The AIDS community has rarely found itself as starkly divided as it does this summer. Predictably, the source of our problems is money. We are fighting with one another over table scraps, when we should instead be demanding the federal government place a higher priority on the lives of poor and working-class people living with HIV and AIDS.
Since 2001, the Ryan White CARE Act budget has grown by a mere $300 million, to $2.1 billion in fiscal year 2006. As of January 2006 we were spending $200 million a day on the war in Iraq, according to the Congressional Budget Office – which means we nearly triple the annual AIDS budget every month.
Meanwhile, the U.S. government estimates an additional 200,000 Americans have contracted HIV since 2001.
The CARE Act, which congress must re-approve every five years, stands alongside Medicaid as the mechanism through which the federal government helps people without resources afford AIDS care and treatment. It has languished on the congressional workbench since last session, however, as AIDS advocates and their representatives have staked out opposing positions on how the bill should be reformed.
Southern AIDS service providers have argued that Ryan White must be rewritten to remove a built-in bias that funnels money to the large metropolitan areas where the epidemic began. Today, they note, 41 percent of people living with HIV/AIDS reside in the South; in 2004, Southern states boasted 7 of the 10 highest rates of AIDS cases per capita, nationally.
And the South’s burgeoning epidemic is uniquely Black. All told, eight of the nation’s 10 Blackest epidemics are in Southern states, at least in part due to the region’s racial demographics.
Those states are clearly struggling to keep up with the building crisis. North Carolina and Alabama consistently have hundreds of low-income, uninsured people on waiting lists to get government-subsidized HIV meds. The dispersed geography means people often must travel across counties to find an AIDS service provider for counseling, medical care, substance abuse treatment and other services.
Clearly, these states need greater help from the federal government in combating this epidemic. Access to quality AIDS care should not depend on where you live in a nation as wealthy as ours.
The White House and many congress members have signaled their support for such reforms, and bills in both the House and Senate would reshape the CARE Act to funnel more money to rural areas.
New York Sen. Hillary Clinton has angered many AIDS service providers and activists in Southern and rural states by holding up passage of those bills, arguing they will dangerously cut New York’s funding. Members of New York’s House delegation have echoed Clinton’s concerns, most recently in an op-ed written by Reps. Eliot Engel and Ed Towns, published in today’s Washington Post.
Sen. Clinton and her colleagues are right to insist that help for rural states not come at the expense of the large metropolitan areas that have spent decades working to bring their own epidemics under control. There are more people living with HIV/AIDS in America today than at any time in history, and AIDS service providers in places like New York City, Chicago and Oakland are having trouble keeping up with the grimly growing demand.
But the dilemma these two realities present is a false one. It is possible to meet both new and old challenges — our government has simply chosen not to do so. Robbing Peter to pay Paul is an absurd strategy to end the epidemic and will fail both the new southern/rural epidemic and the more established, yet still growing urban ones.
And so, as we head into this election season, we must think about whether our government’s priorities match our own. Rather than fighting among ourselves about how to divvy up wholly inadequate resources, we must all demand that our elected officials fight to make sure our government spends its money on the things we value.
No matter how the Ryan White CARE Act gets rewritten, it will amount to meaningless words on worthless paper if Congress continues its refusal to adequately fund the program.