Ryan White Care Act: Not Enough for DC?

With the re-authorization of the Ryan White Care Act underway, the DC area is likely to see a decrease in HIV/AIDS dollars.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is Federal legislation that addresses the unmet health needs of persons living with HIV disease (PLWH) by funding primary health care and support services.

Proposed changes would more equitably distribute Ryan White funds across the states. In the past there has been a strong focus on funding metropolitan areas like San Francisco, NYC, and DC. These cities were overwhelmed at the beginning of the AIDS epidemic. Today, however, HIV has reached out suburban and rural areas. Some of the southern states are feeling the biggest crunch. The most troubling part of this situation is that in some states, the AIDS Drug Assistance Program (ADAP) has simply run out of money, and folks are on waiting lists to get life-saving drugs.

In the most recent ADAP Watch, Alabama, Arkansas, Kentucky, and West Virginia were among the states with waiting lists; Missouri, Georgia, and South Carolina were among the states who had implemented or planned to implement cost-containment strategies. Clearly there are many people in the South (and other states) who need access to medications.

DC is not facing this predicament. Of course, if everyone who was positive in DC knew their status and requested appropriate medical care, we might have a waiting list as well.

Based on the current needs, however, ADAP changes clearly make sense. They mean that literally hundreds of Americans who are waiting for HIV drugs will soon have them. Still, it does mean a reduction in funds for DC and other metropolitan areas. (This is the reason why Hillary Clinton, concerned about her constituency in NYC losing money is holding up the process). It would be nice if rather than redistributing our current pie, we could get a bigger pie, but with the current administration that does not appear to be possible this time round.

Which brings us back to DC. Fortunately, the Washington Blade Reports there will likely be a Hold Harmless Provision, which means that DC will lose no more than 10% of it's funds each year. This should make the transition at least a bit easier.

This CAEAR Report, shows DC Ryan White Care Act funding at $5,934 per person living with HIV/AIDS. We are well above the national average of $4745. Even with a 10 percent cut we are still at $5341.

Perhaps with cuts on their way, this is a good opportunity to look more closely at how effectively we are using the money we have, and holding our Health Department and our HIV/AIDS service orgnaizations accountable for the money they spend.

After all, in 2005 we didn't even manage to spend all of our Ryan White Money, at the end of the year we ended up with three million in unspent funds. That's even after spending $450,000 on World AIDS Day events.

And of course I was a bit suprised to find we had 2.2 million extra dollars lying around for Whitman Walker to prevent them from going bankrupt. I think an organization whose leadership and board takes them to the brink of bankruptcy despite a million dollar budget is not doing that great of a job. I have to question whether investing 2.2 million dollars in an organization in such a state is a smart move. Many HIV/AIDS organizations in DC that primarily serve people of color agree.

The solution to the HIV/AIDS crisis in DC has a lot to do with money. But let's face it, it also has a lot to do with accountability. As we face a decrease in funds, I for one will be looking at not just how much money DC gets, but where those dollars go.