Five months after the expiration of the Ryan White Comprehensive AIDS Resources Emergency Act, which allocates federal funds nationwide, a bill to reauthorize the measure was introduced in Congress by Republican U.S. senator Tom Coburn. But Coburn, who is also a physician, says extending Ryan White funding isn't enough'the program needs to adapt to the evolving domestic epidemic, and his bill aims to achieve just that.
The chief proposed changes are a requirement that 75% of Ryan White funds be spent on primary care and a revamping of the formulas that determine how much money local areas get. Currently, grants are doled out based on the number of cumulative AIDS cases in a region; those with higher counts get more federal dollars. But Coburn's bill proposes linking grant amounts to the number of HIV cases in a region, which would shift more money toward places like the South that have growing HIV caseloads and away from states like New York and California that have older epidemics.
AIDS organizations had a wide variety of reactions to the reauthorization bill ranging from praise to qualified support to outright concern.
AIDS Project Los Angeles officials worry that too much spending on direct medical services will severely cut funds available for much-needed support programs. 'It doesn't do any good to fund a medical clinic but take away the bus pass a poor person needs to get to her appointments,' APLA executive director Craig E. Thompson says.
But the Los Angeles'based AIDS Healthcare Foundation backs the Coburn bill, as do the Children's AIDS Fund, the National AIDS Treatment Advocacy Project, and several other organizations.
Some groups like the AIDS Institute and the American Academy of HIV Medicine support most of Coburn's bill, but they object to certain sections, including a definition of primary care that could exclude mental health and substance abuse services. Calling the Coburn bill 'an excellent starting point,' AIDS Institute officials plan to work with lawmakers toward 'perfecting' the measure during upcoming congressional hearings.
