WASHINGTON (AP) – It began as a big-city epidemic infecting mostly gay, white men, but AIDS is now widespread in the South and among minorities. And the federal law that helps the neediest HIV/AIDS patients hasn’t kept up with those changes.

By some measures, AIDS patients in California and the Northeast get more money per capita than those in the South, and now Southern activists are lobbying for a bigger share.

The dispute, with hundreds of millions of dollars at stake, underpins the first congressional attempt since 2000 to amend the Ryan White CARE Act of 1990, named for the Indiana teenager who died that year after contracting AIDS from treatments for hemophilia.

“We haven’t seen the money shifting with the epidemic. I don’t believe a person should be punished because of where they live geographically, and that’s what’s happening,” said Kathie Hiers, head of AIDS Alabama.

City-rural funding disparities have been exaggerated, counters Phil Curtis of AIDS Project Los Angeles. To Curtis, “This remains largely an urban epidemic.”

The Ryan White CARE Act sends about $2 billion a year to local and state programs that give health care, drugs and other assistance to people who are uninsured or need help on top of Medicaid or private insurance. The services it funds reach over 500,000 people per year, making it the largest federal program specifically for people with HIV.

“It’s served as a lifeline to so many people with HIV who would not have gotten services elsewhere,” said Jennifer Kates, HIV policy director at the Kaiser Family Foundation.

The law gives money to states as well as to 51 “eligible metropolitan areas” with concentrations of AIDS patients. A study by the Government Accountability Office last year found that states with “eligible metropolitan areas” get more money than those without, because patients in the eligible areas are essentially double-counted. A separate peculiarity of the law overwhelmingly benefits San Francisco by including dead patients in formula counts.

Southern states, the Bush administration and others want to eliminate those quirks.

Depending on how the changes are made, California and New York stand to lose about $20 million each, while Southern states could gain millions. Activists from the big states are hoping lawmakers will find a way to add more money for all regions.

“I think the issue is how do we get those areas of the country up to a level that they can offer the same resources, without diminishing the resources available in the most impacted areas of the United States,” said Michael Montgomery, chief of California’s Office of AIDS.

There are more than 1 million people in the United States with HIV/AIDS, and they are living longer because of improved drug regimens. New York and California are home to the most AIDS patients.

But when the disease is measured by cases per 100,000 residents, California is no longer even in the top 10. Several smaller Southern states are, including Louisiana and Georgia.

And minorities account for a growing proportion of AIDS cases. Nearly 50 percent of new AIDS patients are black, compared to 30 percent who are white and 20 percent who are Hispanic, according to the Kaiser Family Foundation.

The GAO study found that the way money is distributed under the main two sections of the law has led to great disparities in per-patient spending. For example, researchers said, in 2004 a patient in California received $5,264, compared to $3,657 for a patient in Alabama.

“New York and San Francisco get all the funding. Birmingham’s a little city and we hardly get anything. That’s not fair,” complained Richard Williams, 32, an HIV-positive Birmingham resident who uses Ryan White funds to help pay for his medications.

Activists and lawmakers in California and the Northeast dispute that, saying it leaves out spending under smaller sections of the law and ignores factors such as quality of care and cost of living.

“Big cities have more cases,” said Richard Eastman, 52, of Los Angeles, who was diagnosed with HIV in 1994. “Sure, maybe some little town in Biloxi, Miss., or something might have 50 or 100 cases, but Los Angeles has 57,000 people in the system that we know about.”

Aides to the lawmakers who lead the House and Senate health committees are negotiating a rewrite of the law that they hope to complete this spring. They say they are seeking a way to distribute money more fairly without subjecting any jurisdiction to a sudden loss of funds.

Senate aides said there’s agreement on some changes, including softening a requirement that states begin counting people with the HIV virus – not just those who’ve become sick with AIDS – by 2007. That’s been complicated because some states, including Massachusetts, still count HIV cases using codes instead of names, which the federal government has refused to accept.

The new bill is expected to create a phase-in period past 2007 for the HIV counts.