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D.C., Md. Face Cut In AIDS Funding
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How much money the District and Maryland might lose depends on what changes are adopted in the Ryan White reauthorization bill pending in the House and Senate. It could be as much as one-third.
For example, if the CDC rejects code-based counts of HIV cases -- and it has not accepted them from any state yet -- the District and Maryland would each lose 38 percent of the money they receive to help people buy AIDS drugs, including life-extending antiretrovirals. Baltimore would lose 30 percent, according to a report released in February by the Government Accountability Office.
One change favored by the Bush administration is making the number of HIV and AIDS cases the primary basis for distributing Ryan White money, eliminating a provision that would give special consideration to places such as Washington and Baltimore, where the epidemic began early. That would shift money to the South and West and increase the losses for places that do not adopt name-based reporting.
In that case, according to GAO estimates, the District would lose $8.8 million, or 19 percent, of its Ryan White funding. Maryland would lose $12.3 million (36 percent) and Baltimore would lose $3.1 million (16 percent).
Although code-based systems can enumerate cases inside a state, they do not allow the CDC to identify people who have been counted in more than one state -- an essential correction to the national data. Only if all states used the same code would that be possible. But in the 11 states that still use codes, there are 10 variations.
Furthermore, one study showed that code-based reporting costs 50 percent more per case, largely because of the labor that health departments expend helping doctors and hospitals code cases properly.
"We have a good code-based system. It's called the person's name," said Matthew T. McKenna, a physician and epidemiologist at the CDC's division of AIDS.
Does name-based reporting have a chilling effect on people coming forward to be tested? A study of CDC-funded HIV counseling and testing sites in New York suggests not. In the two years after that state's name-based system took effect in 2000, the number of HIV tests did not decrease and the percentage of anonymous tests did not increase.
