Bush plan would
shift Ryan White funding to rural areas

The Bush administration on Wednesday called on Congress to reauthorize the Ryan White Act and unveiled proposals for federal AIDS spending that would shift billions of dollars away from urban areas to expand medical care in poor and rural parts of the country with rising HIV rates. No significant new AIDS spending was included in the plan, which was announced by Health and Human Services secretary Michael Leavitt.

The proposals are widely expected to shape legislation being prepared to reauthorize the Ryan White Act. The current act expires on September 30 and must be renewed by Congress in order for federal HIV prevention, treatment, and support funds to continue to be allocated across the country.

In announcing the proposals, Leavitt said they aim to accomplish five key goals: serving the neediest first, focusing on life-extending services, increasing prevention efforts, increasing accountability, and increasing flexibility. Bush's proposal would decrease overall funding to 51 large cities and divert resources to states that have rising HIV infection rates, particularly those in the South. The proposal also would require that a minimum of 75% of Ryan White dollars go to core medical programs for HIV-positive people, leaving many programs that provide such services as transportation to medical appointments, housing, legal assistance, and food banks with reduced funding.

Authority for allocation of Ryan White funds also would be diverted from local planning groups and given largely to "municipal grantees"--typically the city or county health departments that receive the bulk grants from the federal government. Instead, local planning boards will serve in an advisory capacity for funding prioritization and allotment.

Bush's plan also calls for Health and Human Services to develop a list of "core medications" that would be prioritized through the state-run AIDS Drug Assistance Programs.

Many AIDS groups, including the HIV Medicine Association and the AIDS Healthcare Foundation, responded favorably to the proposals. "We strongly support Secretary Leavitt and HHS for today's announcement to overhaul the Ryan White CARE Act by directing more dollars toward core services, particularly the proposal to require local planning councils to direct up to 75% of Ryan White Funding toward medical care," AHF president Michael Weinstein said in a press release.

The AIDS Institute, a Florida-based advocacy group, announced that it also welcomes the Administration's proposals. "We are pleased the Administration has taken a direction in its recommendations that reflect the realities of today's domestic AIDS epidemic," said AIDS Institute executive director Gene Copello in a press release.

But some organizations have expressed concern about the spending proposals, particularly with shifting money away from urban areas with relatively stable HIV infection levels--or from those that have succeeded in lowering HIV infection rates through prevention programs. "Unfortunately, the proposal advanced by the Bush administration would shift inequities from rural and poor states to the inner cities," the AIDS Foundation of Chicago stated in a release. "Improving HIV care in rural America--an important goal--should not come at the expense of poor people with HIV/AIDS who live in urban centers, including Chicago."

San Francisco AIDS Foundation executive director Mark Cloutier also worries that some provisions of the Bush administration proposal would "undermine the continuity of care for thousands of San Franciscans living with HIV disease."