HIV/AIDS in the United States: 2008-2010

While the Federal government's investment in treatment and research is helping people with HIV/AIDS live longer and more productive lives, HIV continues to spread at a staggering national rate. The latest incidence data from the Centers for Disease Control and Prevention (CDC) estimates nationally there were 48,100 new HIV infections in 2009. The following HIV/AIDS statistics only represent a portion of the epidemic in the U.S. -- those cases in states and dependent areas with confidential name-based reporting that have been both confirmed through testing and reported. The CDC estimates that 21% of all persons living with HIV are unaware of their status.

Reported AIDS Casesⁱ

Demographic Trendsⁱⁱ

The HIV/AIDS epidemic disproportionately affects those at risk from social factors such as disparity and discrimination. The following demographic numbers are 2008 year end estimates from the 2009 CDC Surveillance Report of forty-five states and dependent areas with confidential name-based reporting.

Fiscal Year 2010 Funding for HIV/AIDS in the U.S.

At-a-Glance

Prevention

The Centers for Disease Control and Prevention was provided $799,300,000 for HIV prevention programs in 2010. These funds were allocated to state and local health departments and community-based organizations to finance counseling, testing programs, health education/risk reduction activities, and surveillance/monitoring programs.ⁱⁱⁱ

Ryan White CARE Act

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, enacted in 1990 and reauthorized in 1996, 2000, 2006, and 2009 is the centerpiece of the federal government's efforts to improve the quality and availability of care for medically underserved individuals and families affected by HIV/AIDS. The CARE Act, administered by the HIV/AIDS Bureau of the Health Resources and Services Administration, provides funding to states, territories, and other public and private nonprofit entities to develop, organize, coordinate, and operate more effective and cost-efficient systems for the delivery of essential health care and support services to people living with HIV/AIDS and their families.

• Part A -- Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAS): Part A provides funding to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs), areas that are disproportionately affected by the HIV epidemic. To be considered EMAs, metropolitan areas must have more than 2,000 cumulative AIDS cases over the last five-years and a population of 50,000 or more. Cities are considered TGAs if they have at least 1,000, but not more than 1,999, cumulative AIDS cases in the last five years, and a population of 50,000 or more.

  In FY 2010, the United States allocated $678,100,000 in Part A funding.^iv

  • EMAs: Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Ft. Lauderdale, Houston, Los Angeles, Miami, Nassau-Suffolk, New Orleans, New York, Newark, New Haven, Orlando, Philadelphia, Phoenix, San Diego, San Francisco, San Juan, Tampa-St. Petersburg, Washington D.C., and West Palm Beach.
  • TGAs: Baton Rouge, Bergen-Passaic, Caugus, Charlotte-Gastonia, Cleveland, Denver, Dutchess County, Ft. Worth, Hartford, Indianapolis, Jacksonville, Jersey City, Kansas City, Las Vegas, Memphis, Middlesex-Somerset-Hunterdon, Minneapolis-St. Paul, Nashville, Norfolk, Oakland, Orange County, Ponce, Portland, Riverside-San Bernardino, Sacramento, St. Louis, San Antonio, San Jose, Santa Rosa, Seattle, St. Louis, Vineland-Millville-Bridgeton.
• Part B -- States and Territories: Part B helps state health departments improve the quality, availability, and organization of HIV health care and support services. In additional to base grant, Part B funds support the AIDS Drug Assistance Program (ADAP) which provides medications to individuals with low income, the Minority AIDS Initiative (MAI), and Supplemental Grants for Emerging Communities (EC), cities reporting between 500 and 1,999 cumulative AIDS cases in the past five years.

