Bush Plan Would Shift Ryan White Funding to Rural Areas

On Wednesday, in asking Congress to reauthorize the Ryan White Act, the Bush administration unveiled proposals that would shift billions of dollars from urban to rural areas to expand HIV care in regions with rising HIV rates. Health and Human Services (HHS) Secretary Michael Leavitt announced the plan, which includes no significant new AIDS spending. The current act expires on Sept. 30; Congress must renew it for federal HIV funds to continue to be allocated across the country.

Under the proposals, overall funding to 51 large cities would be reduced, with the money redirected to states with rising HIV rates, especially in the South. The proposals would mandate that a minimum of 75 percent of Ryan White money go to core medical programs, thereby reducing funding to many support services. Allocation authority would be shifted away from local planning groups and chiefly assigned to municipal grantees - usually city or county health departments. Planning boards would serve in an advisory capacity for funding prioritization and allotment. The plan calls for HHS to develop a list of core medications that would be prioritized through the state-run AIDS Drug Assistance Programs.

Leavitt said the proposal aims to accomplish five goals:

• Serving the neediest first
• Concentrating on life-extending services
• Increasing prevention efforts
• Increasing accountability
• Increasing flexibility

The HIV Medicine Association stated its support of the proposal. AIDS Healthcare Foundation President Michael Weinstein announced that organization's backing of the overhaul, "particularly the proposal to require local planning councils to direct up to 75 percent of Ryan White funding toward medical care." The Florida-based AIDS Institute is also a supporter.

Some other groups expressed concern. "Unfortunately, the proposal… would shift inequities from rural and poor states to the inner cities," said the AIDS Foundation of Chicago. Some provisions of the plan would "undermine the continuity of care for thousands of San Franciscans living with HIV disease," said Mark Cloutier, executive director of the San Francisco AIDS Foundation.

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