From: MPetrelis@aol.com Date: Fri, 16 Jun 2000 10:00:38 EDT Subject: Rep. Bliley says Ryan White AIDS funding favors San Francisco > 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 > ------------------------------------------------ Michael Petrelis Welcome to AIDS-STATISTICS www.AIDS-statistics.com 2215-R Market Street, #413 San Francisco, CA 94114