  In FY 2010, the U.S. allocated $1,276,800,000 in Part B funds, which included $418,800,000 for CARE and $858,000,000 for ADAP.^v

• Part C -- Early Intervention Services: Part C supports competitive grants to provide medical treatment and medical support services for people living with HIV including HIV testing, early intervention services, risk reduction counseling, case management, outreach, oral health, nutrition, and mental health services. Part C supports Early Intervention Services (EIS) grants that provide services for HIV positive individuals with low income who are uninsured or underinsured as well as grants for planning and capacity building to help rural or underserved communities develop high-quality HIV primary care. In FY 2010, the U.S. provided $206,400,000 in Part C funds.^vi
• Part D -- Capacity Building and Women, Infants, Children, Youth and Their Families: Part D focuses on the operation and development of primary care systems and social services for women and youth, who represent a growing share of the epidemic. In FY 2010, the U.S. provided $77,600,000 in Part D funds.^vii
• Other CARE Act Funding Programs:

  AIDS Education and Training Centers (AETC) Program: AETCs provide training, consultation, and information to HIV health care providers through a network of 1 international center; 5 national centers; 11 regional centers, each of which serves between two and ten states and/or territories; and over 130 local performance sites across all 50 states, the District of Columbia, and the U.S. territories. Funding is allocated to each of the 17 national and regional centers, which then distribute resources to local performance sites in each state. Note that international, national, and local AETC programs may receive funding from HRSA through non-Ryan White grants.

  Total Ryan White AETC Funding^viii: $34,700,000

  AETCs^ix

  International:

  International Training and Education Center for Health (I-TECH)
  901 Boren Avenue, Suite 1100
  Seattle, WA, 98104-3508
  Email: info@go2itech.org
  Phone: 206-221-4944
  Fax: 206-221-4945
  Web Site: www.go2itech.org

  National:

  AETC National Evaluation Center
  University of California, San Francisco
  AIDS Policy Research Center, Center for AIDS Prevention Studies
  50 Beale Street, Suite 1300
  San Francisco, CA, 94105
  Email: aetcnec@ucsf.edu
  Phone: 415-597-9186
  Fax: 415-597-9213
  Web Site: aetcnec.ucsf.edu

  National HIV/AIDS Clinicians' Consultation Center
  University of California, San Francisco
  Department of Family and Community Medicine
  San Francisco General Hospital
  1001 Potrero Avenue
  Building 20, Ward 2203
  San Francisco, CA, 94110
  Web Site: www.nccc.ucsf.edu

  AETC National Center for HIV Care in Minority Communities
  HealthHIV
  2000 S St., NW
  Washington, DC, 20009
  Phone: 202-232-6749
  Fax: 202-232-6750
  Web Site: www.NCHCMC.org

  AETC National Multicultural Center
  Howard University College of Medicine
  1840 7th Street, NW, 2nd Floor
  Washington, DC, 20001
  Phone: 202-865-8146
  Fax: 202-667-1382
  Web Site: www.aetcnmc.org

  AETC National Resource Center
  François-Xavier Bagnoud Center
  School of Nursing, University of Medicine and Dentistry of New Jersey
  65 Bergen Street, 8th floor
  Newark, NJ, 07101
  Email: info@aidsetc.org
  Web Site: www.aidsetc.org

  Regional:

  Delta Region AETC
  Louisiana State University Health Sciences Center
  School of Public Health
  136 South Roman Street, 2nd Floor
  New Orleans, LA, 70112
  Phone: 504-903-0788
  Fax: 504-903-7186
  Web Site: www.deltaaetc.org

  Florida/Caribbean AETC
  University of South Florida, Center for HIV Education and Research
  13301 Bruce B. Downs Boulevard, MHC 1715
  Tampa, FL, 33612
  Email: Contact@FCAETC.org
  Phone: 813-974-4430
  Fax: 813-974-8451
  Web Site: www.FCAETC.org

  Midwest AETC
  University of Illinois at Chicago, Jane Addams College of Social Work
  1640 W. Roosevelt Road, Suite 511 (M/C 779)
  Chicago, IL, 60608-1316
  Email: matec@uic.edu
  Phone: 312-996-1373
  Fax: 312-413-4184
  Web Site: www.matec.info

  Mountain Plains AETC
  University of Colorado Denver
  Department of Medicine, Division of Infectious Diseases
  12631 East 17th Avenue, MS 8204
  Aurora, CO, 80045
  Phone: 303-724-0867
  Fax: 303-724-0875
  Web Site: www.mpaetc.org

  New England AETC
  23 Miner Street
  Ground Level
  Boston, MA, 02215-3319
  Email: aidsed@neaetc.org
  Web Site: www.neaetc.org

