Update on the Ryan White
CARE Act
by Charles Clifton
Since 1996 there has been
a significant decline in deaths from AIDS. A primary factor
contributing to this decline is the services thousands of
low-to-moderate HIV-positive individuals receive from the
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.
As of June 1998, more than 660,000 men, women and children
have been diagnosed with AIDS in the United States. Of that
number over 400,000 have died of the disease. Current trends
indicate that between 650,000 to 900,000 people in the U.S.
are living with HIV, but do not yet have AIDS, and 40,000
new HIV infections occur each year. The Ryan White CARE Act,
originally enacted in 1990 and reauthorized in 1996, is probably
the single most important piece of federal legislation enacted
affecting the healthcare needs and concerns of people living
with HIV. It will expire on September 30, 2000.
The CARE Act supports a crucial
spectrum of services for persons living with HIV who have
little or no access to some basic healthcare necessities.
These services include—but are not limited to—AIDS
medications (AIDS Drug Assistance Programs, or ADAP), primary
medical care, viral load testing, and food and nutritional
services. As it presently operates, the CARE Act is a collaborative
effort that brings federal, state and local governments to
the same table with persons living with and impacted by HIV
and AIDS, health care providers and not-for-profit community
based organizations. These groups and individuals work together
to ensure that specific local health related needs and concerns
are being addressed. While the current structure of the CARE
Act has successfully improved the quality and quantity of
life for HIV-positive individuals, there is still much to
accomplish.
Statistics released in the
January 14th issue of the CDC’s Morbidity and Mortality
Weekly Report show that men of color now represent the majority
of HIV/AIDS cases among gay and bisexual men, exceeding the
number of cases among white gay and bisexual men for the first
time. The CDC report shows that AIDS cases among men of color
increased from 31% in 1989 to 52% of AIDS cases in 1998. “The
face of AIDS among gay and bisexual men is changing,”
said Helene Gayle, M.D., director of the CDC’s National
Center for HIV, STD and TB Prevention. “African-American
and Hispanic men must recognize that this is not a disease
that only affects white, gay men–gay and bisexual men
of all races are affected.”
Researchers now recognize
that this epidemic has grown disproportionately among communities
of color and difficult to reach populations, including African-Americans,
Latinos, women and youth. The CDC report also cites several
possible economic factors contributing to the disproportionate
grown of HIV and AIDS in communities of color, such as high
rates of poverty, unemployment and a lack of access to adequate
health care. In 1998, 60% of the 500,000 individuals who received
primary medical care and support services provided by the
CARE Act were people of color.
Significant inroads have occurred
to reduce inpatient care costs and increase healthcare access
for underserved populations, by provisions established by
the Ryan White CARE Act. However, much work remains to be
done. The CARE Act must be reauthorized in 2000 for many reasons.
HIV/AIDS care continues to grow more complex and people live
longer. As a result the cost of HIV care, drug therapy assistance
and case management threatens to cripple local and state health
care systems. To ensure that health care and support services
as established by the CARE Act can continue to meet the growing
needs of individuals living with HIV/AIDS and communities
disproportionately impacted by the disease, funding must be
increased for every part of the Ryan White CARE Act.
As programs and services established
under the Ryan White CARE Act take center stage in Washington
during this election year, this piece of federal legislation
in all likelihood will be one of the most important debates
on Capitol Hill affecting the lives of HIV–positive people.
Early indications show reauthorization will not be an easy
process. Some members of Congress are in favor of radically
reducing the delivery of services under the CARE Act. Additional
information on the CARE Act, the reauthorization process and
congressional opposition can be obtained from the following
web sites:
AIDS Action–http://www.aidsaction.org
and NASTAD–http://www.nastad.org
However there is something
you can do NOW. Please take time to write a short, handwritten
personal letter. You can write something along the lines of
the one on this page. Urge your Senators and U.S. Representatives
to support swift reauthorization of the Ryan White CARE Act.
The services provided under
the Ryan White CARE Act continue to make it possible for thousands
of Americans with HIV and AIDS access appropriate care and
treatment services, resulting in more productive lives. This
access is threatened if reauthorization is blocked in Congress.
It is imperative that your representative is made aware that
you understand how important these services are for HIV-positive
people and that you appreciate his/her continued support for
the Ryan White CARE Act.
(Thank you to David Ernesto
Munar, Director of Public Policy, AIDS Foundation of Chicago,
for information and suggestions used in this update.)
Charles Clifton is the
director the MOCHA 2000 project for Test Positive Aware Network,
the publisher of Positively Aware. The MOCHA (Men of Color
HIV/AIDS) 2000 project is a collaborative effort among several
Chicago HIV service organizations and the Chicago Department
of Public Health seeking to identify and provide prevention
efforts in communities of color.
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