Sen. Hillary Rodham Clinton is holding up renewal of the primary federal law that battles HIV/AIDS, the 1990 Ryan White Act, causing a rift among activists on the subject and threatening approval of the legislation this year.
Clinton (D-N.Y.) said she opposes the measure because it would lower funding for her home state. But some AIDS groups also see broader political motives at work. Other states that would lose out include California, Florida and Illinois -- all places Clinton would need to win if she seeks the presidency. Her critics also note that many of the states that would receive higher funding under the new formula are rural and southern, which tend to vote Republican.
Clinton was the sole vote against the Ryan White Act reauthorization bill that passed the Senate Committee on Health, Education, Labor and Pensions in May. Ever since, she and other senators have been negotiating to find a consensus that would allow the measure to pass by acclamation before Congress's scheduled adjournment at the end of September. But a compromise has not been found.
"With a bipartisan bill like this, and with time limited, we want to have something that would go through without objection," said Michael Mahaffey, spokesman for the health committee. But, he added, Clinton "objects to the bill in the form passed out of committee."
The senator's insistence on a different formula -- one closer to current law -- has angered several groups that represent AIDS and HIV patients who stand to get more money under the pending bill. Last week, Harry C. Alford, chief executive of the National Black Chamber of Commerce, wrote a letter to Clinton that said, "It is with sadness that I learn about your efforts to block" the law's reauthorization.
Alford said that people of color, particularly in the South, are contracting AIDS at a rapid pace and need more funding than was envisioned when the current formula was devised. "I must share with you the bewilderment of African Americans throughout the country who cannot understand why you are taking this stand against opening the door to more equitable funding that will chiefly benefit people of color," he wrote.
In response, Clinton wrote to Alford yesterday, saying she agrees that AIDS "has had a disproportionate impact on people of color" and "that our federal government can do more." But she said that the Ryan White measure as drafted "would have a devastating impact on New York" and "unfairly shift millions of dollars in funding away from New York and other states that have been hardest hit by the epidemic, jeopardizing their ability to provide vital care and treatment services."
The Ryan White Comprehensive AIDS Resources Emergency Act is named for an Indiana hemophiliac who contracted HIV through a blood transfusion and died of AIDS complications in 1990 at age 18. The now $2 billion-a-year effort has been regularly reauthorized and its funding allocations have often been a matter of contention.
This year's fight has pitted the states in which the AIDS epidemic began -- those with large cities that now have large populations of people with AIDS -- against smaller states in which the incidence of HIV infections, but not full-blown AIDS, has soared. The current-law formula is based on the number of patients with AIDS; the new funding formula would, in effect, distribute funding based on the number of patients with HIV or AIDS.
Support for any particular formula "depends where you sit," said Ernest Hopkins, director of federal affairs for the San Francisco AIDS Foundation. From his vantage, he said, the bill in the Senate "is a problem."
Some of the largest AIDS organization side with Clinton. Gay Men's Health Crisis, for example, "fully supports Senator Clinton's position on the current bill," a spokeswoman said.
On the other hand, Christopher M. Hamlin, chaplain for an outpatient clinic at the University of Alabama at Birmingham, favors the new formula. "The money needs to follow the virus," he said. "More funds need to be directed to the part of the community that has seen the numbers increase so much, especially rural communities."
Some critics see electoral motives behind Clinton's position. "If you look at the states she has to carry to become president -- California, New York, Illinois, Florida -- those would be the hardest hit if the formula were changed," said Charles Grant, founder of AbsoluteCare Medical Center Inc., the largest private HIV/AIDS medical center in Georgia.
Asked why Clinton might countenance lower funding for southern and rural states, Michael Weinstein, president of the AIDS Healthcare Foundation, the nation's largest community-based HIV/AIDS medical provider, said, "I don't think she expects to carry the South."
But even those who disagree with her on the legislation think she will not hurt her standing with AIDS activists. "Senator Clinton overall has an excellent record on these issues. She's a reliable vote and her office is seen as a place to go to support AIDS issues," Weinstein said. On the funding formula, however, he said, "Senator Clinton's view seems very parochial; it looks to the past and not to the future."
A Clinton spokesman said that the senator cannot be said to be obstructing the legislation because it has not yet moved in the House. In the meantime, Clinton, whose fellow New York senator, Charles E. Schumer (D), also opposes the new formula, is awaiting more data about the potential impact of the measure and is continuing to search for a compromise, the spokesman added.