  New York/New Jersey AETC
  Columbia University, Department of Psychiatry
  HIV Center
  100 Haven Avenue #31G
  New York, NY, 10032
  Email: nynjaetc@columbia.edu
  Phone: 212-304-5530
  Fax: 212-304-5555
  Web Site: www.nynjaetc.org

  Northwest AETC
  Harborview Medical Center
  Mail Stop: 359932
  325 Ninth Avenue
  Seattle, WA, 98104
  Web Site: www.nwaetc.org

  Pacific AETC (PAETC)
  Department of Family and Community Medicine
  University of California, San Francisco
  50 Beale Street, Suite 1300
  San Francisco, CA, 94105
  Phone: 415-597-8198
  Fax: 415-597-9386
  Web Site: www.paetc.org

  Pennsylvania/MidAtlantic AETC
  University of Pittsburgh Graduate School of Public Health
  130 DeSoto Street
  A427 Crabtree Hall
  Pittsburgh, PA, 15261
  Phone: 412-624-1895
  Fax: 412-624-4767
  Web Site: www.pamaaetc.org

  Southeast AETC
  Emory University School of Medicine
  1256 Briarcliff Road, NE
  Building A, Suite 238
  Atlanta, GA, 30322
  Email: seatec@emory.edu
  Phone: 404-727-2929
  Fax: 404-727-4562
  Web Site: www.seatec.emory.edu

  Texas/Oklahoma AETC
  Parkland Health and Hospital Systems
  Chase Bank Building
  6300 Harry Hines Boulevard, Suite 250
  Dallas, TX, 75235
  Phone: 214-590-2181
  Fax: 214-590-2184
  Web Site: www.aidseducation.org

  Dental Program: The Ryan White Care Act Dental program provides funding to the Community Based Dental Program, which aims to increase HIV-positive individuals' access to oral health care services while providing education and clinical training for dental care providers. The Dental program also provides funding for a Dental Reimbursement Program which reimburses dental schools, postdoctoral dental education programs, and dental hygiene programs for oral health care of individuals living with HIV.

  In FY 2010, the total funding allocated to the dental programs was $13,600,000.^x

  Minority AIDS Initiative (MAI): The Minority AIDS Initiative (MAI) was created by the United States Department of Health and Human Services (HHS) and the Congressional Black Caucus (CBC) in 1998 in response to the HIV/AIDS health crisis facing racial and ethnic minorities in the United States. The program funding is channeled through several Federal agencies and utilized across all Parts of the Ryan White CARE Act. MAI funds are targeted at HIV/AIDS programs that directly benefit racial and ethnic minority communities.

  Total MAI Funding^xi: $420,000,000

  Special Projects of National Significance (SPNS): SPNS is the research and development aspect of the Ryan White CARE Act. SPNS is responsible for assessing the effectiveness of certain care models, providing support for innovative models of HIV/AIDS service delivery and for assisting the replication of effective models across the nation.

  Total SPNS Funding^xii: $25,000,000

Housing Opportunities for Persons With AIDS

The Housing Opportunities for Persons with AIDS program (HOPWA) provides housing assistance and related supportive services for HIV positive persons with low income and their families. Funding is provided in the form of formula grants, which are awarded to eligible states and cities on behalf of their metropolitan areas, and competitive grants, which are awarded to model projects or programs.

In FY 2010, the HOPWA program awarded $335,000,000 in grants to states.^xiii

National Issues

ADAP -- AIDS Drug Assistance Programs save lives by providing HIV-related medications to uninsured and under insured individuals. ADAPs are primarily funded through Ryan White Part B but also receive state and private pharmaceutical funding. Over 2010, the economic recession put increased pressure on states budgets, at the same time clients seeking to enroll in ADAPs drastically increased. As a result, State ADAPs face a crisis in which 9,039 individuals in thirteen states are currently on wait lists for ADAP as of August 4, 2011 according to the National Alliance of State and Territorial AIDS Directors (NASTAD). Furthermore, cost cutting measures such as reduced formularies and restricted eligibility levels have been taken in eighteen states and Puerto Rico. Greater federal funding for ADAPs is needed so that individuals to receive the life-saving medications that ADAPs provide.^xiv

