Hundreds of People Living With HIV/AIDS in Puerto Rico Not Receiving Medical Care, Doctors, Advocates Say

Hundreds of people living with HIV/AIDS in Puerto Rico are not receiving needed medical care, some local doctors and advocacy groups have said recently, the New York Times reports. According to the Times, the situation "reflects a stew of problems" on the island, including an overstretched health care budget and contention between the commonwealth and San Juan city governments, which run separate HIV/AIDS programs. Federal officials and some local doctors say that the "main culprit" is the island's mismanagement of funding from the Ryan White Program, the Times reports (Eckholm, New York Times, 6/5).

Puerto Rico receives about $58 million annually under Ryan White. Some clinics in San Juan in March began rationing drugs for hundreds of HIV-positive people after they stopped receiving reimbursements from the program. Ryan White invoices from Puerto Rican health agencies have received extra scrutiny since 2005 because of previous management issues. In addition, FBI agents in December 2006 raided four San Juan government health offices that manage Puerto Rico's Ryan White funds as part of a broader fraud investigation.

According to Maria del Carmen Munoz, director of federal affairs for San Juan, FBI agents conducting the fraud investigation seized documents in the December raid that were needed by the local government to obtain Ryan White reimbursements for the clinics -- a claim that the FBI has denied. Munoz said that Puerto Rican health officials have had to request new invoices from the island's clinics and verify their authenticity. Some patient advocates have said that San Juan city government officials and other agencies are at fault for the funding suspension, saying it is a result of mismanagement and longtime corruption in the program (Kaiser Daily HIV/AIDS Report, 3/9).

The Health Resources and Services Administration, which administers Ryan White funding, repeatedly has called for streamlining Puerto Rico's health care system and sent advisers to the island, Laura Cheever, HRSA deputy associate administrator, said. Local physicians say that it takes months to obtain approval from the island's central government to switch a patient to a new antiretroviral regimen, adding that the new drugs often are not available, the Times reports. The commonwealth health department also often makes errors in antiretroviral distribution, some doctors say. In addition, the commonwealth has not shared the $22 million it receives in AIDS Drug Assistance Program funding, according to Hector Sorentini Mendez, San Juan's health director.

"Antiquated equipment and poor communications" also have contributed to issues associated with the provision of antiretrovirals, the Times reports. An audit by the comptroller of Puerto Rico published in November 2006 found that health department records of drug stocks and deliveries to clinics were significantly deficient. Another report found that four of the eight main HIV/AIDS clinics on the island lacked functioning bathrooms or computers, the Times reports.

Puerto Rico officials say the waiting list for the island's ADAP has decreased from 130 in the fall to 36 and soon will be eliminated. Puerto Rican and mainland groups, including the Congressional Hispanic Caucus, during the past year have called on federal authorities to take an increased role in the situation. Administration officials have said that they proposed transferring San Juan's Ryan White funds to a separate agency that would manage them, adding that Puerto Rico's Mayor Jorge Santini Padilla refused, the Times reports. "In the end," it is "up to them to do the planning, allocations and administration, and what we can do in terms of sanctions is very limited by legislation," Cheever said (New York Times, 6/5).