President Bush signed a $464 billion spending bill on Feb. 16 that has raised concerns among experts engaged in HIV prevention and the providing of services to those living with HIV/AIDS.

With the exception of the Department of Homeland Security, the bill funds all domestic agencies and the President’s Emergency Plan for AIDS Relief, which now totals $4.5 billion for several global AIDS and tuberculosis initiatives.

The bill increases funding for the Ryan White CARE Act by $75.8 million, bringing the total to $1.2 billion for the federal program that funds care and services to people living with HIV/AIDS in the U.S., according to a Kaiser Family Foundation Report.

But activists and opinion-makers expressed concerns about the bill well before Bush signed it, noting the “essentially flat funding” for Ryan White and the prospective cuts to Medicare and Medicaid in particular. "Those on the front lines of the battle against AIDS are fighting over how to split a woefully inadequate pot,” the Detroit Free Press editorialized on Feb. 11.

“Domestic health-care programs get slammed in this budget,” said AIDS Project Los Angeles Executive Director Craig E. Thompson in a statement analyzing the budget. “HIV/AIDS programs are once again under-funded while cuts to entitlement programs are precisely the wrong approach to the health-care crisis in America.”

The Medicaid and Medicare programs provide the most federal funding for the care and treatment of PWAs. According to the APLA analysis, the “budget calls for some $76 billion in cuts to Medicare—mostly to providers such as hospitals, nursing homes, hospice and home health providers—and $26 billion in cuts to Medicaid, largely through payments to the states. The California Hospital Association said the cuts could cost California $1.5 billion in federal Medicaid dollars and potentially threaten Gov. Arnold Schwarzenegger’s sweeping health care reform proposals.”

Additionally, Gay Men’s Health Crisis Executive Director Dr. Marjorie Hill told IN at the M.E.E! (Mobilization, Education, Empowerment) Sistahs Getting Real About HIV conference at the Omni Hotel Feb. 7 that their meals-on-wheels program for poor clients is also at risk. GMHC served 96,000 meals last year. The conference, co-hosted by Phill Wilson and the Black AIDS Institute, which also featured a visit from CDC Prevention chief Dr. Kevin Fenton, concluded with a pledge from the 54 participating organizations to actively encourage HIV testing and education and work to increase Ryan White funding.

Project Angel Food Executive Director John Gile told IN that the Association of Nutrition Services Agencies, which includes Project Angel Food, APLA and GMHC, is now trying to figure out how to provide the much needed nutritional meals to the seriously ill “in anticipation of the termination of Ryan White funding” as the federal government moves to allocate federal funding primarily for medical treatment and less for care and services.

For more information on the budget breakdown, see www.kff.org/hivaids from the Kaiser Family Foundation, www.apla.org, www.gmhc.org, www.blackaids.org and www.aidsnutrition.org.