Your article on AIDS funding ('The national lottery', 17 June) rightly highlights the variations between the HIV funds received by different regions in England.

Three points exacerbate this. First, there are even wider funding variations between districts within the same regions.

Second, the Department of Health not only failed to correct any of this for 1999-2000, but left allocations to (beyond) the last minute and then simply rolled forward last year's funds (minus inflation).

Third, local health authorities reinforced the uncertainties by pretending they did not know whether they were likely to receive anything at all.

While the NHS causes unnecessary uncertainty for some of the most vulnerable people in society, the real national lottery is awarding three-year funding. Isn't this the wrong way round?

John Nicholson


George House Trust


Mark Bellis and his colleagues quote statistics very selectively in their argument that funding of HIV/AIDS services in England is inequitable. And they choose the wrong target in implying that Kensington & Chelsea and Westminster health authority, which is financially responsible for the treatment of nearly a quarter of all AIDS cases in England, is overfunded at the expense of Manchester HA.

The changing geographical incidence of HIV/AIDS and the development of combination therapy do indeed mean that there is an urgent need both to review the way in which HIV/AIDS funding is distributed and to ensure that all HIV/AIDS patients have access to the same quality of treatment.

But the funding issue is much more complex, both between and within regions, than Mr Bellis implies. For example, the rest of North West region received nearly five times as much per patient treated as Manchester and nearly half as much again as KCW. An equitable funding formula for both HIV/AIDS treatment and care and HIV prevention would actually mean more money, not less, being allocated to KCW.

Indeed, allocating funding pro rata to numbers of patients treated with an appropriate market-forces weighting would mean over£6m more for KCW (and£13m more for Camden and Islington, with the second highest number of cases treated) compared with only£4m more for North West region as a whole (including Manchester).

K A Newitt

Deputy chief executive

Kensington & Chelsea and Westminster HA