RYAN WHITE CARE ACT: San Francisco Health Department Responds to Recent GAO Letter on City’s Funding

      In response to an Aug. 24 General Accounting Office letter, the San Francisco Department of Public Health issued a statement last week refuting some of the agency's claims about the city's Ryan White CARE Act allocation. While the department admits that San Francisco "receives more Title I funding per capita than other" eligible metropolitan areas, it contends that the funds "fall well short of meeting the need for the full range of services" HIV/AIDS patients need, adding that "significant decreases" in funding would "severely impact" more than 12,000 residents. The department challenges the GAO's conclusion that the city's CARE Act allocation would decrease by 26% if both living and deceased AIDS cases were used to determine funding, arguing that the agency ignored the "density factor," a "critical component" of the 1990 allocation formula that relied on cumulative AIDS cases. Citing the GAO's use of per capita data to measure funding disparities across different metropolitan areas, the department argues that failing to account for density, cost of care, availability of resources, cost of living and population demographics makes "accurate comparisons across jurisdictions impossible." The department also says that the per capita data the GAO uses undercounts the city's living AIDS population by about 23%, and thus the agency "overestimates the per capita figures" for San Francisco. In addition, although the department concedes that the city's AIDS cases have declined, it notes that the rate of new HIV infections has increased, creating additional costs that the GAO failed to address in its report (San Francisco Department of Public Health release, 8/30).