Washington's Response to the AIDS Epidemic: The Ryan White CARE Act

Passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 followed a form familiar to students of policymaking in the American intergovernmental system: the provision of significant federal financing for policy initiatives located primarily at the state and local levels. The successes and failures of the Act, including its 1996 reauthorization, suggest both the strengths and the limitations of that design. This paper examines the structure of the Act as a vehicle for the federal government to fund AIDS service delivery at the state and local levels and the intergovernmental consequences of allocation policies associated with the Act. It concludes that perennial problems of equity and access cannot be resolved by the delegation of responsibility for significant policy or funding decisions to localities; rather, questions about the role of the federal government in overcoming intralocal and interlocal disparities remain to be addressed.     

Ryan White CARE Act Title I Funding Priorities and Unmet Service Needs in Baltimore, Maryland

The analysis presented in this paper explores the similarities and differences between the services selected as priorities for funding by the Baltimore Ryan White CARE Act Title I Planning Council during the first 2 years of the program in this metropolitan area, and services perceived by HIV/AIDS service providers and people living with HIV/AIDS to be unmet needs. The data used for these analyses were collected as part of a study to assess the implementation and impact of the CARE Act legislation in the Baltimore eligible metropolitan area( EMS ). This project includes three interrelated components: (a) a case study of the legislatively mandated Planning Council, (b) a survey of providers representing HIV/AIDS service organizations, and (c) a qualitative field study of the perceptions of people living with HIV/AIDS about the service delivery system. Taken together, the data from these three sources describe the similarities and differences among these three groups involved in HIV/AIDS care in Baltimore, in terms of their perceptions of services needed by people living with HIV / AIDS. The conclusions drawn from this study can be used to strengthen needs assessments in Title I-EMAs throughout the United States.     

Women With AIDS: Will It Change aids Service Organizations?

In the early 1980s, gay men formed AIDS service organizations (ASOs) in areas hardest hit by the disease, such as San Francisco and New York City, to provide assistance to infected members of their own communities. The Ryan White CARE Act of 1990 made funds available for community-based groups, such as ASOs, to provide support services to all people with HIV/AIDS. The epidemiology of AIDS has changed greatly in recent years, and increasing numbers of poor, minority women with children now contract HIV/AIDS. To determine if ASOs are in compliance with the CARE Act, this study surveyed 20 ASOs across the country and a number of their female clients to see if ASOs, some of which were started by gay men, have tailored their services for a growing minority, heterosexual population. The results indicate that a number of ASOs have been slow in responding to the diverse needs of women. Recommendations are offered to make the organizations more responsive.     

Impact of the Ryan White CARE Act on the Availability of HIV/AIDS Services

This article assesses the extent to which the availability of HIV/AIDS services in the Baltimore and Oakland eligible metropolitan areas (EMAs) increased after receipt of funding under Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Survey data on the availability of HIV/AIDS services in each EMA were collected from samples of organizations at two points in time: 1 year before (1991) and 1 year after (1993) the Oakland and Baltimore EMAs received their first installments of CARE Act Title I funds. Cross-sectional and longitudinal analyses of the data were performed to assess changes in the availability of HIV/AIDS services. The results showed that after CARE Act Title I funding became available, the availability of ambulatory medical and social support services in the Baltimore and Oakland EMAs increased. However, the way service availability increased varied significantly, reflecting differing opportunities and constraints present in each community. In Baltimore, the increase in the availability of HIV/AIDS services was due largely to the creation of new organizations that used Title I funds to provide services (system expansion). In Oakland, relatively few new organizations were created, but existing organizations added new HIV/AIDS services (service line expansion). Our data also indicated that in both EMAs the majority of HIV/AIDS organizations receiving Title I funds expanded the capacity of their existing services to meet growing demand.     

