Puerto Rico's AIDS Care in Disarray over Funds

Puerto Rico's AIDS Care in Disarray over Funds

Across Puerto Rico, hundreds of HIV/AIDS patients are not regularly receiving medicine or care, say patients, doctors, and advocates. A thin health budget and rivalry between the commonwealth and San Juan, which run separate AIDS programs, exacerbate the problem. Federal officials and many local physicians blame poor local management of Ryan White AIDS funding, $53 million in 2006, for the shortfall. Over the past five years, disorganization caused $6.5 million to go unspent.

Clinics do not always receive HIV/AIDS drugs on time, and private organizations are often reimbursed six or more months after providing services, causing some to make cuts or close. Federal officials have placed Puerto Rico's AIDS grants under stricter review, threatening to pull funds. The Federal Bureau of Investigation raided four San Juan Health Department offices in December, investigating potential misuse of Ryan White money.

Officials deny misallocating funds, though they admit concern over a shortage in money. A waiting list for HIV/AIDS drugs had to be created in the fall; its ranks have since fallen from 130 to 36 said officials, who expect it to be eliminated soon.

Officials say any lapses in care have been brief. But Dr. José Varga Vidot, director of the private San Juan care group Community Initiative, said he knew at least 75 people who were unable to obtain all their medicine for up to a month. Physicians say switching a patient to a new drug regimen can take months for central health department approval, and newer drugs are often unavailable.

National Ryan White funding has remained stagnant for four years, say advocates, leaving states and territories competing for the funds. The main San Juan clinic has stopped accepting new patients, saying it cannot afford more. Federal administrators said they have offered to place San Juan's Ryan White funds in a separate entity to manage them - an offer Mayor Jorge A. Santini Padilla has refused.

New York Times (06.05.07):: Erik Eckholm

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