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Ryan White Care ACT; Coburn Bill; HCV/HBV Coinfection; SF would lose funding under Coburn CARE Act bill
  By Bob Roehr
SF Bay Area Reporter
Note from Jules Levin: from reading this article you can see there is little appreciation or understanding of the needs for HCV & HBV coinfected patients. In the last paragraph of this article, the government affairs representative from NMAC, the Natl Minority AIDS Council, does not support funding to address the needs of coinfected patients through the Care Act; who are NMACs constituents? Probably, up to 50% or more of individuals accessing care through the Ryan White Care Act have HCV or HBV coinfection. But, this type of attitude id held by all the HIV lobbying groups in Wash DC. None of them have made any productive contributions to addressing these problems of coinfected patients nor support the Care Act to address the problems. The language on coinfection in Coburnfs bill is not as referred to in the text of this article, which says its regarding access to therapy, but the language provides services for testing & counseling, referrals to care providers, and prevention & treatment education for case managers, care providers/doctors, and patients, these are very basic services that are provided for HIV+ individuals with HIV & could easily be incorporated into the infrastructure for HIV provided by the Ryan White Care Act.
Article Text
San Francisco would lose its "hold harmless" status under a bill introduced Tuesday by conservative U.S. Senator Tom Coburn (Oklahoma).
Coburn introduced his bill reauthorizing the Ryan White CARE Act at a Capitol Hill news conference on February 28. AIDS organizations had a wide range of reactions, though most expressed significant reservations about portions of his bill.
Coburn is a pediatrician who played a leading role in reauthorization of the CARE Act in 2000 when he was a representative. He subsequently retired from Congress, served as co-chair of the Presidential Advisory Council on HIV/AIDS, and won election to the Senate.
However, Coburn does not serve on a committee responsible for Ryan White and so there is a question as to whether his version will go anywhere. The act expired five months ago and staff members have been working to hammer out differences in committee.
"This program is critical to meeting the needs of more than a half a million Americans living with HIV/AIDS, and must be renewed and updated. The fact that it hasn't, is a national shame," Coburn said at the news conference. His bill "prioritizes early diagnosis and access to primary health care and treatment, and increasing accountability as to how funds are spent."
Key aspects of the bill include reworking the formula for distribution of funds to reflect current HIV infections rather than cumulative AIDS cases. That would mean increasing resources to the southern part of the U.S. and to minority communities, perhaps at the expense of those currently receiving support. The bill also would require that at least 75 percent of all funds go to primary medical care, and it would add treatment of hepatitis B and C coinfections, something that currently is a state option but not required.
Reaction from the San Francisco AIDS Foundation was swift.
"We're disappointed with the 'hold harmless' provision," said Ernest Hopkins, a lobbyist for the foundation. The city is likely to lose about $7.5 million per year, with cuts occurring either all in the first year, or spread out over three years. "In talking with the senator's staff, it is unclear what the impact on San Francisco would be."
For Coburn "to suggest that he is not interested in taking services away from people, at the same time he is making a proposal to cut $7.5 million out of our formula alone ... There is no way the city could possibly maintain its current system of care, it would collapse. It seems antithetical to what the senator suggested he is trying to achieve," Hopkins said.
Hopkins added that SFAF would "continue to work with the committees of jurisdiction to come up with a bill that is more reasonable," as well as with the California congressional delegation.
"What is the motivation behind focusing so much attention on the pharmaceutical and medical components of this?" Hopkins asked. "I happen to believe those are core constituencies of the Republican Party and that they have had a significant impact on the decision of how this bill was drafted. It doesn't have anything to do with assuring access to care for minorities, that's clear."
Representative David Weldon (R-Florida) said he would introduce the same bill in the House. He did his medical internship and residency in San Francisco just as AIDS was appearing; helped to develop an HIV screening program while in the Army; and treated patients with HIV in private practice.
"This act was written at a time when there were no drugs available [to treat HIV] and it has not been sufficiently modernized," Weldon said. "It is no longer a condition confined to male homosexuals, it is now increasingly a minority disease."
Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles, "applauded" introduction of Coburn's bill. "The revolution in treatment of HIV that took place 10 years ago [with the introduction of protease inhibitors] made it a treatable disease," but the CARE Act has not been modified to reflect that.
In response to questions, Coburn expressed frustration that reauthorization has not moved more quickly. "I think it is time that somebody put something on the floor that makes this process happen."
But in pushing a focus on early diagnosis and care, he also has an agenda of defunding many of those prevention activities with which the conservative lawmaker disagrees. That came out in a veiled way when he said, "Ryan White is not supposed to be an employment opportunity bill, it is supposed to be a bill that solves people's problems that are infected with HIV."
Coburn did not know how much it would cost to add treatment of hepatitis B and C coinfections to the already overly burdened AIDS Drug Assistance Program. He said, "My commitment is to try to get the funding for ADAP to a level where it is successful in meeting the need."
However, Weldon added, "In this budget climate, just to ask for more money is not going to work." He saw the need to restructure Ryan White "so that people who need drugs get them."
"What is more important, something that a planning council wants to do that is not necessarily related to treatment, or care? The patient should come first," said Coburn. "We need to move the money in that direction."
Log Cabin Republicans President Patrick Guerriero said Coburn's bill "provides a powerful jump start to the reauthorization process." But he was otherwise restrained, encouraging people to "examine this bill and engage in constructive dialogue ... to help make sure this process produces the best bill possible."
Dedicating "75 percent for primary medical services is problematic," said Damon Dozier, director of government relations and public policy for the National Minority AIDS Council. "More and more urban areas don't have primary care [facilities]. So it leaves out the crucial question of how do you get there to get the care."
"When you start bringing in hepatitis B and C, then you get into funding issues," Dozier added. "In a tight funding environment where we are shifting resources because we can't give any more money to the act, then you are adding new coverage, that is problematic as well."
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