Diagnosed with AIDS in 1995, Charlie Le Claire says a federal subsidy program for low-income HIV patients has been "an absolute blessing." But because of fiscal tightening by the federal government, such crucial support programs may not be available to thousands of newly diagnosed persons with HIV, advocates say. "Because of the recession and talk of war, we're dealing with a federal government that's less likely to fund health care programs," said Gene Gopello, executive director of Tampa-based Florida AIDS Action.

Funded under Title I provisions of the Ryan White Care Act, the federal program subsidizes medical, dental, and support services to more than 12,500 low-income HIV patients in Miami-Dade and Broward counties. The costliest part of the program, prescription coverage, could receive more funding but possibly at the expense of other services, say patient advocates and service providers. This would mean more money would be available for those already enrolled, but new patients could be left on the sidelines. Some agencies may have to cap enrollment in their programs.

The concern about funding levels comes as agencies are seeing an increase in people seeking their services. In 2002, Florida had a 21 percent increase in new HIV infections. Another factor is the drop in AIDS-related deaths due to medical advancements, which "means you have more people seeking health care," said Judith Williams, chief administrator of Miami-Dade's HIV/AIDS Planning Council.

Congress recently passed a long-delayed spending bill containing a $121 million increase for AIDS care, most of which is slated for prescription costs. Other services saw increases so small that most allocations to the states will likely remain at 2002 levels. Budget managers say more established agencies may have room to cut, but smaller agencies that primarily serve minority communities could be in trouble.

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