The Ryan White Care Act is the centerpiece of the U.S. government’s fight against HIV/AIDS in our nation. A new version of the Care Act has been proposed and must be reauthorized by Congress by October 1, 2006 -- when they go on recess -- for the changes to go into effect.

Tonight, in a mostly empty Senate chamber, four Senators expressed their disappointment that other Senators (who were not in the room) had blocked the revised legislation from reaching the Senate floor. The four, Senator Coburn, Senator Burr, Senator Sessions and Senator Enzi, insist that the Care Act should be revamped for two primary reasons:

First, they believe the Care Act is inherently unfair because over the past 15 years significantly large amounts of the funding have been directed to major cities in places such as California, New York, and New Jersey.

Additionally, they believe there is a need for added funding in underserved areas of the country, particularly in southern states.

To address these two beliefs, they are asking their colleagues to pass a version of the Care Act that would provide the additional funding for southern and central states by taking tens of millions of dollars from those areas with the highest numbers of people living with HIV, most notably California and New York.

It is amazing how being half-right can clearly be so wrong.

Senator Enzi lamented that many major cities across the United States have received additional Care Act funding as “Title I Jurisdictions.” He failed to note that Congress granted this funding because those communities have been so disproportionately devastated by HIV/AIDS. With that funding they have achieved vast successes in slowing the spread of the epidemic. They receive funding based on a formula that considers not only the massive number of infections in these areas, but also takes into account that it simply costs more to care and treat people living with HIV/AIDS in places like New York City, Los Angeles and San Francisco. Despite their successes, these cities continue to need that critical funding.

Senator Burr continued Senator Enzi’s challenge to the current funding scheme by insisting that many people living with HIV in North Carolina are not receiving needed drugs and services. He is absolutely correct that they should have access to these drugs and services, but their access cannot come by denying that same access to people living with HIV in New Jersey, for example.

Senator Sessions then cited the growing need for services targeting African American women in Alabama. Of course the nation has an obligation to address those needs, but not by stripping the services provided to meet the needs of African American women in Los Angeles.

Half-a-dozen times these four Senators pointed out that African American women are a growing part of the HIV epidemic. I thank them for recognizing that important fact. But if these Senators truly wanted to address the racial disparities in HIV/AIDS they would be working to secure services for people in North Carolina, Alabama, Oklahoma and Wyoming without threatening the lives of people of color in Los Angeles and New York. (Of course cities in New York and California also have large populations of gay men and injection drug users, two populations these Senators continue to ignore.)

If Congress would stop addressing the HIV epidemic by proverbially robbing Peter to pay Paul, they could finally take the steps necessary to properly address this epidemic.

The House and Senate could move this bill -- in true bipartisan fashion – by adding the appropriations needed to fully fund the AIDS Drug Assistance Program (ADAP), eliminating wait lists for life-saving medicines across the U.S. They could also fully fund and extend the “hold harmless” provisions to 5 years to allow California and other jurisdictions the opportunity to bring their HIV reporting in line with CDC requirements.

Simply enough, the House and Senate can ensure that rural areas and growing populations have the resources they need without dismantling successful and effective infrastructure elsewhere.

Most importantly, Congress has the chance to not only strengthen the Care Act, but to then move forward next session and make HIV testing available and accessible to all Americans so we can begin to get a handle on this epidemic once and for all.

Instead, Senator Coburn, with the tacit support of Senator Frist, leads the charge for a reallocation of funds that would devastate the major cities at the heart of the epidemic. This attack on thousands living with HIV/AIDS is not only a violation of their Hippocratic oath; it is simply immoral.

Senator Enzi is correct in saying “[the Care Act] is life and death to people across this country.” I hope for all our sakes that he and his colleagues realize over the next 24 hours that there is nothing compelling them to extend life in some states by expediting death in others.



STEPHEN DAVID SIMON

AIDS Coordinator