New York Mayor Takes on Bush on AIDS

New York City health officials say they cannot accurately estimate the cost of the federal Department of Health and Human Service's proposal to revamp the Ryan White CARE Act (RWCA). A "severity of need index" would redirect money to states like Alabama, Mississippi, the Carolinas and Arkansas -- where state and local governments have often failed to fund AIDS services, there are waiting lists for basic AIDS drugs, and services are poorest. Such states will, "in effect get rewarded for doing nothing," said Ronald Johnson of Gay Men's Health Crisis (GMHC).

The proposal deducts metro area AIDS patient counts from state totals. Some officials estimate that New York City -- which is home to an estimated one in every six US AIDS patients -- would stand to lose about $20 million in RWCA funds. In an recent open letter to Congress, Mayor Michael Bloomberg predicted that New York's "existing systems of care would be destroyed." An elimination of "hold harmless" provisions limiting how much money could be lost in one year, giving officials time to manage cuts, may have serious consequences for AIDS patients, Bloomberg predicted.

The proposal mandates 75 percent of funds go to "core medical services," probably direct medical care and prescriptions, and will cut primary medical care, substance abuse, mental health, nutrition and food and rental subsidies. While the AIDS Healthcare Foundation, which operates AIDS clinics, publicly favors the new rules, many other AIDS service providers have been overwhelmingly negative in their response.

GMHC said the proposal marginalizes gay men, especially men of color, who aren't mentioned anywhere in the proposal yet account for the preponderance of new infections among men who have sex with men. The federal government ought to bring other states up to New York's level of care, not focus on how to bring New York down, said GMHC's Johnson. National Association of People with AIDS Director Terje Anderson described it a means to divide the AIDS community based on geography, race and sexual orientation.

The Senate Health, Education, Labor and Pensions Committee will probably hear the proposal in September.

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