i u o t i u ( V S M f .0 « « n u i * S í
Just out ▼ Juno 16. 1099 ▼ 13
R E G IO N A L H IV /A ID S F U N D IN G
The quest for parity
ealth officials in Oregon are explor
ing ways to make AIDS funding more
equitable across the state. The move
is prompted in part by the recent
infiision of federal dollars to the Port
land metropolitan area in the form of Ryan White
Comprehensive AIDS Resources Emergency Act
Title I supplemental grants.
The purpose of Title I is to provide emergency
assistance to areas that have been disproportion
by Inga
ately affected by HIV and AIDS; not surprisingly,
the money is directed toward urban areas, which
is Region 1, which covers Multnomah, Clackamas,
carry heavy AIDS caseloads. While HIV/AIDS
Washington, Tillamook, Columbia and Clatsop
service providers in the Portland metropolitan
counties).
area are pleased by the additional funding, some
In all, an estimated $2.4 million in Title I funds
advocates for people with HIV and AIDS in rural
have also been granted to the area covering
areas are questioning whether they’re getting
Multnomah, Washington, Yamhill and Columbia
their fair share of the funding pie.
counties, as well as neighboring Clark County in
“When the Title I supplemental funds came
Washington.
through, it seemed appropriate that the rural areas
According to state health officials, Region 1
receive a bigger bulk of the Title II funds. Instead,
was initially scheduled to receive about a half
it seemed like the Portland metro area also made a
million dollars in Title II funds, significantly more
grab for the Title II funds,” says Billy Russo,
than any other region. For example, Russo says,
founder of Ruby House, an HIV/AIDS hospice in
Region 5— which comprises Douglas, Coos and
rural Douglas County. “So they get $2.4 million in
Curry counties— was initially slated to receive
Title I funds, plus a huge chunk of the Title II
about $47,000 in Title II funds. Region 4— which
funds. It just doesn’t seem fair to me.”
covers Jackson and Josephine counties—was to
This past December the Portland metropolitan
receive about the
area received $986,510 in Ryan White CARE Act
same am ount.
Title I formula grants, which are awarded noncom-
An o t h e r
petitively to metropolitan areas reporting 2,000 or
$500,000
in
more cumulative cases of AIDS. It marked the first
Title II funds are
time since the act’s passage in 1990 that the area
earm arked for
was eligible for Title I funds.
“statewide ac
Up until then, Oregon had only received Ryan
tivities,” includ
White Title II funds, which are issued to states to
ing $290,000 to
help them improve the quality and availability of
help people with
existing health care organizations and support ser
AIDS pay for
vices for individuals with HIV and AIDS. Title II
designated
also supports home- and community-based care
medications, as
services, drug reimbursement, expensive pharma
well as $16,000
ceutical treatments and insurance continuation.
specifically for
In February, federal health officials announced
Ruby House.
the allocation of an additional $174.7 million in
The remaining Title II funds are distributed among
supplemental Title I funds to help urban areas with
the respective regions.
the growing costs of care for uninsured or
Dace Brown, a community health nurse for the
underinsured people with AIDS. The supplemen
Jackson County Public Health Services HIV pro
tal grants are awarded competitively based on
gram says: “There is a sense that there’s a double
evidence of unmet needs of each area’s residents
dipping going on. Region 1 gets the Title I funds
living with HIV. Nearly all of the $1.5 million in
and the Title II funding, while the other regions
supplemental funds requested by AIDS funding
only receive the Title II funds. The fact is there are
advocates in the Portland metro area was granted.
a lot of free and low-cost services available to
“We knew we would be receiving some supple
people in the metropolitan area that just aren’t
mental funds, but we didn’t realize it would be this
available to people with AIDS living in rural
much,” says Robert McAlister, PhD, HIV program
regions. It’s more expensive for us to get people
manager for the Oregon Health Division. “This is
the services they need. There are transportation
prompting us to take a look at how we can adjust
costs and housing costs. People in the metro area
the level of financial support to other areas in order
can easily get to the services they need. Our clients
for them to be able to meet the needs of people with
usually don’t have those options.”
HIV and AIDS.”
McAlister says, “There is no doubt that there is
Larry Hill, OHD’s HIV program client services
a constant tension between the urban and rural
coordinator, says the state has received an esti
areas. People in rural areas say: ‘How can you
mated $1.2 million in Title II funds for 1995-96,
continue to take so much money while we get so
which will be divvied up statewide among eight
little?’ And the folks in the metropolitan areas say:
designated regions (the Portland metropolitan area
‘Yes, we do take the bulk of the money, but we also
H
Health officials statewide are striving to achieve
equitable distribution offederal support funds
for people with AIDS and HIV
Sorensen
have the majority of cases.’ It makes for a difficult
situation.”
