Treatment was largely for AIDS-related health issues. Many PLWHA received in-patient medical care. ORIGINAL INTENT AND THE RYAN WHITE PROGRAM TODAYīefore the advent of effective combination antiretroviral therapy in the mid-1990s, HIV usually resulted in highly morbid conditions. Public and private organizations serving PLWHA Part F special projects of national significance National, regional education, and training centers Part F AIDS Education and Training CentersĮducation and training of health providers caring for PLWHA 7Ĭore medical services (case management, treatment adherence, outpatient and ambulatory health services, etc.), related support servicesĬity health departments, AIDS service organizations in cities with at least 1000 reported AIDS casesĮarly intervention services, primary careģ50 federally qualified health centers, AIDS service organizations, hospitals 4 Three quarters of a million people are tested for HIV and given risk reduction counseling at Part C providers each year ( Table 1). 4 Part C providers include federally qualified community health centers, AIDS service organizations, family planning agencies, and hospitals. Part C directly funds 350 health care providers, supporting a comprehensive continuum of health care and support services, including outpatient and ambulatory health services, case management and risk reduction counseling (known as early intervention services), medications, medical nutrition therapy, and treatment adherence. 4 Much of this funding is reallocated to local providers, including AIDS service organizations. Most RWP funding goes directly to city and state health departments (Parts A and B, respectively). 4įederal funding for HIV/AIDS care by program in billions of dollars: fiscal year 2012. 6 Two thirds are poor, and three quarters are a racial/ethnic minority ( Figure 1). 6 More than half a million people receive at least 1 medical, health, or related support service each year through the RWP. The RWP’s AIDS Drug Assistance Program provides medication support to 46% of Americans on antiretroviral treatment. 3,4 As a “payer of last resort,” the RWP “fill the gaps for those who have no other source of coverage or face coverage limits.” 5 RWP funding supports the core capacity of community-based providers to offer an integrated care model, including primary medical care, behavioral health, legal assistance, and housing support. Initially funded at $220.0 million, by FY2011 the RWP received $2.3 billion. The Ryan White CARE (Comprehensive AIDS Resources Emergency) Act was passed in fiscal year 1990 (FY1990) to fund community-based HIV care and support services for low-income, uninsured, and underinsured people. To understand the complex and conflicting situation that PLWHA and communities affected by HIV/AIDS are experiencing in 2015, we first have to understand the origins of the RWP. will continue to be necessary after the is implemented. Therefore, the Ryan White HIV/AIDS Program.
Gaps in essential care and services for people living with HIV will continue to need to be addressed along with the unique biological, psychological and social effects of living with HIV. However, as President Obama’s 2010 National HIV/AIDS Strategy stated,
Because the ACA expands health care access and provides protections for PLWHA, some have questioned whether we are witnessing the end of the RWP 1 and whether it will be needed in the future. Critical elements of the Patient Protection and Affordable Care Act ( Pub. The 2009 reauthorization of the Ryan White HIV/AIDS Program (RWP) expired September 30, 2013, although it continues to be funded. The uneven implementation of health care reform-especially in the South, which is largely refusing to expand Medicaid eligibility-will further exacerbate racial and regional disparities in health care access and outcomes. Although the country as a whole is witnessing the largest insurance expansion in half a century, the key source of health care access for PLWHA for nearly a quarter century hangs in the balance. The current period is one of promise and hope as well as uncertainty for people living with HIV/AIDS (PLWHA) in the United States.
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