Action Item: Letters to Senators Boxer and Feinstein

[Oceanbeach]

Dear Forum Friends,

Since the Senate did not pass the new version on the CARE Act this year, funds for FY 2007 will be distributed using the legislation passed in 2000.  Both the existing and proposed legislation create financial problems for Sonoma County and California.  It was proposed by the Executive Committee of the Sonoma county Commission on AIDS that a letter to both of our Senators might serve as an important reminder to ensure that the final version of the CARE Act incorporate changes that would influence California's HIV cases in the allocation of funds and counter the recommendation that 75% of the funds go to "core" services.

There are currently 700 people living with HIV/AIDS in care in Sonoma County and an additional 1300 who are not yet in care.  If you will copy this letter and send it to Senators Feinstein and Boxer, there are 200 people in California who would be grateful.

Senator Barbara Boxer
112 Hart Senate Office Building
Washington DC, 20510

Senator Diane Feinstein
331 Hart Senate Office Building
Washington DC, 20510

Subject: Needed Changes to S. 2823, The Ryan White HIV/AIDS Treatment Modernization Act

Dear Senator,

The Sonoma County Commission on AIDS wishes to express its concerns regarding S. 2823, the Ryan White HIV/AIDS Modernization Act.  Tens of thousands of persons living with HIV disease in California and other states would lose access to vitally needed services as a result of the poorly received policies contained in this legislation.  Since the Senate has not yet passed S. 2823, it is our hope that you will use this time to advocate some adjustments to the Act.

We would like to begin by returning to the core purposes of the legislation.  The intent would simply be to help persons living with HIV to enter and remain in care.  In so doing, we reduce the risk of infecting others and minimize what would otherwise be a massive disruption of local medical, social and economic services.  The current version of the Act does not come close to achieving this purpose.  It adopts an inequitable distribution formula that would radically shift funding for all existing systems of care.  Unpredictable increases or decreases in funding, and continual uncertainty about funding levels does not promote reasonable health funding.  The proposed legislation does not effectively resolve the dilemma of names vs. code based HIV reporting systems.  This seriously compromises the ability of local jurisdictions to respond to needs and prevents the program from achieving any kind of uniformity or parity on a national level.

California will stand to lose millions of dollars annually under the current or proposed legislation.  Given the large number of persons living with HIV/AIDS in this State, it is difficult to imagine how any equitable, evidence-based distribution formula could result in substantially decreased funding for California.  It is essential  that a formula be developed and implemented as soon as possible that fairly measures the true burden of the epidemic, counting both persons with an AIDS diagnosis and those living with HIV.

Second, the requirement that 75% of funds be spent on so-called "Core" services is both arbitrary and unnecessary.  Every jurisdiction understands the importance of, and has prioritized as their top services, primary care, dental care, mental health services, substance abuse counseling,  and the other "Core" services.  What the legislation does not appreciate is that many of the so-called "Support" services are essential in bringing persons into care and providing the financial and psychological stability that permits them to remain in care.  There is no scientific evidence suggesting that 75% represents the optimal proportion for funding of services.  A general recommendation that the majority of funds go to "Core" services would likely achieve the intended result without imposing a randomly selected percentage.

Finally, under the proposed legislation, Sonoma County would still lose Title I status after three years.  We urge you to join with the Senators from New York and New Jersey to preserve the eligibility of the three"small" Title I jurisdictions located in these states.  Maintaining eligibility for these three areas would cost less than $4 million annually, but would preserve established systems of HIV care relied upon by thousands of persons with HIV.  Should Sonoma County lose funding, many of those persons would be forced to seek services and care in San Francisco and Oakland, which are already facing reductions of their own.

We hope that you will continue to work for reauthorization of a CARE Act that maintains the systems of care which have improved the length and quality of life of persons with HIV disease in Sonoma County, in California, and across the nation.
Sincerely,







Dear Senator,