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HIV-positive residents in 39 U.S. cities may soon be facing difficulty accessing some federally supported AIDS services because of program cuts to offset steep Ryan White funding reductions. The Department of Health and Human Services awarded $595 million nationwide in Ryan White AIDS funds in March; the amount is about $5 million less than distributed in 2003. Funding cuts ranged from 3% to nearly 14%. 'This is the worst I've ever seen coming down from Washington,' Ken Malone of Houston's Assistance Fund says. California activists called the cuts of roughly 12% to San Francisco, 8% to Los Angeles, 6% to Oakland, and 5% to San Jose 'devastating.' San Francisco programs that provide legal aid, meals, transportation subsidies, substance-abuse treatment, and alternative health care will all be reduced to offset the funding shortfall, city officials say. Los Angeles lost over $3 million in federal funds and plans to cut administrative costs by 8% and services by 3% in the city, according to Gunther Freehill, county Office of AIDS Programs and Policy spokesman. 'There's no way we can make up this reduction without cutting some services,' he says. 'We just don't have fat to cut anymore.' St. Louis and Newark, N.J., were dealt the nation's steepest funding cuts'13.8% and 13.5%, respectively. The reduction of federal AIDS funds to St. Louis comes in the midst of growing numbers of HIV-positive people in the region; about 35 new infections were reported each month in 2003, up from 10 to 15 new cases per month the previous year. To offset the federal funding reduction the Metro St. Louis HIV Health Services Planning Council cut $700,000 from all city AIDS services except those providing primary care and insurance reimbursements. However, officials say they still expect to have to create waiting lists for some programs. Similar program cuts have been enacted in Houston and New Orleans and are also expected in Florida's Palm Beach and Miami-Dade counties. The Ryan White grants were distributed according to a formula that allocates money based on the number of AIDS patients living in each city. But the 'outdated' funding approach punishes cities with effective and widespread treatment programs that keep HIV-positive residents from progressing to an AIDS diagnosis, according to some experts. The formula also does not take into account that many low-income HIV-positive people who are controlling their HIV infections still need other government-backed services, says Michael Weinstein of the Los Angeles'based AIDS Healthcare Foundation.