MONTGOMERY, Ala. (AP) – Southerners living with HIV or AIDS are not being shortchanged in the distribution of federal funds, as many in the region claim, and in some cases even get more money than those in large cities hit hardest by the initial outbreak, a new analysis says.

Southern AIDS advocates, however, strongly disagree with the findings of the Washington-D.C. based Communities Advocating Emergency AIDS Relief Coalition, saying it’s undermining efforts to secure more funds for the South, where about 45 percent of new cases occur.

At issue is the 1990 Ryan White CARE Act, which provides about $2 billion annually and is the main source of federal HIV/AIDS funding. Congress has been reviewing the act for the past few weeks, with Southern advocates calling for major changes that would route more funds to the region – but other states are resisting for fear of losing millions they’ve come to depend on.

The law expired in September and any reauthorization this year would be its first since 2000.

An April 26 report by the Government Accountability Office found that some states with urban areas receive more funds because of quirks that double-count AIDS patients in 51 Eligible Metropolitan Areas – or EMAs – and in some cases count dead patients.

The GAO found that California patients received $5,264 in 2004, compared with $3,657 for a patient in Alabama. But according to the analysis in the CAEAR report, Alabama received $5,778 that year compared to the national funding rate of $4,475.

CAEAR Coalition board member Jeff Graham says the problem with the GAO study and others done in the past is that they only look at funding from Title 1 and Title 2 of the CARE Act. Most Southern states aren’t eligible for Title 1 money because they don’t have EMAs – cities with 500,000 or more people.

The CAEAR study combined funding from all parts of the CARE Act, which includes areas such as early intervention and assistance to women and children. When that’s done, the disparity between the regions isn’t so great, Graham said.

Coalition officials also say funding to some in the South may be greater than to those in large cities, depending on the way the number of HIV/AIDS cases are counted in those states.

“What’s to be gained by this is to get the correct information out there in this public debate about reauthorization,” Graham said. “It’s to draw the focus to really what is the greatest issue, which is five years of funding cuts.”

AIDS Alabama unleashed a scathing response to the CAEAR Coalition’s report, with CEO Kathie Hiers calling it “politically driven rhetoric.”

Hiers, who is also co-chair of the Southern AIDS Coalition, said she took the study as an attempt to incite a battle between big cities and small states.

Lawmakers from both sides of the debate have been active about the issue of late, with representatives from California, New York and New Jersey speaking out against reauthorization at a recent House Energy and Commerce health subcommittee hearing.

Meanwhile, Alabama Senator Jeff Sessions joined Oklahoma Senator Tom Coburn and North Carolina’s Richard Burr in calling for major changes in the law.

Evelyn Foust, director of the HIV/AIDS Division at the North Carolina Department of Health and Human Services, said advocates from the South aren’t looking at rerouting money from Title 1 states as the best solution.

“My position has been that we should work together to get significant new dollars,” she said. “If there is no new money, then I think we have no choice but to ask them for a redirection of current funds to people who have more need. … I think you have to look at the greater good here.”

Hiers said she understands the position of the CAEAR Coalition, which represents mostly big cities, and would probably take the same stance if she were in their shoes.

“They don’t want to lose any money. Everybody’s built these funding structures on the Ryan White Act and they don’t want to lose money. But I wouldn’t be a true advocate for the people of my state if I didn’t fight to get them help,” she said.

John Paul Womble, development director of the Raleigh-based Alliance of AIDS Services-Carolina, says it’s difficult to think of there being a battle between regions when everybody’s underfunded, but that’s the reality of the situation.

“I think the whole notion of us fighting is absurd until I think about how hard it is here,” said Womble, who was diagnosed with HIV 14 years ago. “It’s sort of a dog-eat-dog fight.

“It was so aggravating to have this discussion between the North vs. the South, until the moment that I realized when I lived in Chicago and lived in Miami it was really easy getting services for clients.”