According to OHD officials, decisions about
how to allocate Title II dollars are made using a
consensus model. Title II requires the establish
ment of HIV care consortia, which are designed to
provide assistance and assure the continuity of
health care to people with AIDS. Consortia mem
bers include representatives from health care, pub
lic and nonprofit support service providers, re
gional representatives, those involved in commu
nity-based organizations, and people with HIV.
“All of these people bring their thoughts and
proposals to the table and they’re discussed at
length. The consortia comes up with [funding]
recommendations which are then put before a
group of local
health officials
[known as the
Conference of
Local Health
Officials]. It’s
not as though
only a few
people
are
making these
decisions,”
says Hill. “Ev
erybody has in
put.” Russo has
attended these
m eetings, as
have representatives of other rural regions.
“These meetings are almost always held in
Portland. It makes it very difficult for the rest of us
to get there,” Russo says. “Not only that, but
[Region 1 ] attracts the people with the most politi
cal savvy. They’re well educated. It can be intimi
dating for people from rural areas.”
Hill doesn’t buy that argument: “Everybody
has a place at the table here. People in rural areas
are no less educated or concerned with these is
sues.”
He adds: “When the Title I supplemental funds
came through, Region I decided to turn back the
$74,000 increase in Title II funds it was supposed
to receive. They wanted the money to go to the
other regions. Because they did that, the other
regions will likely see increases in their Title II
allotments.”
Region 5, for instance, could get more than
double the amount it was initially set to receive
when the Title II funds are reallocated.
Jeanne Gould, HIV services planning manager
for the Multnomah County Health Department
says, “I had asked the consortia to consider a parity
model that would ensure equitable distribution of
funds a year ago, but the rural areas didn’t want to
do that.
“All of a sudden when we got the supplemental
grants, Billy decided he wanted to switch over to
the parity model. He also wanted all the Title II
money handed over. By then we were already in
the very late stages of planning how the Title 11
funds would be spent. Commitments had been
made.”
She adds: “What Region 1 did was say we
wouldn’t take the $74,000 increase coming our
way. We also handed over other unspent funds so
other regions could use them."
And let’s not forget, says Gould, that Region 1
has the majority of AIDS cases. “Seventy percent
of the AIDS cases in Oregon are in Region 1,” she
says.
Jackson County’s Brown, who has attended the
HIV care consortia meetings for the past three
years as a Region 4 representative, agrees: “While
we need money badly in rural Oregon, the reality
is that most of the cases are in [Region 1 ], and if you
look at the dollars per AIDS case, [Region 1] has
been shorted in the past.”
According to OHD, through 1994 Region 1 had
971 people living with AIDS, while Region 5, for
example, had 35. Using Hill’s breakdown, that
would mean $528 in Title II funds per living AIDS
case for Region 1, compared with $1,352 per case
for Region 5.
“Region 1 has always had far fewer dollars per
AIDS case than other regions. In some cases, rural
regions were getting $4,000 per AIDS case com
pared with $400 per AIDS case in Region 1,” says
Gould.
Even when the Title I funds are factored in—
and after the Title II funds are reallocated to the
other regions—Gould says Region I still falls
short in dollars per AIDS case when compared to
nearly all of the other regions. (The numbers are
fluid, but Region 5 is estimated to receive $3,422
per AIDS case, while Region 1 would receive
roughly $2,474 per case.)
Gould admits, however, that Multnomah
County officials have allocated close to $500,000
in general funds for HIV/AIDS services. She says
that money has not been factored into the Region
1 estimates because it stays directly in Multnomah
County and does not extend to other counties in
Region 1.
“I think the Multnomah County Board of Com
missioners is the only county commission that has
allocated substantial general funds for HIV/AIDS
services. I’d like to see other counties do the
same.”
McAlister says, “This is a very tough process.
I don’t know at this point whether parity is pos
sible. What I do know is that we are going to be
working very hard to make [HIV/AIDS] funding
as equitable statewide as we can.”
IS YOUR PET PARI OF THE FAMILY?
Tender, loving care for the furry and
feathered members o f your family!
0*’
Nutrition, Cducotion, Mointenonce, Core, Huge Selection Premium Pet Foods.
Cxotk Bird experts / UWKM, UWKM Inventory of Hond-Fed Boby Birds
Boording for Birds, Rodents & Robbits / Dog Obedience Training
Rquoriums - Fish - Pet & Fish Supplies
Pelleted Bird Feeds
E A STSID E
P€TS ON &AOADUJflV j m
282-5824
W ESTSIDE
fU P iT
246-0424
2762 N€ Broodutoy
j WM |
4444 SUJ Multnomoh Blvd
(Hoilyoiood District)__________________ (Gorden Home/Multnomoh Vjlloge)
r
i
Dr. Patricia E. Huff, D.V.M .
and Associates
2 5 1 9 E. BURNSIDE, PORTLAND
CALL 233-5001
Fun Pet location only
$4 off
any 201b. or larger size of IAMS Pet Food.