A proposal in Congress to shift more federal AIDS money to rural and Southern states could seriously impact the treatment and care of California patients, warn local health officials.

The measure to renew and amend the Ryan White CARE Act would appropriate about $2 billion annually to HIV/AIDS programs across the country. It passed a Senate health committee by a 19-1 vote earlier this month and is expected to have bipartisan support as it goes to the full Senate and House.

A key issue of concern for California lawmakers and activists is that the proposal could come without a substantial increase in overall funding. "If you're not expanding the pool of money, big cities like us are going to lose," said Rep. Hilda Solis (D-El Monte).

But lawmakers in rural and Southern states argue that federal AIDS funding has disproportionately benefited urban areas at the expense of their regions. Southern and rural states are "where the epidemic is going," said Sen. Tom Coburn (R-Okla.).

Local officials said California counties that have recorded declining new AIDS cases are most at risk of losing funding. The current annual $4.8 million Orange County receives in direct federal funding could drop below $1 million within five years, said Donna Fleming, a disease control manager with the county. The Sacramento region could lose $3 million in direct federal funding, said Adrienne Rogers, who coordinates Ryan White programs in that area.

San Francisco is at risk of losing one-fourth of the $28 million it receives annually under a proposal to phase out limits on how much funding a region could lose each year. Craig Vincent-Jones, executive director of the Los Angeles County Commission on HIV, said it is likely local programs there would lose money, though he did not speculate on how much the county might lose.

Michael Montgomery, head of California's Office of AIDS, said some of the state's losses could be offset because the measure eliminates a formula that undercounted California AIDS cases by predicting deaths earlier than they occurred.

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