Land Recycling, Community Revitalization, and Distributive Politics: An Analysis of EPA Brownfields Program Support

This article examines social, economic, and political factors influencing the distribution of resources to local governments under the EPA Brownfields Program, an innovative federal effort to encourage the remediation and redevelopment of contaminated properties. Signed into law in 2002, the Small Business Liability Relief and Brownfields Revitalization Act provided the program with a congressional mandate, new tools to promote reuse such as liability protections, and increased funding up to a level of $250 million per year. This article contributes to research on environmental regulatory reform with an analysis of successful and unsuccessful local government applicants for EPA Brownfields Program support between 2003 and 2007. Building on prior research, we develop a series of expectations and an empirical model, and estimate the influence of program priorities, government and civic capacity, interest group pressures, and institutional politics. Results point to significant relationships between program priorities and award patterns. Contrary both to EPA's explicit commitments to equity and to analysis of pre-2003 award patterns, however, we find negative correlations between the proportions of local populations that are nonwhite or low-income and the likelihood of receiving an award. In addition, better-resourced governments and several dimensions of political representation show strong associations with the likelihood of winning awards. We conclude by discussing implications.     

The Limited Effects of Federal Environmental Justice Policy on State Enforcement

The federal government adopted several measures during the mid-1990s to address concerns about race-based and class-based disparities in environmental protection. This article examines whether these measures affected the pattern of state enforcement of three federal pollution control laws. Using differences-in-differences models to estimate the effects of the federal policy adoption, I find evidence of increases in state enforcement of the Clean Air Act in large African-American communities, but declines in enforcement in communities with large poor and Hispanic populations. Similarly, there is evidence that state enforcement of the Clean Water Act decreased in poor and African-American communities, but there were no real changes in enforcement of facilities regulated under the Resource Conservation and Recovery Act. Collectively, the analysis suggests that the federal policy had minimal positive effects on state regulatory enforcement.     

The White House and Congress on Child Care and Family Leave Policy: From Carter to Clinton

Over the last two decades four presidents produced a variety of family policy initiatives with mixed results. Carter issued his nine-point plan on the family and convened the first White House Conference on Families in American history. Reagan created the White House Working Group on the Family and issued Executive Order 12606, which established family impact statements. George Bush continued many of Reagan's policies and pushed family values to near the top of the political agenda by 1992, and Bill Clinton set forth his eight-point plan on the family and moved quickly to reverse many of the policies of the Reagan-Bush era. Discussed is the role of the White House and Congress in shaping two family policy initiatives in particular: The Child Care and Development Block Grant of 1990 and the Family and Medical Leave Act of 1993.     

Federal Aid and Rural County Highway Spending: A Review of the 1980

The Reagan/Bush Administrations cut back federal support for state and local governments during the 1980s, causing total real resources available to finance local roads and bridges to increase very slowly between 1977 and 1989. The effect of federal aid on spending for infrastructure has been subject to debate for many years. Some studies have indicated that federal aid is stimulative, while others report that federal aid substitutes for local resources. This article examines the effect of state and federal aid on county highway spending. The analysis demonstrates that, in 1987, federal aid was stimulative but state aid was not. In light of changes brought about by the Surface Transportation Efficiency Act of 1991 (ISTEA), we can expect federal aid to have a stronger relationship with local highway spending.     

Performance Goal Achievement in Fiscal Federalism: The Influence of State Partisan Environments and Regulatory Regimes

With tight budgets and hyper‐partisan interactions within and between the states and federal government, attention is being paid to the implementation of federal programs. This is particularly important because, as the recently implemented American Recovery and Reinvestment Act suggests, state administrators are often the implementers of federal policy. This study integrates the fiscal federalism literature with that on implementation and bureaucratic response to examine the effect that within‐state factors have on the degree of performance goal achievement in federally funded, state implemented programs. The findings suggest that, when implementing federal programs, state administrators face conflicting political incentive structures and policy‐specific capacity and capability deficits that influence their motivation and ability to achieve performance goals.     

