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District of Columbia and Maryland May Face Cuts to AIDS Funding

The District of Columbia (DC) and the state of Maryland are in jeopardy of losing significant federal funding designated for the care of individuals with HIV/AIDS if they continue to stick to a code-based system for recording new HIV infections. The Centers for Disease Control and Prevention (CDC), which is the main government agency responsible for tracking HIV infections, is strongly encouraging state health departments to use name-based systems. Approximately a dozen jurisdictions, including DC and Maryland, still use code-based tracking, even-though the CDC has strongly encouraged all state health departments to switch to a name-based system.

A bill pending in the U.S. House and Senate, to reauthorize federal funding through the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act, also includes the creation of new funding formulas that account for HIV prevalence. If these changes go into effect, and DC and Maryland fail to adopt the CDC reporting recommendations, they would each stand to lose millions of dollars in federal funds for the purchase of AIDS drugs and other services.

Some state health departments, such as those in Illinois and Maine, have already made the switch. In addition, certain activists and advocacy groups once opposed to name-based reporting primarily due to the stigma associated with HIV, are now in favor of the system. The impetus for this change of attitude lies primarily with the proven ability of state health departments to maintain individual’s confidentiality and the availability of more effective AIDS drugs. “There is this opportunity to do good – of getting people to find out about their HIV status so they can begin treatment if it’s appropriate,” said Mark Cloutier, executive director of the San Francisco AIDS Foundation.

Although some groups are amenable to the proposed change, others have expressed unequivocal opposition. “We oppose it no matter how much time we are given,” said Denise McWilliams of the AIDS Action Committee of Massachusetts. She explained that individuals, “will be driven away from the system if we cannot guarantee confidentiality.”

Health officials in Maryland have said that if name-based reporting is necessary to keep federal funding that the state will comply. “We will do what we need to maintain our funding to fight this epidemic,” said Michelle A. Gourdine, Maryland’s deputy secretary of health. Officials in DC have also expressed cooperation but with a caveat. “The district follows the CDC guidelines, and consistent with that is currently exploring the transition to name-based reporting of HIV infection,” said Marsha Martin, senior deputy director of the DC health department. She added that any new system, “must ensure full protection and absolute confidentiality.”

The Ryan White CARE Act was enacted in 1990 to address the health needs of people living with HIV disease, especially those with low incomes and inadequate health insurance. The Health Resources and Services Administration’s HIV/AIDS Bureau administers the program, which funds primary health care and support services for eligible individuals.

The bill to reauthorize the Ryan White CARE Act, which expired on September 30, 2005, was introduced earlier this month by Senator Tom Coburn (R-OK).

Source: The Washington Post, March 13, 2006


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