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 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
housing and other services. "I don't believe a person
should be punished because of where they live
geographically," she said.
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," added Phil Curtis of AIDS
Project Los Angeles.
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. HIV 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. (AP)