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Money for AIDS
  NY Times
August 29, 2005
To the Editor:
Re "Guarding the Fight Against AIDS" (editorial, Aug. 18, see below):
Reauthorization of the Ryan White Care Act is an opportunity to respond to recent changes in the spread and treatment of the disease.
The administration wants to improve its ability to determine where the need is greatest. Currently, Care Act money is distributed through formulas that use unreliable data, double count AIDS cases and include hold-harmless provisions. These formulas don't even take into account the number of H.I.V. cases in a community.
The administration's proposal would distribute money through a new severity-of-need analysis that reflects the number of H.I.V. cases, poverty and available services.
The administration also wants to allocate 75 percent of funds to core medical services.
These proposals were developed after months of consultation with national experts and H.I.V.-AIDS groups. The administration looks forward to working with Congress and the treatment community to enact these proposals into law.
Elizabeth M. Duke
Administrator, Health Resources and Services Administration
Dept. of Health & Human Services
Rockville, Md., Aug. 19, 2005
Guarding the Fight Against AIDS, EDITORIAL
August 18, 2005
NY Times
It doesn't take a degree in public administration to know that the government should not be in the business of punishing the places that try hardest. That's what the Bush administration is planning to do when it comes to money to fight AIDS.
In its proposal to reauthorize the Ryan White Care Act, the Health and Human Services Department wants to slash financial aid to the metropolitan areas that have done the most pioneering work in AIDS treatment and prevention, and redirect the money to states that have lagged behind. If approved by Congress, the changes could devastate existing state and city programs in the most AIDS-intensive areas of the nation, penalizing New York, California and a dozen other severely afflicted regions by cavalierly redefining the rules.
The new proposals have the laudable goal of finally attacking the desperate problems of AIDS patients in states that have chosen to ignore the issue for the last generation. People shouldn't be penalized because they live in a state that lacks either sympathy or willingness to pay for adequate public health programs. But this neglect should hardly be remedied at the expense of major centers where state, local and private authorities have taken the initiative to provide the most effective treatments.
Until now, Washington has always protected ongoing programs against sudden drops in support. That would end in the $2.1 billion program budget called for under the administration's plan. While the original law encouraged broad-based support services to deal with AIDS-related problems like drug addiction and homelessness, the new version would mandate that 75 percent of the funds be narrowly directed to "core medical services" and drugs. That core list has not yet been drafted, but it appears that the intent may be to encourage states and localities to cut back on programs like drug treatment, counseling and family support. The government could reduce federal aid to reflect the existence of private and local programs, thereby punishing areas that have rallied the community to combat AIDS.
The Ryan White act could clearly stand some improvements, particularly greater accountability and a stronger education and prevention emphasis. And as everyone knows, the administration has dug itself into a financial hole with its tax cuts, forcing every agency to try to do more with less. But this particular initiative is both irresponsible and unfair.
The obvious answer is to prod negligent states to provide more care and funds, while also maintaining the proven efforts of the regions where the disease is most prevalent. The administration's approach amounts to a wholesale undermining of the most successful programs. Congressional hearings begin next month, not a moment too soon for the public and for responsible lawmakers to rebuff such a wrenching setback to the AIDS campaign.
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