By Karen Ocamb

Many gays and AIDS activists gasped when President George W. Bush named Oklahoma Republican Sen. Tom Coburn to serve as co-chair of the President's Advisory Council on HIV and AIDS in 2002. After all, he merited a zero rating on the Human Rights Campaign's Congressional Scorecard and, as the Washington Post noted in 2004, he once described the "gay agenda" as "the greatest threat to our freedom that we face today."

But on Feb. 28, Michael Weinstein, president of AIDS Healthcare Foundation, co-hosted a press conference with Coburn in support of the senator's new bill reauthorizing and amending the Ryan White Care Act. Coburn, a doctor, was actually the primary sponsor of the CARE Act reauthorization signed into law in 2000, which expired on Sept. 30, 2005.

"Sen. Coburn's proposed amendments will allow the CARE Act to better respond to the current state of HIV/AIDS, and significantly improve the delivery and effectiveness of care and services nationwide by recognizing that AIDS is first and foremost a medical issue," Weinstein said. "HIV is now a chronic, but treatable medical condition. However, funding still largely reflects a time when HIV/AIDS was a terminal disease. The Ryan White CARE Act must be updated to reflect changes in the disease and its demographics. It is time to end the national embarrassment of having people living with HIV/AIDS in 10 states on waiting lists to receive life-saving anti-retroviral treatment, while many areas around the country spend disproportionate funds on administrative costs. This timely proposal will be an effective tool in ensuring the best use of federal dollars and improving delivery of HIV/AIDS care and services to those Americans most in need."

"As a physician, I have personally cared for many of those who depend upon CARE Act funds and I know firsthand how critical the program is to meeting the needs of more than half a million Americans living with HIV/AIDS. The CARE Act must be reauthorized and restructured to meet the changing needs of the AIDS epidemic," Coburn said. "Despite spending more than $20 billion annually on HIV/AIDS at the federal level, up to 59 percent of Americans with HIV are not receiving proper treatment and nearly 40,000 Americans become newly infected annually with HIV. Increasingly, HIV/AIDS is a disease that affects minorities, with African American women representing the fastest growing proportion of new cases. The proposed Ryan White CARE Act amendments of 2006 address disparities of care by prioritizing early diagnosis, expanding access to primary medical care and treatment, and better targeting federal resources to communities where the epidemic is growing to ensure that our focus remains on where the disease is today and where it is headed."

The Ryan White CARE Act Amendments of 2006 were written with input from AHF and many other AIDS community leaders, according to an AHF press release. The amendments are designed to re-prioritize and create new funding formulas that "would take into account HIV prevalence, require that 75 percent of CARE funding is spent on primary care, require that facilities that receive federal funding conduct mandatory HIV testing and increase annual funding for AIDS Drug Assistance Programs," according to a Kaiser Family Foundation summary. Additionally, Coburn said his bill "prioritiz[es] early diagnosis and access to primary health care and treatment and increas[es] accountability for how funds are spent."

"A number of the bill's features reflect many of the improvements our members have deemed necessary to transforming the health care they provide for their patients living with HIV/AIDS," Dr. Howard Grossman, executive director of the American Academy of HIV Medicine, said in a statement. "We are glad to see the proposed improvements to the AIDS Drug Assistance Program (ADAP), namely the minimum formulary under ADAP as well the increases in funding authorizations for the program. We are also pleased by the proposed coverage of care and treatment for those co-infected with hepatitis B and hepatitis C."

Grossman expressed "concerns" about a number of the bill's provisions, however, including the mandatory 75 percent of funds for primary care and treatment. "Our members, who provide care for more than 350,000 patients, are very clear in the message they communicate to us: Primary care includes more than drugs and doctors' visits. AAHIVM strongly recommends that primary care be more broadly defined to include other critical aspects of care like treatment adherence counseling and substance abuse counseling, and are happy to engage in developing a more accurate definition of 'primary care' than the one the bill currently offers."

Craig E. Thompson, executive director of AIDS Project Los Angeles, also expressed concern about the 75 percent standard. "The Republicans have made 'local control' the mantra of their party," Thompson said in a statement. "Yet Sen. Coburn is advocating a top-down funding scheme that can only inhibit the local jurisdictions who know best how to spend their Ryan White funds. More importantly, this sort of mandate will also hurt the very groups -- such as women and communities of color -- that Sen. Coburn says he wants to help. Today, the majority of people living with HIV/AIDS are poor and marginalized people who need more, not fewer, support services. It doesn't do any good to fund a medical clinic but take away the bus pass a poor person needs to get to her appointments."

Additionally, Thompson said, cities like Los Angeles "should not be forced to cut back on vital support services such as mental health services, child care, food banks, treatment education and case management in order to satisfy an ill-considered mandate from Washington."

With more than 1.1 million Americans living with HIV/AIDS, he noted, the number of people often requiring CARE Act services "grows by some 22,000 each year."

Florida Republican Congressmember Dave Weldon intends to introduce a companion bill in the House of Representatives.

For more on Coburn's bill, go to www.coburn.senate.gov.