The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was enacted by Congress in 1990 and reauthorized with amendments in 1996 and 2000. The next reauthorization is anticipated some time in fall 2005. The primary purpose of the Act is to “provide emergency assistance to localities that are disproportionately affected by the Human Immunodeficiency Virus epidemic”. The amended Act requires formula grants based on the “estimated number of living cases of acquired immune deficiency syndrome in the eligible area involved”. Estimates are derived by using methods specified in the Act. The amount of funds received by each eligible metropolitan area (EMA), (under Title I), or state, (under Title II) is determined by the locality’s proportion of the total estimated number of persons living with AIDS. The Ryan White CARE Act formula is used by the Health Resources and Services Administration (HRSA) for the legislative requirements of the CARE Act. Additional information on the CARE Act is available at http://www.hrsa.gov.

Currently, AIDS case counts are used to guide the distribution of funds under the CARE Act. However, concerns have been raised that such allocations are not equitable because the epidemic is not adequately reflected by AIDS cases alone and that areas with emerging HIV epidemics are under-funded because all cases of HIV disease are not included. A related concern with basing allocations on AIDS cases is that jurisdictions are not compensated for providing early access to care and treatment. Therefore, interest is growing in using HIV as well as AIDS data to guide these funding decisions. The current legislation states that cases of HIV disease rather than cases of AIDS will be used in FY 2007. When the CARE Act is reauthorized in 2005, Congress may consider changes to the current formula or additional language specifying how and when HIV data may be incorporated into funding formulas.

This report presents the AIDS case counts reported to CDC through June 30, 2005 that were provided to HRSA in July 2005 (Table 1, AIDS case counts by state; Table 2, AIDS case counts by EMA; Table 3, AIDS case counts for cross-state EMAs). HRSA applies the weights provided by CDC to these counts to determine the proportional distribution of persons living with AIDS.

Ryan White CARE Act Method of Estimating the Number of Persons Living with AIDS

At the end of June each year, AIDS cases reported during the preceding 120 months are aggregated into ten 12-month periods and 10 “survival” weights are applied to the 10 AIDS case counts. For example using the data presented in Table 1, the first year July 1995- June 1996 (i.e., the earliest) count is multiplied by .47. The second year July 1996- June 1997, count is multiplied by .57 and so on for all 10 counts. The summary count (total of these 10 weighted counts), which results from this computational formula, is the estimated number of persons living with AIDS in the EMA or state for purposes of the Ryan White CARE Act funding allocations. The survival weights are updated by CDC according to methods specified in the Act. The weights were most recently updated in July 2005 using data reported to CDC through June 2005.

The legislative authority for the method of estimating the number of persons living with AIDS under Title I is Section 2603(a)(3)(c) of the Ryan White CARE Act. The legislative authority for the Title II estimation of the number of persons living with AIDS is Section 2618(2)(d). The same set of survival weights is used for both Title I and Title II. The 2005 weights are

Year 1 — .47
Year 2 — .57
Year 3 — .64
Year 4 — .67
Year 5 — .73
Year 6 — .75
Year 7 — .80
Year 8 — .84
Year 9 — .88
Year 10 — .93

For each 12-month reporting period, the proportion of persons reported with AIDS and not reported as deceased as of June 30 is (cases minus deaths)/cases. This proportion is the weight for the 12-month period.