Mixed messages & bounded rationality: The perverse consequences of real ID for immigration policy

Policies concerning undocumented immigrants are inevitably ambivalent, creating uncertainty and confusion in the implementation process. We identify a clear example of this ambivalence —U.S. law setting standards for determining the credibility of asylum seekers—that resulted in an increase in asylum grants despite policymakers' intention to make it harder for individuals to obtain the status. We argue that this law, The REAL ID Act of 2005, sent mixed messages to immigration judges (IJs), street-level bureaucrats who implement immigration policy. It increased IJ discretion, but set vague limits. We theorize that IJs, behaving in a bounded rationality framework, use their professional legal training as a short-cut and look primarily to the courts for guidance. Our evidence supports our argument. After the passage of the REAL ID Act, IJ decision-making is more closely aligned with the preferences of their political and legal principals, and, in the final score, the federal circuit courts are the winners.     

Forging Creative Partnerships

While much public attention focuses on the impact of immigration policy at the national level or in major metropolitan areas, the realities of political policy regarding refugees and immigrant populations are also felt in smaller, more rural communities as well. Local decisionmakers increasingly face new community needs at a time when mandated programs are being shifted as federal responsibility changes. This article recounts the work of a unique, ongoing collaborative effort that began in 1996 establishing a partnership between health care and public safety services in support of low-income and immigrant populations in the city of Portland, Maine. The project seeks to address two of the most pressing problems associated with immigrant populations: preventive medical care and the reduction of neighborhood violence. The project is predicated on the belief that community building works best when all residents are stakeholders in a vision that includes strong schools, safe neighborhoods, and healthy families. The elements of the Portland experience in service provision are recounted for other state and local policymakers in forging new and collaborative working relationships among service providers and government agencies     

Toronto's Health Department in action: influenza in 1918 and SARS in 2003

This article compares the Toronto Health Department's role in controlling the 1918 influenza epidemic with its activities during the SARS outbreak in 2003 and concludes that local health departments are the foundation for successful disease containment, provided that there is effective coordination, communication, and capacity. In 1918, Toronto's MOH Charles Hastings was the acknowledged leader of efforts to contain the disease, care for the sick, and develop an effective vaccine, because neither a federal health department nor an international body like WHO existed. During the SARS outbreak, Hastings's successor, Sheela Basrur, discovered that nearly a decade of underfunding and new policy foci such as health promotion had left the department vulnerable when faced with a potential epidemic. Lack of cooperation by provincial and federal authorities added further difficulties to the challenge of organizing contact tracing, quarantine, and isolation for suspected and probable cases and providing information and reassurance to the multi-ethnic population. With growing concern about a flu pandemic, the lessons of the past provide a foundation for future communicable disease control activities.     

PERSPECTIVES ON THE SAGEBRUSH REBELLION

The Sagebrush Rebellion began in the late 1970s with the objective of transferring various categories of federally owned lands to the states. The movement was centered in western “public lands” states, where nearly half the total land area is in federal ownership. Within a relatively short period of time this objective was changed to one of “privatizing” federal lands, of selling these land into private ownership. While the Sagebrush Rebellion has been highly political in its activities, the movement can be viewed in the perspective of historical land disposition policies in the U.S. These policies were changed near the turn of the century from alienating public lands into private ownership to their retention and management by the federal government. Confusion over the economics of building a free enterprise system based on private property rights, and the costs associated with building such as system, appear to have been major factors in changing land policies. Two important aras in which this occurred were the Homestead Act of 1862 and timber. The provisions of the Homestead Act imposed heavy costs on settlers, and these costs caused a reaction against the economic system that was being built.     

THE ART OF NEOLIBERALIZING PARK MANAGEMENT: COMMODIFICATION,POLITICS AND HOTEL CONSTRUCTION IN PALLASYLLÄSTUNTURI NATIONAL PARK,FINLAND