Enhanced Comprehensive HIV Prevention Plan (ECHPP) -- In 2010, the Centers for Disease Control and Prevention (CDC) released a plan for prevention targeting twelve cities (Miami, New York City, Chicago, Los Angeles, Washington D.C., Atlanta, Philadelphia, Houston, San Francisco, Baltimore, Dallas, San Juan) that compromise 44% of all infections in the United States. In accordance with the National HIV/AIDS Strategy, the Department of Health and Human Services (HHS) built upon the program with what is known as the "twelve cities" project by coordinating cross-departmental collaboration with the Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), National Institutes of Health (NIH), and Substance Abuse and Mental Health Services Administration (SAMHSA).

Syringe Exchange -- In 2009, the nationwide ban on a state's use of federal funds for Syringe Exchange Programs (SEPs) was removed through appropriations legislation and signed by President Barack Obama. Numerous studies have indicated that SEPs offer vital care and services to intravenous drug users and reduce risk behavior. Yet, despite long held support from the CDC, NIH, and the majority of the medical and scientific community, syringe exchange programs remain politically targeted.^xv There are currently 221 exchange programs operating one or more exchange sites in 32 states, D.C., Puerto Rico, and the Indian Nations.^xvi

Policy and Law

Criminalization, which is often dependent on known HIV status, creates barriers to testing along with discouraging disclosure and fostering stigma. U.S. Federal law has one statue specific to HIV criminalization under which no prosecutions have been made. A few cases have used HIV-related enhancements, though no official guidelines on HIV-related enhancements exist. Under the Uniform Code of Military Justice which applies to members of the U.S. Armed Forces, there exists no provision specific to HIV. However, military service members have been prosecuted through general criminal assault provisions, failure to follow (safe-sex or disclosure) orders, and conduct prejudicial to good order. Certain state and local jurisdictions have HIV-specific criminal laws and many have made prosecutions and arrests based on HIV status.^xvii

AIDS United Partners and Grantees

AIDS United promotes collaborative local planning and provides strategic grants and technical support to more than 400 direct service organizations annually through our Community Partnerships, Public Policy Committee, and targeted initiatives such as AmeriCorps, Access to Care (A2C), GENERATIONS/Women's Initiative, Southern REACH, Puerto Rico grantmaking, and the Syringe Access Fund.

U.S. State Level AIDS Leadership

Julie Scofield
National Alliance of State and Territorial AIDS Directors, Executive Director
444 North Capitol Street, NW, Suite 339
Washington, D.C. 20001
Phone: (202) 434-8090
E-mail: jscofield@nastad.org^xviii

References

1. HIV/AIDS Surveillance Report, 17 (2005), 18 (2006), 19 (2007), 20 (2008), 21 (2009), Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, available from: www.cdc.gov/hiv/topics/surveillance/resources/reports/.
2. HIV/AIDS Surveillance Report, 21 (2009), Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, available from: www.cdc.gov/hiv/topics/surveillance/resources/reports/.
3. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
4. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
5. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
6. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
7. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
8. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
9. About the AIDS Education & Training Centers, AETC National Resource Center, available from: www.aids-ed.org/aidsetc?page=ab-00-00.
10. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
11. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
12. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
13. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
14. ADAP Watch Update -- August 5, 2011, NASTAD, available from: http://nastad.org/Files/020843_ADAP%20Watch%20update%20-%208.5.11.pdf.
15. Syringe Exchange and HIV/AIDS, AIDS United (published under formerly AIDS Action), available from: www.aidsunited.org/uploads/docs/Learn-Syringe_Exchange_and_HIV.pdf.
16. Syringe Exchange Programs in the United States 2011, amfAR, available from: www.amfar.org/uploadedFiles/On_The_Hill/SEPS.pdf?n=3826%29.
17. Ending and Defending Against HIV Criminalization: A Manual for Advocates, Volume 1, State and Federal Laws and Prosecutions, The Center for HIV Law and Policy, Fall 2010, available from: www.hivlawandpolicy.org/resources/view/564.
18. NASTAD Staff, National Alliance of State and Territorial AIDS Directors, available from: www.nastad.org/contact_us.aspx.