Summary: The distribution of federal resources needs to reflect the changing nature of the HIV/AIDS epidemic. New medicines and treatments have lengthened the life expectancy of infected persons. Before the 1996 reauthorization of the Ryan White CARE Act, which replaced cumulative AIDS case counts with estimates of living AIDS cases, the areas of the country with the longest experience with the disease benefited most from using cumulative case counts. HIV counts have not been considered in the funding formulas. Today, only about 60 percent of the states include HIV cases that have not progressed to AIDS. To ensure that the formulas provide an equitable distribution of funds, all states would need to report HIV cases. All states are expected to be reporting new HIV cases by 2003. Currently, states with an eligible metropolitan area (EMA) receive more funds than those who do not have an EMA. States such as California and New York, for example, received $5,240 per case, or 60 percent more than states without an EMA. Finally, a hold-harmless provision in the 1996 reauthorization that would help states transition from a cumulative AIDS cases to living AIDS cases has been very gradual; however, only San Francisco has benefited from the hold-harmless provision as of 1999. GAO recommends changing the Ryan White funding formulas to enhance comparable funding across the states. GAO believes that including living HIV case data will improve the ability of the Ryan White CARE Act to effectively deliver funding to needy persons.
