Thank you letter to Sen. Jeffords
from Log Cabin Republicans
March 30, 2000
The Honorable James Jeffords
Chairman, Committee on Health,
Education, Labor and Pensions
United States Senate
Washington, DC
20510
Dear Mr. Chairman:
I am writing to thank you for consulting with us on the Ryan White CARE
Act Amendments of 2000. All of us who care about HIV/AIDS policy owe a
debt of gratitude to you for your consistent leadership on this important
issue, and we are confident that the reauthorization of the Ryan White
CARE Act will be a productive process with you at the helm of the
Committee.
We have reviewed the legislative summary and draft language, and wanted
to give you our views. As you know, we have long advocated in the
appropriations process that the federal AIDS strategy must prioritize
saving and extending the lives of people with HIV/AIDS. Congress had been
very responsive in this regard, and has increased funding for Ryan White
by hundreds of millions of dollars above President Clinton's annual budget
requests since 1996. These increases by Congress have had special emphasis
on funding for AIDS drug assistance, which has helped to dramatically cut
the AIDS death rate nationwide. As we begin the reauthorization process,
we want to emphasize again that this prioritization strategy has clearly
worked -- and it should become institutionalized in the Act itself.
Most notably, we're pleased to see the inclusion of the new
supplemental ADAP grants, something we have long advocated. This begins to
address the inequities between urban areas and rural states in funding for
access to life-saving treatments and medical care.
We also applaud the Title I amendment which requires support service to
be health care related. It is vital to make sure that funding across the
Titles reflect the priorities of the HIV/AIDS epidemic of today, and don't
maintain inefficient bureaucracies that are peripheral to health care.
These changes are good beginnings, but there are additional measures we
believe should be added to the Act that are not currently in the draft:
UPGRADING AETC's
It is crucial to upgrade the Part F AIDS
Education and Training Centers (AETC's) to address the increasing need for
clinical personnel training in underserved areas of the country. This is a
vital care-related service that strategically goes hand-in-hand with ADAP
funding as the means to saving and extending lives of people with HIV,
especially in underserved areas where there are thousands of clinical
patients (many of whom are women and people of color) who are still only
on AZT or another monotherapy regimen and AETC support is not available in
the area. The lives of those patients are clearly at risk, and they are
likely to become seriously ill and more seriously dependent on costlier
entitlement support without basic clinical care and access to the full
range of AIDS treatments. Upgrading AETC funding can help address this
problem at the start.
COUNTING METHODS
We share the concerns of advocates who see
that a continued system of counting patients through the weighted AIDS
multi-year formula rather than through incidence of living HIV-positive
patients, will make the Ryan White CARE Act progressively less responsive
to the epidemic as it is now. The Senate draft phases in a requirement by
FY 2003 in Title II for people with HIV who are not currently in care, but
we urge the further consideration, along with HIV/AIDS community
advocates, of a way to ensure that the counting issue is more
comprehensively addressed. This would require additional consensus on the
method of tracking HIV-positive individuals, but we hope this is still
achievable among community advocates, since the problems resulting from
not reaching consensus will be serious for current and future HIV
patients.
UNDERSERVED POPULATIONS
As we mentioned in regard to AETC's,
women and people of color have been increasingly underserved since the
Amendments of 1996, and the Senate draft does address this problem in many
ways, such as in the set-aside amendments for women and children in Titles
I and II. However, the funding inequities based on geography have also
impacted people of color who make up substantial HIV populations in some
rural states. The Title II supplemental grants will help address this, but
we look forward to exploring additional ways with the Committee and
community advocates to address this problem, which shouldn't be allowed to
worsen over the next five years.
SUNSHINE PROVISIONS
Finally, we believe it is overdue to
include basic federal sunshine standards in the Ryan White CARE Act for
grant recipients, especially in light of the recent GAO report on this
subject. We hope this will be in the final version of the Act.
We want to again applaud you for your leadership on this issue, and by
starting the process with some good additions. We recognize this will be a
continuing process, and look forward to working with you and the Committee
in the months to come. Our goal, like yours, is to complete work on the
Amendments Act expeditiously and with widest consensus, while we continue
to articulate our views of the best AIDS policy going forward.
Thank you for your consideration.
Sincerely,
KEVIN IVERS
Director of Public Affairs
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