House Minority Leader Nancy Pelosi (D-Calif.) has sent a letter to HHS Secretary Tommy Thompson calling for a "full explanation" of a $4 million reduction in San Francisco's Ryan White CARE Act funding, the San Francisco Chronicle reports (Gordon, San Francisco Chronicle, 3/19). HHS on March 1 announced the grant as part of 51 grants totaling more than $595 million for cities nationwide to provide care and support services for low-income HIV-positive people. The grants, which are overseen by the Health Resources and Services Administration, are funded under Title I of the Ryan White CARE Act. Funding amounts are based on a formula using the estimated number of people living with AIDS in each city, with supplemental grants awarded competitively based on the "demonstration of severe need" and other criteria. San Francisco received $29.8 million in funding for its HIV/AIDS programs and services, including physician visits, home-based care, hospice care, substance abuse treatment, mental health services, case management and assistance in obtaining medications for HIV-positive people who have partial or no health insurance (Kaiser Daily HIV/AIDS Report, 3/2). The city's grant amount for fiscal year 2004 is 12% less than the amount the city received in FY 2003, the Chronicle reports (San Francisco Chronicle, 3/19).

Pelosi's Letter
According to Pelosi's letter, San Francisco "experienced the largest dollar reduction of any [eligible metropolitan area] and the third highest reduction by percentage." She said that the reduction "will have a devastating impact on HIV/AIDS services in the Bay Area" (Pelosi letter, 3/12). She said that the $4 million cut would "force" the city to eliminate 1,171 hours of treatment adherence services, 554 days of adult day health services, 1,779 dental procedures, integrated case management for 527 people and "numerous other services that are critical to maintain and improve the health of people living with this terrible disease" (San Francisco Chronicle, 3/19). According to Pelosi, San Francisco "cannot sustain a loss of this magnitude without undermining the safety net for the most vulnerable persons living with HIV/AIDS in our community." Pelosi requested that Thompson provide a "detailed explanation of the process by which allocations were made, a response to the concerns raised [in the letter] and documentation that allocations were made in an equitable and accountable way." Pelosi also said she hopes to be able to work with Thompson to "identify other funds within [HHS] to help offset these cuts and prevent reductions in vital health services for people living with HIV/AIDS in the San Francisco Bay Area" (Pelosi letter, 3/12).

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