Seeks Explanation from HHS Secretary for Devastating $4 Million
Cut in San Francisco AIDS Funding
CA -- House Democratic Leader Nancy Pelosi sent the following letter
today to Health and Human Services Secretary Tommy Thompson in response
to the $4 million cut in San Franciscos Ryan White CARE Act
Title I award:
Tommy G. Thompson
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
Re: Ryan White
I am writing
to express my strong concern about the $4 million cut in San Franciscos
Ryan White CARE Act Title I award, which was announced on March
1st. This reduction will have a devastating impact on HIV/AIDS services
in the Bay Area.
was one of the first epicenters of the AIDS epidemic and continues
to be one of the hardest hit areas in the country. With an estimated
23,000 people living with HIV/AIDS, the San Francisco eligible metropolitan
area (EMA) has the highest per-capita rate of total AIDS cases,
the third highest number of total AIDS cases, the fifth largest
number of people living with AIDS, and the tenth highest rate of
new AIDS cases in the nation. In addition to the disproportionate
rate of AIDS cases, the rate and prevalence of HIV infection in
the population of our EMA are increasing. It is estimated that 1
in 40 San Franciscans are infected with HIV.
We are all
grateful that improved access to care and increasingly effective
HIV treatments have resulted in a decline in deaths among persons
living with HIV/AIDS. However, fewer deaths and increasing rates
of infection mean there are more people living with HIV/AIDS and,
consequently, more people in need of Ryan White CARE Act services
than ever before.
The San Francisco
EMA bears a significant share of the HIV/AIDS epidemic and relies
heavily on Title I funds to provide vital services and increase
access to care. The sizeable population in San Francisco living
with HIV/AIDS is increasingly impoverished, homeless, and struggling
with co-morbidities such as hepatitis C, addiction and mental illness.
In addition, San Francisco is one of the most expensive places in
the country to provide medical care, and housing costs continue
to be among the highest in the nation.
a funding reduction of $545,110, or 3.3 percent, in our Title I
formula award pursuant to the hold harmless provision in the Ryan
White CARE Act Amendments of 2000. However, the San Francisco EMA
was unprepared for an additional $3.5 million, or 21 percent cut,
in our supplemental award, which combined with the formula reduction
resulted in a 12.1 percent overall reduction. San Francisco experienced
the largest dollar reduction of any EMA and the third highest reduction
The San Francisco
EMA cannot sustain a loss of this magnitude without undermining
the safety net for the most vulnerable persons living with HIV/AIDS
in our community. A $4 million reduction would force San Francisco
to cut 1,171 hours of treatment adherence services, 554 days of
adult day health care services, 1,779 dental procedures, integrated
case management for 527 people, and numerous other services that
are critical to maintain and improve the health of people living
with this terrible disease.
Our EMA has
consistently scored well on its previous Title I supplemental applications,
as evidenced by its supplemental award as a percentage of its formula
award. The Health Resources and Services Administration (HRSA) has
historically identified few weaknesses, and has even cited San Francisco's
application as an example of a well-written proposal.
the Summary Report from HRSA for the EMAs 2004 application,
I am concerned that the evaluation contains several inaccuracies
and clear contradictions. The following are just two examples of
misinformation contained in HRSAs Summary Report:
Factor 3 - Severe Need, one weakness reads, The needs of each
population included are not addressed in a meaningful, specific
way. However, a strength in this same category indicates,
The application provides very comprehensive information on
the disproportionate impact on certain populations, and sub-populations.
It is difficult to see where the application is lacking in this
regard, particularly since San Francisco received a sizeable Minority
AIDS Initiative award, which is based upon the same application.
Another weakness in Scoring Factor 3 states, The application
does not adequately address gender in epidemiological data; the
application does not to [sic] even mention men in the gender section.
However, a strength in this same category reads, The application
includes very comprehensive epidemiological data, including several
instances of prevalence estimates (e.g., among homeless MSM) and
comparisons between groups. Indeed, the application clearly
states in several places (pp. c, 33, 34, 39, 40) that men who have
sex with men (MSM) account for the largest share of the epidemic
in the EMA.
request a detailed explanation of the process by which allocations
were made, a response to the concerns raised above, and documentation
that allocations were made in an equitable and accountable way.
In addition, I hope that we will be able to work together to identify
other funds within the Department of Health & Human Services
to help offset these cuts and prevent reductions in vital health
services for people living with HIV/AIDS in the San Francisco Bay
Thank you for
your immediate attention to this matter. I look forward to working
with you to ensure that people living with HIV/AIDS in the Bay Area
and across the country have access to the Ryan White CARE services
they need to stay healthy.
House Democratic Leader