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Donning a blue baseball cap to match his blue jeans and beige sweater, Roger Cobb stares calmly from behind his thin, black-framed eyeglasses as he describes his plan to get injected with Procrit the following day, a procedure that will increase his red blood cell production. A client at Whitman-Walker’s Austin Center for Health and Living in Northwest Washington, Cobb begins his day at 9 a.m., when he checks in for breakfast. At 10:30 he meets with a nurse to discuss any health concerns. Later, he chooses among three group activities that vary each day: a 12-step program, creative writing, or health education. If time permits, he might participate in gym activities, knit, watch a movie, or see a play with other clients. For five days a week this is how Cobb, who has been living with AIDS for more than two decades, lives his life. He says the regimen is what sustains him socially, emotionally, and physically�it’s what keeps him alive. Cobb’s counseling and medical treatment for the past 10 years have been paid for because of the Ryan White CARE Act, which Congress passed in 1990. But lately, he worries. If adjustments aren’t made to the act before it is reauthorized, Cobb, along with thousands of other AIDS patients in the District and across the nation, might lose access to health care and support services, some lobbyists say. “The interaction at the center, the camaraderie, the attention to my health is what helps me maintain my quality of life,” he says. “I can’t have that taken away. This place has been a vital part of my being able to attain any quality of life. I have no idea what I would do without it.” Key provisions of the reauthorization bill have sparked contention among HIV/AIDS advocates and lobbyists. Some argue that individuals like Cobb will get lost in the money shuffle proposed by the bill, but others contend that those who have been neglected before will now get help. The provisions would rework the formula for distribution of funds to address those areas with a larger number of newer HIV infections, rather than cumulative AIDS cases. That would mean increasing resources to Southern and rural states while stripping funds from larger states with urban areas that have historically been seen as epicenters of the epidemic. SOUTHERN SHIFT The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, passed 16 years ago, created $2 billion a year in funding for HIV/AIDS services. It is used as a last resort for low-income individuals with HIV/AIDS, filling gaps in health care for the uninsured or underinsured. Sen. Mike Enzi (R-Wyo.) is the primary sponsor of the reauthorization legislation in the Senate, but Congress adjourned before passing it. Democratic senators from New Jersey and New York blocked Senate consideration of the House-approved bill, calling for adjustments. “The AIDS lobbying community is very divided on this issue. It’s very sad,” says Carl Schmid, a lobbyist and director of federal affairs for the AIDS Institute, a national, nonprofit public policy organization that supports the proposed redistribution of funds. “When people talk about losing funding, someone is gaining it, like rural areas who probably have been ignored in the past,” Schmid says. “This is a compromise. No one is going to be completely happy.” But Cobb sees it differently. He has Medicaid and even a primary physician, he says. And he doesn’t stand for compromising his health or his life. Cobb, who is African-American, grew up in Southeast Washington and contracted the virus at 33 through unprotected sex. He attends Ryan White CARE meetings and hears about how funding changes will affect some areas. “I’m very concerned,” Cobb says. “If funding is cut, I don’t know how I would receive the quality of care I get now. This is my life here. I don’t know where I would go.” Once a big-city disease infecting mostly gay white men, the epidemic is now prevalent in the South and among minorities. Shifting the funds would help cover minority HIV and AIDS patients in Southern and rural communities, which are seeing a greater number of newer HIV cases. Some advocates believe overall funding should be increased, not shifted. According to reports released by the Centers for Disease Control and Prevention, African-Americans, who make up only 12 percent of the U.S. population, account for half of all diagnosed HIV/AIDS cases, most of which are in larger, urban communities. And although Hispanic and African-American women combined make up roughly 25 percent of all U.S. women, this group accounts for a staggering 83 percent of all HIV/AIDS cases reported.According to the CDC, an estimated one in 20 District residents is infected with HIV. The District’s alarming HIV/AIDS rate is growing at 12 times the national average. States with mostly urban populations, including New York and New Jersey, as well as the District, might lose funding for their HIV/AIDS patients. Southern states such as Tennessee and Alabama stand to gain funds, lobbyists say.Sen. Hillary Rodham Clinton (D-N.Y.) is one of several senators who strongly oppose siphoning money from larger states. Damon Dozier, director of government relations for the National Minority AIDS Council, says his advocacy group is lobbying for changes to be made before the bill is finally reauthorized. “It would have a deleterious effect,” Dozier says. “There is a real fear in many communities that central urban areas will lose funding and systems of care will be destabilized. There are folks who are not going to get the care they need if you shift funds. Everyone wants the money, but you have places that have bore the brunt of the epidemic for years but stand to lose money. We know minorities will be affected. We’re trying to find out to what extent they will be affected.” D.C. SERVICES AT RISK More than half of the Ryan White CARE Act funds are distributed to organizations serving minority populations, mainly African-Americans.About 6,500 patients, 80 percent of whom are 200 percent below the poverty line, entered the Whitman-Walker Clinic last year for some form of HIV/AIDS treatment, counseling, or testing. Last year the clinic, which is the area’s primary community-based provider of HIV/AIDS services, received $5.5 million in Ryan White funding, says Chip Lewis, the center’s director of media relations. The day treatment program at the Austin Center and Max Robinson Center received $131,592. Its Legal Services program got $121,705. The rest went to the larger clinic operations. If changes aren’t made to the Ryan White CARE Act, the Whitman-Walker Clinic might have to depend more heavily on fund-raising events and private contributions, clinic officials say. “The Ryan White CARE Act is a real focal point for people living with HIV and AIDS,” says lobbyist William McCull, who serves as political director for AIDS Action, a D.C.-based HIV/AIDS advocacy program that is part of the Ryan White Legislative Group but is trying to stay neutral on the proposals. “It has been a place to go for people who have nowhere to go. It’s disappointing to get to this point where we are having a difficult situation in making sure funding gets to everyone who needs it.” With the AIDS epidemic continuing to ravage the nation, the legislation is long overdue. The act expired in September 2005 without being reauthorized, and some states, advocates say, are already running out of funds. “The sad thing is that people are more concerned about lobbying to keep the status quo than helping the patients,” Schmid says. “Everyone is looking at what’s best for a certain state or city. What’s important is what’s important for all patients.” A joint statement endorsed by several HIV/AIDS lobbyists and advocacy groups, including Cities Advocating Emergency AIDS Relief Coalition, the National Minority AIDS Council, the Southern AIDS Coalition, and the National Alliance of State and Territorial AIDS Directors, addressed to members of Congress reads: “We do not believe that there must be winners and losers in this reauthorization process in order to address the needs of people living with HIV/AIDS in all parts of this country.The final bill must address the needs of communities where the rates of new HIV infection are growing rapidly without undermining the care structures in those communities where the majority of those living with HIV reside.” Cobb, who sees himself as giving back to youths in the community by sharing his life experiences and preaching the importance of safe sex at Whitman-Walker’s Austin Health Center, agrees. “I feel fine today,” he says, pulling down the brim of his cap as he stands in a hallway at the Austin Center, preparing to leave for the day. He’ll feel even better, he says, if he knows he can always return tomorrow.
Osita Iroegbu can be contacted [email protected].

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