In 2005 there were nearly 30,000 people living with HIV/AIDS in Puerto Rico,¹ giving it the fifth-highest concentration of HIV/AIDS cases in the United States.  At least 12,000 of these people were receiving antiretroviral treatment,² many through government funded programs, like those funded by the Ryan White Care Act.   However, earlier this month the New York Times reported that due to mismanagement of funds,  hundreds of HIV-positive individuals in Puerto Rico have recently lost access to antiretroviral treatment for weeks at a time, often endangering their already fragile health. 

HIV/AIDS treatment can cost more than $25,000 a year per person and Puerto Rico’s health care resources are already overstretched.  The Times reports that while poorer states on the mainland receive up to 75% of their Medicaid money from the federal government, Puerto Rico receives just 13%.³  The government is responsible for making up the difference⁴.  This leaves the local government strapped in providing for low-income AIDS patients.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was enacted in 1990 and sought to improve the quality and availability of care for individuals and families affected by HIV/AIDS.  Ryan White CARE provides funding to states, territories, and other public and private nonprofit entities to develop, organize, coordinate, and operate treatment programs more effectively.  Under this program, Puerto Rico receives about $58 million a year.⁵

Two agencies are responsible for administering these funds, the Puerto Rico Department of Health (PR DOH) and the municipality of San Juan. Both have been accused of administrative ineffectiveness, severe shortages of personnel and resources, as well as possible corruption and fraud.⁶  According to the Times, this disorganization has lead to a loss of over $6.5 million over the last five years, because the funds failed to be used or had to be returned due to misuse. For example, a recent National Minority AIDS Council (NMAC) report states that in 2005, “an Office of the US Inspector General report detailed a series of incidents around the ‘misuse’ of funds that made it necessary…to require the PR DOH to return over $1.5 million to the Federal government.”⁷  

In addition, the Times states that local physicians say it takes months to obtain approval from the island’s central government to switch patients to a different antiretroviral program. The Health Resources and Services Administration, which administers Ryan White funding, has repeatedly called for streamlining Puerto Rico’s health care system. 

Beginning in May some clinics had to start rationing out drugs for their patients because they were unable to receive reimbursements under Ryan White.  Patients themselves must often wait six months before receiving reimbursements for their prescriptions.  Some clinics have also scaled back their hours and staff levels.⁸  The Times detailed the experience of Rolando Warren Gonzalez, who, in the last year, suffered six two-week periods with no drugs, undercutting the benefits of the program and endangering his health.  The NMAC report also profiled several people affected by the AIDS crisis on the island, including a government employee named Samuel who stated that, “many of the clinics and offices operated by his agency do not have electricity, telephones or even running water.”⁹

One doctor explained that, “the state of HIV treatment here is a catastrophe,” and that he knew of at least 75 people who were unable to obtain their necessary prescriptions for up to a month.¹⁰  Hector Figueroa, the director of a drug treatment program in Caguas, said that patients sometimes only receive 15 days worth of medicine per month.¹¹

According to the Times and NMAC, stories like these are repeated across this U.S. territory, and hundreds of HIV-positive individuals are not receiving vital medical care.  Senators Coburn (R-OK) and Clinton (D-NY) have both written letters to Michael Leavitt, Secretary of Health and Human Services stating their concerns about the administration of the federal program.  Most recently, Representative Velázquez (D-NY) introduced H.R. 2736, the HIV Emergency Local Partnership Act of 2007 on June 15, 2007.  This bill would increase the federal government’s funding of Puerto Rico’s Medicaid budget and increase the Ryan White grant budget by an additional 50 million dollars.¹²  The bill is cosponsored by Fortuño (R-Puerto Rico), Serrano (D-NY), and Solis (D-CA).

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