WASHINGTON — The federal government is providing fewer safety-net funds for women and children living with HIV/AIDS in many large cities with high infection rates. At the same time, 19 other cities are for the first time receiving funds to help this population, according to federal data.
Federal officials say the broader geographic focus is part of the national HIV/AIDS strategy. The goal is to respond to the changing epidemiology of the disease in a more coordinated way and to target areas of the country with unmet needs. Seven of the cities getting new funding are in the South, the epicenter of new HIV infections.
The federal government provides about $70 million in safety-net grants a year to community groups, hospitals and health departments to pay for comprehensive primary HIV medical care and support for women, children and youth living with the disease. The grants are the smallest component of the $2.3 billion Ryan White program that provides HIV-related services to more than half a million people who lack sufficient health-care coverage or financial resources.
Most Ryan White money is awarded directly to health departments in states and jurisdictions based on the number of people living with the disease. But grants to help HIV-positive women and children are awarded competitively to providers, usually every three years. This year, for the first time in more than a decade, criteria were changed to place less emphasis on youth-specific services, one grant applicant said. New grants were also capped at $500,000.
As a result, grants for about 10 major cities, including Washington, New York, Baltimore, San Francisco and Los Angeles, were substantially reduced, data show. Washington’s grant was $350,000, a 75 percent reduction from the $1.4 million awarded last year. New York received about $6.2 million, down nearly 40 percent from $9.8 million last year.
At the same time, providers in a number of cities received money to help HIV-positive women and children for the first time. The diverse group of 19 cities ranged from Tacoma, Wash., to Morgantown, W.V. Many are mid-sized cities. The seven in the South include Macon and Savannah, Ga., Henderson, Ky., Wilmington, N.C., and Charleston, S.C.
“If there is a push to provide more services in the South, I’m not sure it should be done at the expense of HIV-positive people who happen to live in the North,” said William Barnes, executive director of the Washington, D.C., program that failed to win funding for the first time in more than a decade.
With limited dollars, “some tough choices had to be made about the most effective use” of funds, said Martin Kramer, spokesman for the U.S. Health Resources and Services Administration. The agency, part of the U.S. Department of Health and Human Services, administers the program named for the Indiana teenager who became a poster child for HIV/AIDS when he was expelled from middle school because of his infection with HIV after a contaminated blood treatment. White died in 1990.
Cities such as Washington and New York also receive tens of millions a year from other Ryan White funding specifically designated for metropolitan areas hardest hit by the epidemic. Metropolitan Washington, for example, will receive about $54 million in total Ryan White funds this year; last year the amount was $56 million.
Most of the 19 cities receiving new funds for HIV-positive women and children don’t receive that category of funding, Kramer said.
The awards were announced in August. Many providers who received smaller grants are scrambling to adjust.
“There’s winners and losers because there was no new money added,” said Michael Ruppal, executive director of The AIDS Institute, a national nonprofit.