The federal government provides about $70 million in safety-net grants a year to community groups, hospitals and health departments to pay for comprehensive primary HIV medical care and support for women, children and youth living with the disease. The grants are the smallest component of the $2.3 billion Ryan White program that provides HIV-related services to more than half a million people who lack sufficient health-care coverage or financial resources.
Most Ryan White money is awarded directly to health departments in states and jurisdictions based on the number of people living with the disease. But grants to help HIV-positive women and children are awarded competitively to providers, usually every three years. This year, for the first time in more than a decade, criteria were changed to place less emphasis on youth-specific services, one grant applicant said. New grants were also capped at $500,000.
As a result, grants for about 10 major cities, including Washington, New York, Baltimore, San Francisco and Los Angeles, were substantially reduced, data show. Washington’s grant was $350,000, a 75 percent reduction from the $1.4 million awarded last year. New York received about $6.2 million, down nearly 40 percent from $9.8 million last year.
At the same time, providers in a number of cities received money to help HIV-positive women and children for the first time. The diverse group of 19 cities ranged from Tacoma, Wash., to Morgantown, W.V. Many are mid-sized cities. The seven in the South include Macon and Savannah, Ga., Henderson, Ky., Wilmington, N.C., and Charleston, S.C.
“If there is a push to provide more services in the South, I’m not sure it should be done at the expense of HIV-positive people who happen to live in the North,” said William Barnes, executive director of the D.C. program that failed to win funding for the first time in more than a decade.
With limited dollars, “some tough choices had to be made about the most effective use” of funds, said Martin Kramer, spokesman for the U.S. Health Resources and Services Administration. The agency, part of the U.S. Department of Health and Human Services, administers the program named for the Indiana teenager who became a poster child for HIV/AIDS when he was expelled from middle school because of his infection with HIV after a contaminated blood treatment. White died in 1990.
Cities such as Washington and New York also receive tens of millions a year from other Ryan White funding specifically designated for metropolitan areas hardest hit by the epidemic. Metropolitan Washington, for example, will receive about $54 million in total Ryan White funds this year; last year the amount was $56 million.
Most of the 19 cities receiving new funds for HIV-positive women and children don’t receive that category of funding, Kramer said.
The awards were announced in August. Many providers who received smaller grants are scrambling to adjust.
“There’s winners and losers because there was no new money added,” said Michael Ruppal, executive director of The AIDS Institute, a national nonprofit.
Advocates say it’s too soon to know the impact in Washington. The nation’s capital has a higher HIV infection rate than any state and among the highest for cities. There are 14,465 adolescents and adults, or about 2.7 percent of the population, diagnosed as living with HIV. That is well above the 1 percent considered by the World Health Organization to be a general epidemic.
Unlike other cities where the at-risk population might be concentrated among intravenous drug users or men who have sex with men, the District has a mixed epidemic, with a huge burden falling on heterosexual African Americans. Officials have said 90 percent of all women with HIV are black.
In previous years, the $1.4 million in safety-net funds was awarded to Children’s National Medical Center. It partnered with several community organizations to help about 1,200 HIV-positive women, infants, children and youth.
“Overwhelmingly, these are people who are living below the poverty line,” said William Barnes, director of the project. The funds helped pay for mental health services and case management, services not often covered by insurance. That support is critical to keeping HIV-positive people in treatment.
Adolescents need special support, said Adam Tenner, executive director of Metro Teen AIDS, one of the community groups that received past funding to work with dozens of HIV-positive youth. For the short term, the group has received funding from other sources to continue the work.
This year, an arm of the parent company that owns MedStar Washington Hospital requested about half a million dollars to serve the same population and same service area as Children’s; it was awarded $350,000 a year for a five-year project. The hospital’s infectious diseases clinic will be the primary source of care. It plans to partner with some of the same community groups.
Leon Lai, an infectious disease doctor at the hospital, said final details are still being worked out.The hospital plans to “do the best we can to use these funds wisely and maximize the best care possible,” he said.