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AIDS Groups Battle Over Federal Funding
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NY Times
By REUTERS
Published: August 10, 2006
LOS ANGELES (Reuters) - A proposal in Congress to require that more of the federal money spent on uninsured AIDS patients go to drugs and doctor visits is drawing criticism from some AIDS groups, who say it will force cuts in basic services like meals and housing.
Opponents, including the Gay Men's Health Crisis and New York Democratic Sen. Hillary Clinton, say it would undermine care of the nation's most vulnerable patients.
Support for the main Senate bill on the issue, sponsored by Republican Mike Enzi of Wyoming and Democrat Ted Kennedy of Massachusetts, is coming from many health-care providers who want to establish national care standards and increase access to life-saving drugs.
The bill would mandate that three-fourths of the funds from the Ryan White Comprehensive AIDS Resources EmergencyAct, the nation's largest HIV-specific federal grant program, be used for medical services.
Opponents say the mandate would force them to cut non-medical services they consider critical for overall patient care.
Designed to fill gaps in local funding, the Ryan White program has never in its 16-year history included a broad prescription for how money should be spent.
Another divisive proposal on the table includes revamping the formula that directs money from the program in a way that could reduce funding to such historic hot spots like San Francisco and New York City. Those seeking change want more money for rural areas and emerging AIDS centers like Oakland, California.
The Ryan White program, which was named for the boy who got the disease from a blood transfusion and helped raise mainstream awareness, provides care for tens of thousands of patients with no insurance or inadequate coverage and has a budget this year of just under $2.1 billion.
The Enzi-Kennedy legislation is stalled in Congress. The program must be reauthorized by Congress every five years and its next authorization is scheduled for next month.
More than 1 million people living in the United States are HIV-positive. Half are not in treatment and a study has suggested that one-fifth of them do not have insurance.
AIDS ESTABLISHMENT
One of the more outspoken supporters of the change is AIDS Healthcare Foundation President Michael Weinstein, whose Los Angeles-based group's mandate over more than two decades has gone from helping people die with dignity to getting them the drugs they need to live.
Weinstein said the Ryan White program needs to change to reflect the 1996 debut of drug cocktails that turned AIDS into a treatable, although still life-threatening, illness.
``If we reauthorize Ryan White without recognizing that, it would be criminal negligence,'' he said, adding that it's time for a shakeout among AIDS service providers who have not kept pace with the fast-moving HIV virus.
``Ryan White is not about maintaining the AIDS establishment. We have to examine all of the sacred cows and we have to slaughter most of them,'' he said.
As demand rises amid a lack of significant funding increases for the Ryan White program, Weinstein worries that there won't be enough money to pay for new, more costly treatments to battle drug-resistant HIV strains.
Janet Weinberg, managing director of development and legislative funding at Gay Men's Health Crisis, which feeds 350 people a day in New York City and offers help with housing and legal issues, said her group could lose up to $1 million per year at a time when clients are coming in sicker, poorer and with other problems like Hepatitis C or addictions.
``If you don't know where you're putting your head at night, are you going to get to the doctor?'' she asked.
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