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The U.S. has halted payments to clinics that treat AIDS patients in Puerto Rico, forcing hundreds of poor people to go without free medicine in a U.S. territory with an AIDS rate nearly double that of the mainland.
Puerto Rican officials blame the FBI, saying agents investigating fraud seized documents that clinics need to get reimbursement for drugs and services. The FBI denies it is responsible.
Patient advocates blame the San Juan city government and other island agencies, saying the problem is a result of mismanagement in a program that has a history of corruption.
The 21 clinics, which are privately run under the administration of the San Juan city government, say they stopped receiving reimbursement from the the federal government in late 2006, but the rationing and cutbacks only began in recent weeks as their budgets have started to run low.
Some clinics have reduced their hours, staff levels, and the amount of medicine they distribute.
''We're in the middle of a terrible crisis where patients are missing their treatment, and the disease will gain the upper hand,'' said the Reverend Samuel Agosto, director of Caribbean Youth House, a suburban clinic that has cut back staff dramatically and turned away about 15% of its 700 patients. ''When they come back to their treatment they won't be the same.''
Others clinics say they will face similar problems within days.
''We've maxed out two lines of credit, and we've had to start fund-raising,'' said Dr. Jose Vargas Vidot, director of the Community Initiative clinic in the Hato Rey neighborhood. ''We can hold out maybe another 15 days.''
More than 26 of every 100,000 people in Puerto Rico have AIDS, a rate nearly double that on the U.S. mainland, according to statistics from the Centers for Disease Control and Prevention. Intravenous drug use has helped push up the AIDS infection rate in the island of 4 million.
Puerto Rico also has a per capita income about half that of the poorest states and a majority live below the poverty line set by the federal government.
The Caribbean territory receives $58 million annually under the Ryan White CARE Act, a U.S. program that supports clinical services for poor patients.
Since 2005, invoices in the AIDS program from Puerto Rican health agencies have had extra scrutiny in Washington because of past management problems, said Tina Cheatham, a spokeswoman for the U.S. Health Resources and Services Administration.
A scandal broke in the 1990s after 12 administrators of the now-defunct San Juan AIDS Institute were exposed for embezzling $2.2 million in federal funds. Yamil Kouri, the former director, was convicted in 1999 and released from prison in October after serving half of a 14-year sentence.
In December, FBI agents raided four San Juan city government health offices that manage the AIDS funds as part of a fraud investigation. No arrests have been made and authorities have declined to discuss the investigation.
But Maria del Carmen Munoz, director of federal affairs for San Juan, said agents seized invoices and other documents that the local government needed to process claims for reimbursement to the clinics, ignoring warnings about the potential outcome.
Munoz said health officials had to request new invoices from the clinics and verify their authenticity, and proceeded more slowly out of concern about the investigation.
''We are hopeful that within this month, all the...invoices will be paid,'' she said.
FBI spokesman Harry Rodriguez declined to discuss the investigation but said the agency ''takes the appropriate measures to ensure the public is not affected in any way.''
So far, about 2,000 patients in the San Juan area face rationing of their medication, receiving only enough to last five to seven days each month, said Anselmo Fonseca, codirector of an AIDS advocacy group. Clinics in other parts of the island are receiving the Ryan White funds and operating normally.
''People's lives are in danger,'' Fonseca said.
Last week Bill's Kitchen, which offered nutrition counseling for nearly 1,000 HIV patients, canceled the service and laid off six employees. The organization has kept its doors open as a food bank, director Sandy Torres said.
Cheatham said problems in distributing funds from the federal program are not uncommon, and the agency is offering technical assistance to help the city make payments. But some advocates question whether delays would be tolerated on such a wide scale in the mainland United States.
''One of the most difficult things is getting the mainland to recognize Puerto Rico as being part of the country,'' said Guillermo Chacon, vice president of the New York City-based Latino Commission on AIDS. (AP)