Following the growth of nature‐based tourism, national parks and other protected areas have become important tourist attractions. This article examines the legislative process of revising the Act on Pallas‐Yllästunturi National Park, located in northern Finland, to enable the renovation and enlargement of the old hotel. The first draft of the government bill published in 2008 led to widespread public opposition, and thus, construction rights were reduced substantially before the new Act was passed in 2010. The main question of this article is why the Finnish government changed its policy on national park governance that had existed for decades. We assess the extent to which the changes in park governance can be interpreted as part of the worldwide neoliberalization of nature, as well as what kind of forces and values work against neoliberal management ideologies. We examine how the process of revising the Act proceeded in the Parliament and analyse on what grounds the hotel construction was defended and opposed in the discussions. Finally we ponder how the political disagreements are explained by neoliberal frames. We conclude that the neoliberal element was one part of the process, but it intertwined with local political reality creating results hardly resembling textbook definitions of neoliberal or classic liberal ideals. Mixed ideological principles, contextual economic conditions, and complex dependencies between individual actors create cases which must be analysed carefully to find out if neoliberal elements really exist and how they are transformed. Close relations between economic and political actors and creation of economic monopolies should raise doubts if vocabulary of liberalization is just a disguise of actions supporting hidden political and economic interests.     

Spatial Diffusion of the HIV/AIDS Epidemic: Modeling Implications and Case Study of AIDS Incidence in Ohio

This paper extends a compartmental epidemiological model for HIV transmission and AIDS incidence to include hierarchical and expansion spatial diffusion. An implication of the resultant model is that hierarchical diffusion causes the large infection growth rates of densely populated areas at the top of the central places hierarchy to “chain” down and dominate small local growth rates during the exponential-growth phase of the epidemic. Also, hierarchical diffusion causes a high transient growth rate in the first few years of a local epidemic. The spatial compartmental model fits observed AIDS incidence spatial diffusion patterns in Ohio reasonably well.     

Securitising HIV/AIDS in the Xinjiang Uyghur Autonomous Region

For the People's Republic of China, the localised HIV/AIDS epidemics in the Xinjiang Uyghur Autonomous Region are emerging as threats to those persons affected by the disease, but also to the stability of Xinjiang. This article examines the HIV/AIDS epidemic in Xinjiang and considers the impacts it may have on human and political security. The authors argue that due to its remote location and the religious, cultural and ethnic diversity of its population, and current political situation, Xinjiang poses difficult obstacles to effective programs in tackling HIV/AIDS, and the pandemic has disproportionately affected the minority nationalities in the region compared to their Han counterparts. If the HIV/AIDS pandemic among minority nationalities in Xinjiang continues to grow, it has the potential to further weaken social cohesion there, as well as Uyghur human security. Therefore, a HIV/AIDS pandemic in Xinjiang could tip the balance in terms of ethnic and regional stability.     

Geographic earnings inequality by race, 1960–2016

Geographic inequality and racial disharmony are considered major factors in America's political divergence. This paper calculates geographic earnings inequality from 1960 to 2016 separately by race. From 2000 to 2016, White geographic inequality was significantly higher, and Hispanic geographic inequality was significantly lower, than Black and Asian geographic inequality. White geographic inequality rose from 1980 to 2008. Black and Hispanic geographic inequality fell from 1960 to 1980. Rural controls explain substantial shares of White geographic inequality in all years. Region and rural controls account for large shares of Black geographic inequality, especially from 1960 to 1990. Post-1990, geographic inequality changes are largely explained by changes in overall earnings inequality, but 1960–1990 changes are not. Between-race differences in geographic inequality translate into high-income metropolitan statistical areas having had, since 1980, significantly smaller shares of Whites among their low-income residents.     

Alternatives to the “New Urban Politics”: finding locality and autonomy in local economic development

The New Urban Politics (or NUP) of local economic development has become one of the dominant themes in urban political economy in the last twenty years. But despite the volume of research this has generated, basic problems remain in the theories that underlie this academic and political work. This paper begins with a discussion of the understandings of the central concepts of locality and autonomy in the NUP. These understandings of locality and autonomy are then criticized for failing to recognize the relational and processual character of both of these constructs. Local autonomy is then retheorized as the capacity to control the production of place. In particular, the paper focuses on groups constructing institutions and relationships of local ownership. These organizations, it is argued, have combined the goals of local autonomy and local economic development, and in so doing have produced new localities in the places in which they are organizing.