Puerto Rico’s HIV/AIDS Community is in Crisis

For over two years HIV/AIDS advocates in Puerto Rico have been voicing their concern, at times gracefully but more recently more vociferously, about the continued mismanagement and alleged misappropriations of Federal funds designated to test, treat and care for the islands HIV/AIDS affected and infected community.

That voice has now been joined by concerned advocates in New York, Washington, DC, Boston, Chicago, Florida and anywhere that decent people have a genuine concern for those suffering administrative injustice and abuse.

The HIV/AIDS Community in Puerto Rico asks;

• Reassurance from Federal authorities (Senate Health, Education, Labor and Pension, Congressional Hispanic Caucus, and/or the Secretary of Health) assuring the HIV/AIDS community in Puerto Rico that the Federal Government will not allow the crisis to continue.

• Immediate intervention in the form of a Federally assigned third party fiduciary agent that can take control of the misappropriated/mismanaged Federal funds and work to accelerate the disbursement of available monies to the service agencies. Currently, services in many places have been disrupted or discontinued.

• A Senate Health Education Labor and Pension (HELP)/Congressional Hispanic Caucus (CHC) committee fact finding visit to PR.

• Senate HELP oversight hearing of Health and Human Services and Health Resources and Services Administration, Puerto Rico Department of Health and the San Juan EMA grantee on the issue of administrative injustice and abuse and the lack of leadership and concern.

• The Department of Health and Human Services/HRSA to conduct a statewide needs analysis and plan of action to respond to the impending HIV/AIDS crisis that will develop as a result of the prolonged mismanagement and alleged misappropriation of Federal funds. Further, an injection of the funds ,via the fiduciary agent , to stem the decline in service delivery, bring infection rates, mortality rates under control and put an end to the AIDS Drug Assistance Program waiting list.

To date the advocates have expressed their views to Puerto Rico’s Governor, Anibal Acevedo Vila and the Mayor of San Juan, Jorge Santini. Also, they have been on held routine conversations with the Aids Task Force and the Puerto Rico Department of Health. These efforts have not produced the desired result.

In September 2006 the advocates began a concerted effort to reach out to the US President, as well as Congressional leaders. They have successfully presented the issues before the following committees;

• Presidents Council on HIV AIDS (PACHA)

• Office of the Secretary of Health and Human Services

• Congressional Hispanic Caucus

• As well as individual Congressional leaders in both parties and in both Houses.

To date, these efforts have produced letters of support for a more affirmative action on the part of Secretary Micheal Leavitt from;

• 17 Members of the Congressional Hispanic Caucus including Health Chair Hilda Solis and CHC Chair Joe Baca as well as Representatives Velazquez, Serrano, Guitierez among others.

• Senator Hillary Clinton, member of the Senate HELP Committee.

• Senator Tom Coburn, MD, member of the Senate HELP Committee.

• And thankfully, a growing base of support from national HIV/AIDS advocacy organizations.

Despite this wide and growing support, the Secretary of Health and Human Services has only responded by offering additional technical assistance to the two administrative agencies that have historically mismanaged or misappropriated the funds.

This is insufficient. It demonstrates a despondent and reluctant response from the very leadership of the premiere organizations tasked with the wellbeing of these HIV/AIDS infected individuals.

Brief History of the HIV/AIDS Crisis in 

Puerto Rico

 Two agencies in Puerto Rico administer 75% (over $54 million) of the Federal funds allocated for the treatment and care of HIV/AIDS. One of these is the Puerto Rico Department of Health (PRDOH), which administers all Ryan White Title II, AIDS Drug Assistance Program (ADAP), US HUD Housing Opportunity for People with AIDS (HOPWA) as well as SAMSHA and CDC Prevention funds. The other is the municipality of San Juan, grantee for the San Juan Eligible Metropolitan Area, that administers the Ryan White Title I funds (and some HOPWA funds) for over 30 municipalities – including, but not limited to, San Juan.

Historically, the deepening HIV/AIDS crisis in Puerto Rico stems from several challenges: these include a) administrative ineffectiveness; b) severe shortage of both qualified personnel and administrative resources (computers, telephones, fax machines, office equipment, etc); c) willful non-compliance by grantees of federal conditions of awards; d) unwillingness or weakness of local and national political leaders to step forward; and e) possible fraudulent practices and/or corruption.

Both the PR DOH and the San Juan EMA suffer from some or all of the above problems, symptoms of a healthcare system in administrative decay.

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