Subject: Rep. Bliley says Ryan White AIDS funding favors San Francisco
From: [email-masked]
Date: Fri, 16 Jun 2000 10:00:38 EDT

> House Commerce Committee Chairman Tom Bliley sent the following letter to
> members of the California delegation regarding Ryan White CARE Act Title I
> funding.
> 
> 
> June 2, 2000
> 
>   Thank you for your letter concerning the reauthorization of the Ryan
> White Comprehensive AIDS Resources Emergency ("CARE") Act and your pledge
> to help ensure passage of the Committee's product by the close of the
> session.
> 
>   The Ryan White CARE Act should address the health care necessities
> of all Americans living with HIV/AIDS equally, without prejudice to their
> race, sex, or place of residence.  But, largely due to the way this
> program has evolved, some Americans living with HIV/AIDS are treated in an
> Orwellian fashion more equally than others:  as the enclosed chart
> illustrates, while those living in the San Diego eligible metropolitan
> area ("EMA") received $3,047 in Title I Ryan White CARE Act funding in
> FY99, those in San Antonio received $2,509 while those in San Francisco
> received $5,958.  This unfair disparity is a lingering artifact of
> pre-1995 policies embedded in the Ryan White CARE Act  that paid for
> treatment based on the number of AIDS patients, living and dead, who were
> diagnosed in any given EMA.  The era of paying for the treatment of the
> long dead is long over.
> 
>   Not only does the funding allocation of the Ryan White CARE Act need
> to be brought in conformity with common sense, but the way our public
> health system responds to the HIV/AIDS epidemic needs to be brought up to
> date in light of the latest scientific understanding.  AIDS surveillance
> has been the cornerstone of national efforts to monitor the spread of HIV
> infection in the United States and to target HIV-prevention programs and
> health-care services. Although AIDS is the end-stage of HIV infection, in
> the past, monitoring AIDS-defining conditions provided population-based
> data that were a crude indicator of the spread of HIV. Up until the late
> 1990's, public health officials were grudgingly satisfied with monitoring
> AIDS as a marker for the true extent of HIV infection.
> 
>   In the year 2000, advances in HIV treatment have slowed the
> progression of HIV disease for infected persons on treatment and
> contributed to a decline in AIDS incidence. These advances in treatment,
> as well as factors like the rapid spread of HIV among populations not well
> served by AIDS prevention efforts, have rendered AIDS surveillance data
> significantly less valuable in identifying trends in the incidence of HIV
> infection or the impact of the epidemic on the health-care system.  
> 
>   According to the written testimony of Loretta Davis-Satterla,
> Director, Division of HIV/AIDS-STD with the Michigan Department of
> Community Health before the Subcommittee on Health and Environment on May
> 11, 2000, "In Michigan, confidential HIV reporting has been required by
> statute since 1989.  Confidential HIV reporting has greatly enhanced
> Michigan's ability to rapidly and effectively respond to the dynamics of
> this epidemic . . . In contrast to AIDS case surveillance, HIV case
> surveillance provides data to better characterize populations in which HIV
> infection has been newly diagnosed, including persons with evidence of
> recent HIV infection. Compared with persons living with AIDS, those
> reported living with HIV infection in Michigan are more likely to be women
> (18% for AIDS vs 26% for HIV) and African Americans  (55% for AIDS and 62%
> for HIV).  Approximately 1% of AIDS cases occurred in both persons aged
> 13-19 years and 20-24 years . In comparison, 4% of HIV cases occurred in
> persons aged 13-19 years and 13% of HIV cases occurred in persons 20-24
> years. Thus, AIDS case surveillance alone does not accurately reflect the
> extent of the HIV epidemic among African Americans, women, adolescents and
> young adults."
> 
>   To address the challenge of insufficient value being derived from
> AIDS data alone, Surgeon General Satcher, CDC, and the Council of State
> and Territorial Epidemiologists (CSTE) have recommended that all states
> and territories include surveillance for HIV infection as an extension of
> their AIDS surveillance activities.  It is imperative that the Ryan White
> CARE Act be reauthorized to provide the incentives to move public health
> in the direction laid out by the Surgeon General, CDC, and CSTE  so that
> the HIV/AIDS epidemic can be tracked more accurately, and appropriate
> funding and information about this disease be better directed to at-risk
> Americans.
> 
>   Again, thank you for your letter, and I look forward to working with
> you on this issue.
> 
>                   Sincerely,
> 
>                   Tom Bliley
>                   Chairman
> 
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