States Spar Over Federal HIV/AIDS Funds

The federal government spends about $2 billion annually on Ryan White CARE Act programs for the states and 51 metropolitan areas to provide health care, treatment and other assistance to HIV/AIDS patients who are uninsured, underinsured or receiving Medicaid. However, per capita spending is greater for patients in states where the epidemic hit earliest, in urban areas, especially in California and Northeastern states. On Thursday, the House Energy and Commerce Committee has scheduled a hearing to reauthorize the act, and some advocates are lobbying Congress to ensure it reflects the epidemic's increasing prevalence in the rural South.

"We haven't seen the money shifting with the epidemic," said Kathie Hiers, head of the nonprofit AIDS Alabama, which provides patients housing and other services. "I don't believe a person should be punished because of where they live geographically," she said.

California received $5,264 in Ryan White funds per patient in 2004, compared with Alabama, which received $3,657 per patient. However, advocates and lawmakers from California and the Northeast say this analysis ignores considerations of the quality of care and the cost of living, and it fails to measure all Ryan White grants.

"I think the issue is how do we get those areas of the country up to a level that can offer the same resources, without diminishing the resources available in the most impacted areas of the United States," said Michael Montgomery, head of California's Office of AIDS. "This remains a largely urban epidemic," said Phil Curtis of AIDS Project Los Angeles.

Congress is considering how it can distribute the funds more equitably without depriving any one area. Depending on how the act is changed, $20 million could be lost each from California and New York, where most U.S. AIDS patients live. Southern states could gain millions. Some activists from big states, however, remain optimistic that Congress can add money to all parts of the country.

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