The U.S. Senate adjourned without taking decisive action on the reauthorization of the Ryan White CARE Act, the largest dedicated federal funding program for HIV/AIDS care, treatment and support services for low-income, uninsured and under-insured individuals. The legislation that controls the $2 billion CARE Act expired a year ago and, despite a significant amount of work done in good faith by many, the bill under consideration would have unacceptable, destabilizing effects on San Francisco and many of the hardest-hit areas of the country, including the states of California, New York, Washington, New Jersey, and Maryland, and the District of Columbia.

On September 28, the U.S. House of Representatives passed H.R. 6143, the Ryan White HIV/AIDS Modernization Act of 2006, by a 325-98 vote. All but two California Democrats voted against the legislation that would cut funding to California by as much as $50 million by the fifth year of the authorization. San Francisco, with the highest per capita caseload of people with AIDS in the country, stands to lose more than $13 million over the next four years, which is a one-third cut in San Francisco's current Ryan White CARE formula funding. An estimated 11,000 San Franciscans rely on CARE funding for their care and treatment.

On September 29, 2006, in a colloquy with Senators Mike Enzi (R-WY) and Ted Kennedy (D-MA), Senator Barbara Boxer (D-CA) was assured that California will not experience a steep drop in funding in the fifth year of the reauthorization if events beyond California's control prohibited an accurate name-based HIV count.

"Health care and treatment access for one low-income, uninsured group should not be provided at the expense of another," said SFAF Executive Director Mark Cloutier. "The version of the CARE Act that the House of Representatives recently passed does not address the emerging needs of people newly diagnosed with HIV/AIDS, let alone the current needs of people already living with the disease. New resources are essential if we are going to avoid creating waiting lists that lead to delayed or insufficient health and social services for people with HIV regardless of where they live and when they contracted the infection. The current funding behind reauthorization could lead to premature deaths of people waiting or not accessing necessary services."

The San Francisco AIDS Foundation (SFAF) urges the Senate, when it reconvenes in November, to adopt legislation that does not disrupt existing systems of care, while still investing new resources in regions of the country with emerging HIV epidemics. SFAF supports bill language that: ensures that areas with high HIV/AIDS prevalence and incidence will be equally competitive for supplemental funding; extends the "hold harmless clause"-originally designed to protect jurisdictions from drastic year-to-year cuts- for the entire five years of the reauthorization period; increases authorization levels for all titles of the CARE Act and immediately increases appropriations for Fiscal Year 2007 by 3.7 percent.

"Due in no small part to the CARE Act and state and local investment, more people are living with HIV and AIDS now than dying from it. This is truly remarkable and it needs to be celebrated. The current legislation on the table would reverse this trend," said Nancy Pelosi (D-CA), Democratic Leader of the House.

"Had the Ryan White CARE Act passed the Senate as written by the House, San Francisco would have lost $1 million per year for the first three years and $10 million in year four. These are funds that those living with HIV and AIDS depend upon for care. The inaction by the Senate has forestalled this for now. Meanwhile, we will work with our partners and with the community to bring about a better and more equitable outcome for those who depend on these resources to maintain their health and their lives," Mitch Katz, MD, Director of Health, San Francisco Department of Public Health.

The San Francisco AIDS Foundation is a community-based organization that provides a comprehensive array of services - including financial benefits counseling, client advocacy, housing assistance, needle exchange, and the California AIDS Hotline (800-367-AIDS). The agency reaches thousands of others through community outreach, public policy efforts, prevention campaigns, and the Web. For more information visit www.sfaf.org.