D.C., Md. Face Cut In AIDS Funding

Several jurisdictions got the message -- Philadelphia switched in October, and Illinois and Maine changed in January. (Virginia already has name-based reporting.) Some of the holdouts want more time. It takes about three years to change systems, and they do not want to be penalized in the interim. Elsewhere, it is a matter of principle.

"We oppose it no matter how much time we are given," McWilliams said.

In the District and Maryland, which also use a coded system, health officials appear to be hedging their positions.

"The district follows the CDC guidelines, and consistent with that is currently exploring the transition to name-based reporting for HIV infection," said Marsha Martin, senior deputy director of the District Health Department. Any new system "must ensure full protection and absolute confidentiality. We must make certain the public feels that test has been met."

Michelle A. Gourdine, Maryland's deputy secretary of health, said last week that "there is a potential name-based reporting may be required, and if it is, Maryland will comply. We will do what we need to maintain our funding to fight this epidemic."

Joshua M. Sharfstein, Baltimore's new health commissioner, was more supportive. "I do see advantages to adopting a name-based system in Maryland," he said. "But it is essential to make sure there is a transition period, and that states should not be penalized during it."

Without a transition period in the new Ryan White provisions, the District and Maryland could lose several years of full funding even if they move to name-based reporting.

It takes about three years for a name-based HIV reporting system to get up and running. Consequently, the two jurisdictions would miss the law's fiscal 2007 deadline this fall even if they switched over now. Also, the change would require action by the D.C. Council and the Maryland General Assembly, neither of which has a proposal on the issue before it.

At risk is money used to help HIV-positive people in many ways -- paying for medical care and drugs, subsidizing housing and community clinics, and training health workers. Two-thirds of AIDS care in the United States is paid for by the federal government through Medicaid, Medicare and the Ryan White act.

"Ryan White is the payer of last resort. It is the safety net underneath the safety net," said Laura Hanen, director of government relations for the National Alliance of State and Territorial AIDS Directors.

Ryan White was a teenager in Kokomo, Ind., a hemophiliac who contracted the AIDS virus through a blood product. After White's condition was diagnosed in 1984, his school banned him as a health risk. In the early years of the epidemic, he became a symbol for AIDS discrimination and spoke publicly about how the infection could -- and could not -- be acquired.

White died in 1990 at 18.