, D-San Francisco, sent a letter late Tuesday to Health and Human Services Secretary Michael Leavitt demanding an explanation for the decision, which she said violates an agreement reached in January between the administration and congressional Democrats that would have kept AIDS programs in the three counties largely intact.
"The drastic nature of this cut will have a devastating impact on services that keep people living with HIV/AIDS in the Bay Area healthy," Pelosi wrote.
She warned that the cuts would have "severe repercussions on San Francisco's system of care."
After receiving word of the cuts, San Francisco's HIV Health Services Planning Council proposed on Monday a 36 percent reduction in distribution of Ryan White money to support services for clients of city AIDS programs. Among the programs bracing for cuts are meal deliveries, emergency housing, legal assistance, benefits counseling and emergency financial aid.
The council voted to maintain Ryan White funding for core services such as primary medical care, mental health and substance abuse, home health care and case management.
Dr. Edward Machtinger, director of the Women's HIV Program at UCSF, said the cuts do not directly affect the core services he provides. But he said those efforts rely heavily on support programs such as housing that are facing cuts.
"Our program is dedicated to effective and comprehensive care for some of the most vulnerable women in the city," he said. "These cuts to support services imperil our ability to effectively care for them."
Rules for distributing AIDS money to cities and counties under the Ryan White program -- named for an Indiana boy who died of the disease in 1990 -- have been a byzantine tangle since Congress created it 17 years ago.
For years, the Republican-controlled Congress tried to wrest money from cities such as San Francisco and New York that were early beneficiaries of the program, and redistribute it to other communities, particularly in the South. In the waning weeks of the last Congress, they succeeded in directing more money to rural areas.
As a result, San Francisco officials had already expected belt-tightening on AIDS programs. On Tuesday, however, the final cuts authorized by the Bush administration turned out to be $8.6 million deeper than anticipated.
About $7.4 million of those unexpected cuts will fall on San Francisco, which has the third-largest number of people living with HIV infection of any city in the United States.
In her letter to Leavitt, Pelosi called those cuts unacceptable. She said the agency's funding formula designed by Congress included a provision meant to minimize the effect of cuts imposed by the new law.
The Bush administration's allocation of the money, however, represents an undoing of that protection, Pelosi said.
Health and Human Services officials could not be reached for comment.
E-mail Sabin Russell at srussell@sfchronicle.com.
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